Equipment Rentals

Business problem
Medical/surgical and critical care units in our hospitals sometimes must rent beds and other equipment. A poorly designed process caused significant overpayment of rental charges for several reasons:

• No effective tracking of rental orders placed directly with vendors (after hours) by patient units.
• Rented equipment was not promptly returned upon discharge of patient.
• Inability to tie vendor invoices back to purchase orders, making it impossible to ensure accuracy of charges.

Closing the loop
The fundamental problem was a lack of communication:

• between the inpatient unit and the nursing manager; and,
• between nursing and purchasing.

We needed an automated process that allowed nursing to easily rent equipment when needed, while ensuring that information flowed to the nursing manager and to/from purchasing.

The first step in the new process collects the information from the nursing unit (shown below):

• Select the patient unit and click the "Get" button, which populates the Patient field with a list of current patients in that unit (from ADT Event Alerts).
• Select patient who needs the rental bed.
• Select type of bed.
• Add any comments and select the nursing manager who should approve the request.
• During off-hours (16:00 – 08:00 M-F, and Sat/Sun/holidays) the nursing unit may call the vendor without waiting for approval. During these hours, "Vendor call placed" is displayed (shown below).

When the request is submitted, a confirmation screen is displayed for the requestor (shown below).

The approver is automatically notified by e-mail and pager. The e-mail message includes a direct link to the request (shown below).

The approving nursing manager is shown the screen below:

If an approver does not have access to the e-mail message with the link to a specific request, a list of pending requests is available. First the patient unit is selected (shown below).

Any pending requests for that unit are displayed, and selecting any request (shown below) displays the same approval page (shown above).

Once the request is approved, an automatic e-mail is sent to the purchasing department. This e-mail contains all the information necessary for purchasing to create a purchase order and place the order with the vendor (shown below).

The e-mail message for purchasing contains a direct link to the equipment request (shown above). Using that link, purchasing updates the request with the purchase order number. This directly connects the request with the purchase order number, ensuring that invoices can be verified with requests.

Finally, when the patient is discharged, ADT alerting data trigger an automated e-mail to the purchasing department (shown below). This e-mail serves two purposes:

• Notify purchasing to contact the vendor to arrange immediate pickup of rented equipment; and,
• Provide all necessary data (dates, patient units and cost centers) for purchasing to charge the rental cost to the correct cost center(s).

[Click the image above to see the full size image]

Outcomes
This application was implemented quite recently, so it is too soon to have data about its use. However, it already seems clear that more effective tracking of equipment and requests will:

• Significantly reduce expenses by eliminating overcharges.
• Reduce expenses by ensuring immediate pickup of equipment by vendor.
• Eliminate rework with purchase orders and invoices by nursing staff, nursing managers and purchasing staff.
• Retain the flexibility for nursing staff to immediately obtain equipment after hours without degrading the tracking process.
• Nursing was enthusiastic enough about this application to request another module for tracking Wound Vac rentals and supplies (about to go live).

Lessons learned

• Persistence pays. Other priorities distracted the nursing and purchasing managers who initially suggested this application, but we kept nudging and nagging until the application was fully tested and implemented.
• Savings can be found in some obscure corners of an organization. I had no idea this process existed until line managers requested that it be automated.

Posted 21 November 2008