Consignment is the right model for high-value, low-predictability items: implants, stents, pacemakers, specialised cath-lab consumables. The supplier holds the stock in your OT; you pay on use. The trouble starts when “use” is recorded on a sticker in a procedure file and reconciled, if at all, quarterly, by the supplier. We have seen groups billed for 8–15% more consignment items than were implanted.
Three controls
1. Capture at point of use
Every implant has a GS1 barcode with GTIN, lot and expiry. Scan it into the procedure record at the time of use (most HIS have an implant log; a USD 100 scanner and a simple form work where they do not). The scan is the trigger for the supplier invoice. No scan, no invoice.
2. Reconcile monthly, hospital-led
Count the consignment stock with the supplier representative present, monthly. Opening stock + deliveries − scans = closing stock. Any gap is investigated the same week. The hospital issues the usage statement; the supplier invoices against it, not the other way round.
3. An agreement with teeth
The consignment agreement should state: who owns the stock (the supplier, until scan), who bears expiry (the supplier, with a rotation obligation), the maximum stock level, the reconciliation process, the price list and its validity, and the right to audit. Many hospitals run consignment on a handshake and a price list; that is where the leakage lives.
The commercial upside
Once tracking is reliable, consignment becomes negotiable. You can show the supplier exactly what moves and offer a lower stock level or a faster payment term in exchange for price. You can also see which surgeons use which implants at what cost, which is the start of a value-based procurement conversation with the clinical team — far better held with data than with opinions.
Where to start
Pick the cath lab. It has the highest value per item, the best barcoding and usually one or two dominant suppliers. Run the three controls for 90 days, measure the gap between billed and scanned, and take the result to the OT next.