Everything flows: transportation and material flows in hospital logistics

During a visit to the hospital, patients naturally expect to receive comprehensive care. Not only does this include the proper treatment, but also a hospital bed and regular meals for example. Patients typically don't ask about the transport logistics this entails for the hospital. They are also rarely interested in what happens to any surgical or hazardous waste – maybe that's because they feel uncomfortable about asking or perhaps they are simply not interested.

The overall concept of the hospital as a system is – similar to the human body – only maintained thanks to the invisible processes running in the background. In this setting, instead of the bloodstream and the lymphatic system, logistics flow control ensures that everything works. Efficient planning, management, and optimization of these flows – a functioning logistics stream and supply chain – is just as important in hospitals as it is in other businesses. “Logistics are virtually a hospital’s most important supportive discipline. All of the areas responsible for supply chain management have to get their items to the hospital’s respective wards and departments. And if those items don’t arrive right on time, it not only results in major process delays but also reduces hospital efficiency,“ says D.Eng. Sebastian Wibbeling, Head of Health Care Logistics at the Fraunhofer Institute for Material Flow and Logistics (IML). Efficient hospital logistics must support all healthcare and medical processes in the best way possible and thus ensure optimal treatment and safety for patients.

Hospital logistics generally differentiate between three main flows: patient, information, and material flows. In addition to medical devices, laboratory samples, sterilized instruments, and pharmaceutical products, material flow also includes everyday commodities such as hospital beds, meals and beverages – and also waste products that need to be managed. If you keep in mind that hospital waste can clearly pose a risk of infection, waste management no longer seems so mundane.

From a spatial and functional perspective, a hospital is made up of different hospitals wards and special departments, the surgical area and the emergency department. Additionally, there are often external suppliers such as caterers to supply the kitchen or pharmacies as pharmaceutical distributors. Together with the aforementioned logistics flows, these different functional subareas make up the hospital infrastructure.

The respective material flows run in three directions: towards the hospital or inbound, within the hospital or internal and away from the hospital or outbound. This results in the hospital logistics subtasks of procurement, in-house storage and transportation as well as waste management.

There are a number of supporting technologies for each of these subareas. For example, when it comes to in-house transportation management, resources such as transport trolleys can make it easier for hospital staff or other service providers to transport pharmaceutical products and materials. Oftentimes there is also a so-called ATS, an automated material transport system. This umbrella term covers a number of technologies such as power-and-free systems, automated guided systems (AGV) and electronic monorail systems (EMS).

When it comes to receiving and storing materials – or when sending patient specimens to a laboratory – barcodes or RFID chips are often used as tools. As it pertains to procurement and disposal, special packaging systems and identifiers ensure that samples, sterile equipment or potentially hazardous shipments are securely packaged and transported.

Yet how can hospitals gain – and maintain - a complete overview of the location, quantity, and availability of all important materials to ensure that a scheduled surgical procedure runs smoothly for instance? Or how can they accurately factor in delivery times and potential complications in surgical planning?

Software supported digital solutions in hospital logistics are one possible option. “Digital solutions are very common in all areas of logistics. Although the different areas are individually organized, they are connected through interfaces. For example, there is a food ordering and management system and a warehouse and pharmaceutical ordering system. Of course, the sterile processing department also works with software, “explains Dr. Wibbeling. RFID technology plays a key role in many digital approaches. These chips – if they are attached to surgical instruments or sterilized devices for example – make it possible to track equipment within the hospital at all times. The corresponding software also enables planners to schedule surgical interventions in real time. The availability of the necessary sterilized equipment can be synchronized with room and staff availabilities. Deliveries needed for surgeries can also be accurately forecasted.

Fully integrated digital solutions, which form a kind of central hub for all logistical processes promise highly efficient logistics management for hospitals. ”In essence, automated registration of all workflows, all materials, relevant media, and patients will be possible in real time. This will promote increased economic efficiency and improve patient safety in the future,“ says Armin Schorer, Managing Director at ASANUS Medizintechnik GmbH, whose company provides software solutions for instrument management as well as medical products with intelligent logistics and RFID chip technology. Integrated solutions also make it possible to record and completely automate processes and procedural steps. With this approach, hospital staff would simply need to follow the steps as indicated by the software.

In the hospital of the future, fully integrated logistical processes could rule out any type of human error. On the one hand, automated processes are meant to make it impossible for staff members to forget important procedural steps. On the other hand, hospital staff that only follows software instructions doesn't necessarily inspire confidence in most patients.

Fully integrated digital systems in German hospital logistics are presently still a thing of the future – even if some partial solutions are already in use. "Networked solutions still don't play a big role at the moment. They have not been implemented yet in most cases. Many hospitals haven't given any thought yet to the necessary requirements for this type of integration," says Achim Schorer.