James Russell, RN-BC, Value Analysis Facilitator, UF Health at Jacksonville
VCU Health System, Richmond, VA
Value Analysis Facilitators frequently find themselves estimating the impact of a project prior to implementing a change, or even evaluating a potential change. Using data and metrics can keep the project balanced and fair. It may sound simple but it isn’t always and can require some explaining.
Imagine a project originating with a staff nurse. She works at more than one hospital and uses what she describes as a better peripheral IV catheter at her other job. She completes a Product Request Form asking for the “better” product to be evaluated. You get to facilitate the project.
The project’s etiology is clinician preference. The project’s sponsor just likes one better than another. However, we need a better argument than that for measurable goals. There are 3 questions we ask the sponsor to answer in every project and sometimes they need a little help with the wording. In this case we get the following:
1. What’s the problem(s) we’re trying to solve?
· Missed PIV starts, requiring more attempts.
· Practitioner needle sticks.
· Practitioner blood exposure from PIV’s.
2. How will this new product help us solve it?
· It has a built-in “flash detector” to help clinicians know when they are in the blood vessel (and can stop advancing the catheter).
· It has a passive safety mechanism to prevent needle sticks.
· It has a valve to prevent backflow of blood.
3. What data will we measure to evaluate the project’s success?
· PIV catheter usage per adjusted patient day (APD).
· Employee health data to note the new product’s effects on needle sticks and blood exposures.
· Practitioner surveys to gauge their opinions post conversion.
The beauty of having a consistent process is that the project will follow a prescribed path toward a decision. The first step is to create a grid with baseline data on the current products. The existing PIV catheters will be benchmarked in terms of pricing and utilization. How much do we spend? How many do we use? How many do we use per APD? This last question is important. For products that are only used in an inpatient setting (i.e. heart valves), the statistic “products per patient day” can be used. However, PIV catheters are used in the outpatient setting as well, so the patient days statistic must be adjusted with an outpatient factor. This metric is important in comparing our facility to others.
Let’s presume we use 200,000 PIV catheters annually. Is that a lot? Who knows? Let’s further presume we have 300,000 APD’s. That gives us a rate of 0.67 PIV’s/APD. Very generally, this means each day a patient is present at the facility, they have a 67% chance of getting a PIV. Now we can benchmark this rate against other facilities and see if we are on the high end, low end or somewhere in the middle in terms of utilization. This statistic normalizes our data and we can be compared to other facilities regardless of their size. Again, this is important to know as we will want to compare how this number changes to assess increases or decreases in utilization if we convert to the requested product.
The new product will have to be benchmarked in terms of pricing, GPO contracting, FDA approvals, recall history, etc. The company being evaluated will need to sign a liability waiver and provide products to be evaluated at no cost. They will be required to provide some type of pre-evaluation education, reference materials, and disclosure of any relationships with members of the facility’s staff. In this way, all projects are treated in a transparent manner and they follow the same steps and must meet the same requirements.
Our grid will also tell us the spend and usage deltas should we decide to convert to the new product (assuming a successful evaluation). Is the new product more expensive or less as an “each” price? The new product claims to decrease PIV attempts (due to the blood flash). If that’s accurate, could we end up utilizing fewer “eaches” while paying a higher “each” price? Estimating the effect on our annual volume and spend is important. Let’s presume we spend $2.00 on each PIV we buy currently. At our 200,000 each volume, that’s an annual spend of $400,000. Let’s further presume the new product costs $2.20 each. At a 1:1 ratio, we would estimate a new annual spend of $440,000, or a $40,000 increase in supply costs for the new item (10%). If the new item boasts it will decrease “missed attempts” by 10%, then our estimated utilization will be 180,000 “eaches”. At $2.20 each, our new spend will be $396,000 or a $4,000 decrease in annual spend (2%). If the product is as good as it boasts, we could pay more for each item and still save money!
The evaluation (or trial) will involve several different units with different needs to get varied opinions. The PIV project is clinically intricate in that it requires hands-on training by the vendor. Once the clinicians perform their evaluations and give their opinions, the tally will show what to do next. Let’s presume the project is successful and the intent is to convert to the new products.
The clinicians will want the new PIV’s as soon as they can get them. They’ve already evaluated the new products and decided they were superior. They don’t want to hear about MMIS issues with the item master, distributor stocking requirements and lead time, drawing down of the “old” product to decrease the waste when the conversion takes place, par level issues for each individual unit or contract negotiations with the vendor. They want the item you told them to look at. Don’t even think of telling them they can’t have it because the vendor won’t come down enough on their price. You should have done that way before the evaluation! It’s too late once the clinicians decide they like it…your leverage is gone!
Return on Investment (ROI)
After conversion, usually on a quarterly basis, we will run the numbers on the new product. This is where the 3rd of our three questions comes back into play. What’s happened with our utilization of PIV catheters? Did our PIV’s/APD increase, decrease or stay the same? Remember, we were hoping for a decrease to justify the increase in the “each” cost. Did it happen? What’s happened with blood exposures and needle sticks? What were the results of the survey we sent out?
All of these things require follow up and can provide great insight into a fair evaluation of the project’s success (or lack thereof). Let’s presume our PIV’s/APD have decreased by 5%. Let’s further presume our blood exposure and needle sticks from PIV’s have decreased. Using this data can provide both our clinical and operational customers with the details to determine the project’s success from both their points of view. As facilitators, we shouldn’t have to interpret the data for them, they can make up their own minds. We just need to be fair and balanced when presenting it.
Jim Russell is a Value Analysis Facilitator UF Health at Jacksonville and has more than 25 years of nursing experience, specializing in critical care and psychiatry. He has been a Staff Nurse, Charge Nurse, Clinical Coordinator, Nurse Manager, Director, and Chief Nursing Officer. He worked for many years in the for-profit community healthcare sector and also has several Academic Medical Centers on his resume. Jim sat for 5 years on the Nursing Advisory Board for a HealthTrust, performing Value Analysis for nursing related products and represented more than 70 hospitals. He is currently on several Advisory Councils and Special Interest Groups for UHC and Novation. When not at work, he can be found rolling around with his hyperactive rescue Husky. You can contact Russell with your questions or comments at James.Russell@jax.ufl.edu