Title: Facility: Author: Recovering Ambulance Linen Midwest Region Larry J Haddad, CLLM Textile Management Consultant Midwest Region BACKGROUND A 294-bed, not-for-profit community hospital in the Midwest region formed a partnership with Standard Textile, Inc. to provide textiles and apply their linen management expertise to reduce overall linen expenses and improve customer service. The hospital has a relationship with two ambulance companies to provide full-service emergency and non-emergency transportation. A facility audit conducted by Standard Textile Consultants exposed the ambulance services did not provide their own linen for patients during a transfer; instead, they take hospital-owned linen. The estimated annual value of linen taken during patient transfers was approximately $15,000, or about $1,200 per month (FY 2010). STRATEGY The challenge was to develop and implement a lasting strategy to reduce mysterious linen loss and meet the hospital s cost reduction initiative. The objective: reduce the amount of linen lost during a patient transfer by ambulance and recoup the cost of any linen lost. IMPLEMENTATION A three-part approach was taken to reduce linen loss: Part 1- Linen Awareness Campaign; Part 2- Ambulance Linen in the Emergency Department; and Part 3- Linen Tracking System. Parts two and three were implemented simultaneously. Midwest Region Page 1
Part 1 Linen Awareness Campaign Standard Textile Consultants reviewed linen inventory results and documented a steady increase in linen losses. Based on documented losses in conjunction with observations of linen use practices, particularly the ambulance companies disregard for hospital policies, the consultants recommended a Linen Awareness Campaign to focus on linen abuse and linen loss. In the summer of 2010, Standard Textile Consultants participated in an extensive Linen Awareness Campaign. This campaign took place over two days and was presented to both hospital management as well as hospital staff. Other presenters in the campaign included materials management, linen room supervision, nursing, the laundry services provider, and hospital security. The primary focus was to educate linen users on the costs associated with linen abuse and linen loss. Standard Textile Consultants presented an overview of current linen use practices, with a special emphasis on ambulance companies linen use, associated costs of linen use, abuse, and loss, and recommendations for improvement. Part 2 Ambulance Linen in the Emergency Department A supply area in the Emergency Department was stocked with linen deemed clean and usable but did not meet the hospital s standards for patient care use. This ambulance linen was for exclusive use by ambulance companies and included flat sheets, pillow cases, bath towels, bath blankets, and reusable linen bags with a selfclosing top (for soiled linen retrieval). The bag of soiled linen was to be returned to the hospital for reprocessing by the hospital s laundry services provider. The ambulance company was not charged for using this ambulance linen. Part 3 Linen Tracking System Management recognized not every ambulance team would use the ambulance linen and would continue to take from the hospital s regular linen supply. To address this issue, a system was developed to track linen removed from the hospital s regular clean linen supply either from the Emergency Department or the nursing floors. The tracking system requires the ambulance team to obtain a Linen Log Sheet (available at every nurse station), and list each linen item and the quantity taken. The linen log sheet is signed by both the nursing unit and the ambulance team. The nursing unit is responsible for gathering the log sheets and returning them to the Materials Management office for tabulation and billing to each ambulance company. Midwest Region Page 2
RESULTS Ambulance Linen in the Emergency Department The Linen Distribution Department was disappointed to learn the ambulance companies did not take advantage of the ambulance linen supply. Nursing department personnel reported ambulance teams continued to take clean linen from the exam rooms, patient rooms, and clean linen carts. During the facility audit, Standard Textile Consultants observed this behavior as well. Furthermore, the laundry processor reported there was little to no soiled linen returned from the ambulance companies. This strategy was not working very well and was abandoned. Linen Tracking System When first implemented, the new tracking system faced resistance. Nursing unit personnel were reluctant to collect the linen log sheets from the ambulance companies and ambulance personnel were reluctant to cooperate. The response rate was low and continued to fall. The average response rate fell from 59% in 2010 to an average of 42% in the first 2 months of 2011 (reference Attachment 1). The hospital s Security Department was enlisted to provide assistance. Beginning in March 2011, security personnel began to distribute the linen log sheets to each ambulance crew as they arrived in the Emergency Department. Each ambulance crew returns the completed sheet to the security officer on duty. The officer checks the log for accuracy and completeness. Then the security officer and the ambulance driver sign the log sheet. The security officer sends the completed log sheet to the materials manager for tabulation. The compliance results have been dramatic. The response rate from April 2011 through September 2011 was 100%! CONCLUSION Cost Impact The partnership between Standard Textile s Consultative Services, the hospital Linen distribution management and the Security Department has been a success, and linen loss is declining. The amount of money reimbursed to the hospital is falling, from an average of $1,037 per month in 2010 to $732 per month in 2011. This decline implies less linen is being removed from the hospital (reference Attachment 1). Management has taken a very aggressive step to reduce linen loss (one of the most aggressive steps in the industry) and has done an excellent job of tracking linen taken and recovering the cost of the linen. Midwest Region Page 3
The continued success of this strategy depends on the cooperation of all parties. Using the security staff to distribute and collect linen log sheets was the most effective strategy for recovering linen lost through ambulance. Additionally, the hospital has only one ambulance entrance, and the Security Department monitors this entry continuously. Midwest Region Page 4
ATTACHMENT 1 FY 2010 Ambulance Transfers Linen Log Sheets Returned Percent Participation Reimbursements Jan 244 150 61% $827 Feb 222 171 77% $926 Mar 237 156 66% $1,054 Apr 215 110 51% $1,013 May 244 131 54% $1,037 Jun 222 164 74% $1,223 Jul 226 154 68% $943 Aug 209 97 46% $826 Sep 243 143 59% $1,148 Oct 259 134 52% $1,261 Nov 243 131 54% $946 Dec 272 122 45% $1,235 TOTAL: 2,836 1,663 59% $12,439 YTD 2011 Ambulance Transfers Linen Log Sheets Returned Percent Participation Reimbursements Jan 238 126 53% $974 Feb 251 78 31% $713 Mar 274 223 81% $610 Apr 241 241 100% $737 May 255 255 100% $463 Jun 246 246 100% $604 Jul 224 224 100% $1,082 Aug 245 245 100% $652 Sep 239 239 100% $757 Oct Nov Dec TOTAL: 2,213 1,877 85% $6,592 NOTE: Hospital Security Department started distributing log sheets in March 2011 Midwest Region Page 5