The ASC Efficiency Imperative

Ambulatory Surgery Centers operate in a highly competitive, margin-sensitive environment. Unlike hospitals, ASCs don't have the luxury of cross-subsidizing surgical services with higher-margin activities. Every minute of OR time and every dollar of supply cost directly impacts profitability.

Surgical turnover time—the period between one case ending and the next beginning—is a critical efficiency metric. Industry benchmarks show:

• Average ASC Turnover Time: 25-35 minutes
• High-Performing ASCs: 15-20 minutes
• Each Minute Saved: Enables 1-2 additional cases per OR per month
• Revenue Impact: $50-150K additional annual revenue per OR

Simultaneously, surgical supply costs represent 40-50% of ASC operating expenses. Reducing waste while maintaining clinical quality is essential for financial sustainability.

1. Procedure Pack Rationalization: The Foundation

Most ASCs have accumulated procedure packs over years, often based on individual surgeon preferences without systematic review. The result is excessive variety, outdated contents, and significant waste.

Common Procedure Pack Problems

• Excessive Variety: 15-20 different packs for similar procedures
• Outdated Contents: Items that are no longer used but still included
• Surgeon-Specific Packs: Custom packs for each surgeon doing same procedure
• Over-Inclusion: "Just in case" items that are rarely used
• Wrong Quantities: Too many of some items, too few of others
• Poor Quality Items: Cheap items that don't perform well

The Rationalization Process

Step 1: Inventory Current State

Document all existing procedure packs:

• Pack name and item number
• Procedure type(s) it's used for
• Complete contents list with quantities
• Cost per pack
• Annual usage volume
• Which surgeons use it

Step 2: Analyze Utilization

For each pack, track what's actually used vs. what's included:

• Observe 10-20 cases using the pack
• Document which items are opened and used
• Note items that are opened but not fully used
• Identify items that are never opened
• Record additional items needed beyond pack contents

Step 3: Consolidate Similar Packs

Look for opportunities to combine packs:

• Surgeon-Specific Packs: Can 3 surgeons use the same pack with minor modifications?
• Procedure Variations: Can laparoscopic cholecystectomy and laparoscopic appendectomy share a base pack?
• Modular Approach: Create base packs with add-on modules for variations

Step 4: Optimize Pack Contents

For each pack, apply these principles:

• Include Only Essentials: Items used in 80%+ of cases
• Right Quantities: Based on actual usage, not "just in case"
• Quality Over Cost: Don't include cheap items that don't perform—they create waste and frustration
• Standardize Brands: Use same brand across packs where possible for volume leverage
• Consider Packaging: Items that come in sterile packs of 10 but you only need 8? Order separately or negotiate custom pack size

Step 5: Surgeon Review & Approval

Present optimized packs to surgeons:

• Show utilization data demonstrating what's actually used
• Calculate cost savings from rationalization
• Emphasize that rarely-used items will still be available (just not in pack)
• Offer trial period to validate changes
• Incorporate feedback and finalize

2. Turnover Kit Design & Staging

Beyond procedure-specific packs, optimize your turnover kits—the supplies needed to clean, prepare, and set up the OR between cases.

Essential Turnover Kit Components

Cleaning & Disinfection

• EPA-registered disinfectant wipes or spray (appropriate for OR surfaces)
• Microfiber cleaning cloths (color-coded by area)
• Mop heads and handles
• Waste bags (red bag, regular trash)
• Sharps container (if needed)

Room Setup

• Table drapes and covers
• Equipment covers (C-arm, microscope, etc.)
• Positioning aids (gel pads, foam supports)
• Warming blankets
• Suction canisters and tubing

Patient Prep

• Skin prep solutions (chlorhexidine, betadine)
• Surgical drapes (standard sizes)
• Marking pens
• Razor/clippers for site prep

Documentation & Safety

• Surgical count sheets
• Specimen labels and containers
• Timeout checklist
• Patient identification labels

Staging Optimization

How and where you stage supplies dramatically impacts turnover time:

Core & Flex Model

• Core Room: Central sterile processing area where packs are opened and inspected
• Flex Carts: Mobile carts staged with procedure-specific supplies for each case
• OR Cabinets: Fixed storage in each OR for commonly-used items
• Turnover Stations: Dedicated area with all turnover supplies organized for rapid access

Case Cart System

• Build complete case cart for each scheduled procedure
• Include procedure pack, implants, medications, and all supplies needed
• Stage outside OR before case starts
• Roll in during turnover for immediate setup
• Reduces time searching for supplies

Preference Card Accuracy

• Maintain accurate, up-to-date preference cards for each surgeon and procedure
• Review and update quarterly based on actual usage
• Include special equipment, positioning, and supply needs
• Ensure SPD and OR staff have access to current cards

3. Custom Pack Development with LAC Health

Working with a distributor that offers custom pack services can dramatically simplify your supply chain and reduce costs.

Benefits of Custom Packs

• Exact Contents: Only what you need, in quantities you use
• Single SKU: Order one item number instead of 20 individual items
• Volume Pricing: Distributor leverages volume across all pack components
• Reduced Receiving: One box to receive instead of multiple items
• Simplified Inventory: Track one SKU instead of many
• Consistent Quality: Same contents every time

LAC Health Custom Pack Process

Step 1: Consultation & Analysis

• Our clinical specialists observe your procedures
• We analyze your current packs and utilization
• We identify optimization opportunities
• We calculate potential savings

Step 2: Pack Design

• We propose optimized pack contents based on evidence and your feedback
• You review and approve (or request modifications)
• We source all components and negotiate best pricing
• We provide cost comparison vs. current state

Step 3: Prototyping & Testing

• We build prototype packs for your review
• Your team tests in actual procedures
• We incorporate feedback and refine
• We finalize pack specifications

Step 4: Production & Delivery

• We assemble packs in our clean room facility
• Quality control inspection of every pack
• Delivery on your schedule (weekly, biweekly, etc.)
• Consistent lead times and fill rates

Step 5: Ongoing Optimization

• Quarterly reviews of pack utilization
• Adjustments based on procedure evolution or feedback
• Continuous cost optimization as component pricing changes
• Annual formal review and re-approval

4. Implant & High-Cost Item Management

For ASCs performing orthopedic, spine, or other implant-heavy procedures, implant costs often exceed all other supply costs combined. Optimizing implant management is critical.

Consignment vs. Purchase Models

Consignment Model

How it Works: Vendor places implant inventory at your facility. You only pay for what's used. Unused items returned.

Pros:

• Zero inventory investment
• Always have full size range available
• Vendor manages inventory and expiration
• No risk of obsolescence

Cons:

• Higher per-unit pricing (typically 10-15% premium)
• Vendor controls availability
• Dependent on vendor relationship

Purchase Model

How it Works: You purchase and own implant inventory.

Pros:

• Lower per-unit costs
• Volume discounts available
• Full control over inventory
• Can negotiate better terms

Cons:

• Significant capital investment ($100-500K depending on volume)
• Risk of obsolescence when new products launch
• Must manage inventory and expiration
• Storage space required

Hybrid Model (Recommended)

• Purchase: High-volume, predictable implants (e.g., standard knee implants)
• Consignment: Low-volume, high-variety items (e.g., revision implants, specialty sizes)
• Benefit: Optimize capital efficiency while maintaining full product availability

Implant Standardization

The highest-impact cost reduction for implant-heavy ASCs is standardizing to fewer manufacturers:

• Current State: Surgeons using 4-5 different implant manufacturers for same procedure
• Impact: No volume leverage, complex inventory, higher costs
• Goal: Standardize to 1-2 manufacturers per procedure type
• Savings: 15-25% through volume pricing and reduced inventory complexity

Implant Standardization Process:

1. Analyze Outcomes: Review 1-2 years of data. Are outcomes different across manufacturers?
2. Surgeon Engagement: Present data showing clinical equivalence
3. Competitive Bidding: Run RFP with manufacturers competing for exclusive or primary status
4. Trials: Allow surgeons to test finalist products in actual cases
5. Decision: Select 1-2 manufacturers based on clinical performance and cost
6. Implementation: Phase in over 6-12 months with extensive training and support

5. Workflow Integration & Staff Training

Optimized packs and supplies only deliver value if workflows and staff training support efficient use.

Standardized Workflows

Pre-Case Setup Protocol

1. Review Schedule: Confirm procedure, surgeon, special needs (10 minutes before case)
2. Pull Case Cart: Retrieve pre-staged cart with all supplies (5 minutes before)
3. Room Check: Verify equipment functioning, supplies present (3 minutes before)
4. Open Packs: Open procedure pack and arrange on sterile field (as patient enters)

Turnover Protocol

1. Patient Exit: Transfer patient to PACU, remove drapes (2-3 minutes)
2. Trash & Linen: Remove all waste and soiled linens (2-3 minutes)
3. Terminal Clean: Disinfect all surfaces per protocol (5-7 minutes)
4. Restock: Replace used supplies from turnover kit (2-3 minutes)
5. Equipment Setup: Position table, lights, equipment for next case (3-4 minutes)
6. Final Check: Verify room ready, supplies present (1-2 minutes)
7. Patient Entry: Bring in next patient (2-3 minutes)

Total Target: 17-25 minutes

Staff Training & Competency

Ensure all OR staff are trained and competent in:

• Pack Contents: What's in each procedure pack and where items are located
• Setup Procedures: Standard approach for each procedure type
• Turnover Protocol: Step-by-step process with time targets
• Equipment Operation: All OR equipment and troubleshooting
• Preference Cards: Surgeon-specific requirements and variations
• Emergency Procedures: What to do when supplies missing or equipment fails

Training Methods:

• Initial Orientation: Comprehensive training for new staff (8-16 hours)
• Competency Assessment: Observed setup and turnover with checklist validation
• Ongoing Education: Monthly staff meetings to review new products, procedures, or issues
• Cross-Training: Ensure multiple staff can cover each role
• Refresher Training: Annual re-training on key procedures

6. Technology Enablement

Modern ASCs leverage technology to optimize supply management and OR efficiency.

Essential Technology Solutions

1. Surgery Scheduling System

• Integrated with preference cards
• Automatically generates supply pick lists
• Alerts to special equipment or implant needs
• Optimizes OR scheduling based on procedure type and duration

2. Inventory Management System

• Barcode scanning for receiving and usage
• Automated PAR level management
• Expiration date tracking and alerts
• Integration with surgery schedule for predictive ordering

3. Preference Card Management

• Digital preference cards accessible to all staff
• Version control and approval workflow
• Integration with case cart building process
• Usage tracking to identify outdated preferences

4. Supply Chain Analytics

• Cost per case reporting by procedure and surgeon
• Utilization analysis (what's used vs. what's opened)
• Waste tracking and root cause analysis
• Benchmarking vs. industry standards

5. Vendor Integration

• EDI for automated ordering and invoicing
• Vendor-managed inventory for consignment items
• Electronic proof of delivery
• Automated three-way match (PO, receipt, invoice)

7. Measuring Success: Key Performance Indicators

Track these metrics to ensure your optimization efforts are delivering results:

Continuous Improvement Process

Monthly Supply Chain Meetings

• Review KPIs and trends
• Discuss issues and concerns from clinical staff
• Identify improvement opportunities
• Prioritize initiatives
• Assign action items

Quarterly Pack Reviews

• Analyze utilization data for all procedure packs
• Identify packs with high waste rates
• Conduct observations of cases using problematic packs
• Propose and implement pack modifications

Annual Strategic Review

• Comprehensive assessment of supply chain performance
• Benchmark against industry standards
• Evaluate supplier performance
• Set goals and initiatives for coming year

Partner with LAC Health for ASC Excellence

LAC Health specializes in supporting ambulatory surgery centers with tailored supply chain solutions:

🏥 Custom Pack Development

• Clinical specialists analyze your procedures and design optimized packs
• Clean room assembly with quality control
• Flexible quantities and delivery schedules
• Ongoing optimization based on utilization data

📦 Implant Management Solutions

• Consignment programs for all major manufacturers
• Vendor-managed inventory services
• Case-by-case ordering with next-day delivery
• Loaner instrument management

⚡ Rapid Response Delivery

• Same-day emergency delivery available
• Local fulfillment centers for fast replenishment
• 97%+ fill rates on all orders
• Real-time inventory visibility

📊 Performance Analytics

• Cost per case reporting and benchmarking
• Utilization analysis and waste identification
• Turnover time correlation with supply factors
• Customized dashboards and KPI tracking