Patricia Hoch is the Senior Sourcing Director & Value Analysis at Inova Health System in Northern Virginia, and the CEO of GapLogic. She recently joined Hospital IQ for a leadership roundtable on reopening surgical services during COVID-19 recovery where she provided her expertise on the supply chain.
Inova Health Systems usually performs about 10,000 procedures a month across all of our locations, but we’ve had nearly 8,000 postponed in some way. My greatest concern is when we and other hospitals are ready to re-open surgical services, patients aside, staff aside, rooms aside, will the supplies be there to support all of these rescheduled procedures?
Many of the supply chains were overwhelmed from the COVID-19 demand, so I get a little nervous when I hear everyone else talking about how they want to reschedule all of the cases as quickly as they can. That pent up demand of cases translates to a pent up demand of supply. As everyone flips the switch back on, all these materials that have been sitting idle are going to disappear quickly.
We’ve been able to make it through with the amount of PPE our system has, though we’ve been kicking the can down the road a bit. Find some more stuff, kick the can some more. But what if you suddenly need to double test? Everyone knows we have a national test shortage. If you want to test every single person who’s coming in for a procedure as well as the people doing the procedure, can we strategically move that testing swab volume to the OR, or are you going to continue with whatever your testing program was before that? Everyone who’s in the supply chain industry would agree there’s no swab volume to do both simultaneously right away. The same question needs to be asked for N95 masks. Facilities will go very quickly from 45 days worth of supplies on hand to 2 days worth on hand.
Unfortunately, the supply chain is going to, at some point, be the limiting factor to whether or not hospitals can run cases. And we don’t have a great gauge on when the chain will return to normal because even suppliers have very cloudy visibility with what’s in their manufacturing pipelines right now. All manufacturers are currently making masks and gowns, which has been tremendously helpful, but what were they making before? Because that’s not being made. We need to know what is in the supply line moving forward. Even something as simple as disinfectant. Oxivir, is pretty much gone.
Facilities will also need new protocols if they want to get everyone back to work as quickly as possible with this new set of limitations. One of the things we’ve been doing is having an open dialog with clinical teams planning reopenings and what their strategies are. Our awareness of the clinical schedule is much more acute than normal because ordinarily it wouldn’t be tracking tests and pack volume on a case-by-case basis.
With regards to sterile processing, I’m assuming that people are reprocessing masks or sterilizing their own swabs. We tasked our SPD with the job of figuring out these new processes and standards, but what happens when we add instrument return and the like to their COVID-19 response duties?
We are looking into reusable resources, such as reusable gowns, because the disposable market is about as depleted as it possibly can be. If there’s a second wave any time in 2020, I’m not convinced that we will be able to recover from it by then. Most likely, it will take at least 18 months for the supply chain to recover, even if things stay at a relatively normal volume, just for us to get back to where we were manufacturing-wise pre-COVID. Manufacturing is not nimble and it’s especially not nimble in the healthcare world, so I suspect a second wave will be brutal on the supply chain.
These are difficult facts to face, but we must face them. Those of us in the supply chain don’t like to be at the forefront. Usually if people are looking to us, something is wrong. The supply chain is going to be a limiting factor in reopening your OR. I don’t know how anyone wouldn’t be impacted.