Kanban Cards

The operating rooms at Lucille Packard Children's Hospital are trying to phase in a Kanban card system. Based on the Toyota production system, it is a way of managing inventory. Anesthesiologists use a lot of supplies; we go through IV equipment, airway equipment, monitoring devices, and small things - tape, syringes, needles - quickly. But it's hard to estimate for each case how much we'll use, and since cases are dynamic, we may go through unexpected supplies. How does the anesthesia tech know how much to restock between cases, especially if turnover is less than fifteen minutes?

At the VA, the anesthesia techs change out entire supply carts; they prepare new carts and swap them with the old one, using the time during the case to restock the old ones. However, this can be labor-intensive. At Stanford, anesthesia techs go through the carts at the end of a case, make a list, and restock what they think is missing; it actually works pretty well, but there are occasions when they miss a specific item that we need. Stanford carts are also quite overstocked so there is leeway if one device or equipment isn't replaced.

The Kanban card system is used by Toyota to create a lean just-in-time method of equipment management. It's pretty simple, actually. The supply is determined by the demand. When I use up a stock of syringes, for example, I place a specific card in a box that is checked intraoperatively. This signals early to the tech to bring those supplies during the turnover. This obviates the need for me to remember what I used, for the tech to rummage through drawers during a case, or for the tech to tabulate items during the turnover. Inventories are smaller because there is a greater guarantee that everything that needs to be restocked will be restocked. I imagine that this may be electronic in the future.

I'm all for efficiency, cost-reduction, and improved turnover, but I'm still getting used to adjusting to the new system. Many of us anesthesiologists are used to having huge inventories of everything and not needing to worry about the process of restocking, but we're starting to realize that the behind-the-scenes supplies management is much less efficient when every operating room has an oversupply of everything. So hopefully this new system ensures we have what we need and not too much excess.

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