The Blind Spot Undermining Hospital Margins

By Shawn Sefton, MBA, RN

A circulator flips through a picklist that doesn’t match the back table. A surgeon asks for a device, and the nurse hesitates, “Is it even here?” A supply tech finds an expired implant just as the case is closing. The nurse tries to document the implant, but the scanner isn’t working and she can’t find it in the item master. Hours later, a revenue integrity analyst sits with unexplained and missed charges.

None of these moments make headlines. But together, they add up to stress in procedural rooms, missed revenue, unbudgeted waste, and hours of manual data entry. Hospitals can track a FedEx package from Memphis to Miami in real time. But the orthopedic plate placed in a patient yesterday? Sometimes it disappears into the system like it never existed.

Photo by RDNE Stock project: 

The status quo can’t keep up

OR and procedural room documentation systems are failing to keep pace with the realities of modern surgery. The problem isn’t that hospitals don’t try to record implants and supplies, it’s that even newer system designs struggle to capture every supply and implant, resulting in missing and unreliable data.

Manual documentation, whether electronic or on paper, depends on perfect input often during the most complex moments of a procedure. In reality, barcode scanners can fail and reconciliation happens hours, sometimes days, after the fact. As a result, up to 50% of the supplies and implants used in ORs go undocumented.

Meanwhile, reconciliation teams are left deciphering handwritten item numbers, trying to match unlabeled implants to the correct records, and often chasing down clinical team members long after a case ends just to ensure proper billing and records.

The result is incomplete, unreliable data that breaks the billing chain. Missed scans and documentation errors often mean items never make it onto the claim, directly translating into missed charges and lost revenue.

The impact?

Not only do missed charges create an administrative burden but hospitals can lose up to 30% of billable revenue tied to supplies and implants, a margin loss that would be unimaginable in any other industry.

What’s more, failing to accurately capture these items can introduce significant quality, regulatory, and patient safety risks, exactly the kinds of problems health systems try very hard to avoid.

What perioperative leaders are saying

With OBBBA requirements tightening margins, hospitals are under pressure to minimize waste, understand costs and protect profitability more than ever before. Because the OR drives up to 70% of hospital revenue, it’s no surprise that Becker’s first Perioperative Summit kept circling back to the topic of revenue.

Workforce relief is non-negotiable for hospitals that want to scale. When nurses and techs can anticipate surgeon needs, the OR hums. Delays vanish, substitutions shrink, cases flow and surgeons trust their team. Staff stress levels lower. As another leader put it, “Getting nurses away from the supply screen and back to anticipating the surgeon’s needs is the biggest win.”

While resolving missed OR and procedural room charges is critical, leaders also underscored the importance of integration. Technology must fit into daily workflows and EHRs if it’s going to stick in such a fast-paced environment. As one panelist emphasized, “If it doesn’t integrate and work for our people, it won’t scale.”

Many OR leaders are taking action but ultimately still missing far too many products due to systems that fail them, with one leader at Becker’s Perioperative conference saying, “The number of items that go unscanned every case is disturbing.”

However, one healthcare system decided to find a solution and the results are compelling.

How one hospital turned admin chaos into profit

Owensboro Health set out to audit and resolve this very problem. Their perioperative teams were grappling with manual, error-prone documentation in the OR. Nurses entered supply and implant data by hand, items slipped through the cracks, inventory data lagged, and billing teams spent hours chasing missed charges.

Determined to improve workflow and margins, Owensboro Health rolled out an AI-enabled automated supply and implant capture program across its ORs. The impact was significant:

• Delighted clinical, revenue integrity, and supply chain teams
• 48% reduction in monthly expired product costs
• 90%+ reduction in ERP inventory depletion errors
• 12% increase in monthly billable revenue

The volume of cases didn’t change. What changed was product and implant visibility. For staff, that meant fewer end-of-shift reconciliations and less administrative burden. For leaders, it meant millions in recovered revenue.

What should leaders do?

Many hospitals aim to close the OR documentation gap by adding extra staff processes and duplicative tracking systems. This looks like control but creates silos, extra work, and ultimately flawed data.

While plenty of AI tools overpromise, some were built to solve administrative problems like this. It is important to assess solutions carefully. Here are key ways to evaluate AI tools for perioperative documentation:

• Prioritize real-time integration—Does the solution capture data as cases unfold, or does it rely on manual reconciliation after the fact?
• Check workflow alignment—Can it fit seamlessly into existing OR workflows without adding screens and clicks for nurses and techs?
• Look for measurable impact—Can it demonstrate clear metrics, like improved item capture rates, reduced reconciliation time, case costing, expiry management or recovered revenue?
• Evaluate interoperability—Does it connect cleanly with your EHR, ERP, and billing systems, or does it create another silo?
• Test with frontline staff—Does it make the job easier for nurses, techs, and supply teams, or just shift work elsewhere?

Closing the loop

Every day, critical details in the OR slip through the cracks of manual systems. A recalled implant from last week’s surgery. A missed charge for a high-cost disposable. Small moments, easily overlooked, that quietly add up. They create blind spots that chip away at hospital margins, wear down staff, and skew reports that leaders rely on to make decisions. But this no longer has to be the norm. AI technology now gives hospitals the ability to see and capture what’s been missed. Hospitals that act can protect their margins, ease the load on their teams, and bring clarity back to the center of care. The gap is clear. The tools exist. It’s time to close the blind spots.

Shawn Sefton, MBA, RN, is Clinical Advisor at AssistIQ.

Scalable platform sheds light on how cancer spreads

Study links support cells to improved cancer cluster survival in bloodstream  

HOUSTON, TX (March 27, 2026) – Metastasis, the spread of cancer from a primary tumor to other parts of the body, is difficult to study in the lab, in part because researchers lack reliable ways to recreate the conditions cancer cells encounter as they travel through the bloodstream.

Rice University bioengineers report a new platform designed to streamline one of the major challenges for metastasis research: Called the Advanced Tumor Landscape Analysis System, or ATLAS, the platform makes it easier to generate large quantities of cancer cell clusters that accurately model those involved in metastasis. Using the platform, the Rice team gained new insights into the mechanisms that enable cancer clusters to survive in the bloodstream during the metastatic process.

Developed in the lab of Michael King, Rice’s E.D. Butcher Professor of Bioengineering, ATLAS builds on earlier work using superhydrophobic surfaces, i.e. materials that strongly repel water. When droplets containing cells are placed on these surfaces, they bead up rather than spread out, encouraging cells to stick to each other and produce three-dimensional clusters.

“Metastasis is still poorly understood because adequate laboratory techniques to recreate this complex process are lacking,” said King, a Cancer Prevention and Research Institute of Texas Scholar who also serves as special adviser to the provost on life science collaborations with the Texas Medical Center.

The King lab has been working for years on new high-throughput approaches of creating clusters of cancer cells, both on their own and alongside stromal cells, which are noncancerous but are frequently found in the tumor microenvironment. To study what happens during the metastatic process, the researchers expose these models to conditions that closely resemble those in the body ⎯ either via animal models or laboratory blood flow experiments.

Compared to earlier methods, ATLAS takes less time to deploy and costs less to produce. It uses 3D-printed microwell arrays that are treated to create the same kind of water-repelling effect seen in nature, such as on a lotus leaf.

“The way this is achieved, both in nature and in the laboratory, is to create a surface that is rough on a nanoscale level, and then to coat the nanoscale bumps with a nonwetting substance such as Teflon or wax,” said Alexandria Carter, a doctoral student in the King lab who is the first author on the study. “Here, we achieved this for the first time through 3D printing, which means the method is scalable and easily adoptable by other labs.”

Going beyond method development into actual testing, the researchers used ATLAS to create clusters of prostate cancer cells, including ones containing a type of stromal cell called cancer-associated fibroblasts, or CAFs. Testing revealed that cancer clusters are more likely to survive when traveling in groups, especially when CAFs are present. These support cells actively help cancer cells withstand the stresses of circulation and continue to grow.

“One of the most exciting elements of our paper is that it does not just report on a new experimental method for other researchers to use, but it also reports new fundamental biological results,” Carter said. “Perhaps in the future the next generation of prostate cancer drugs will target these CAF ‘escorts’ as a way to prevent metastasis.”

Carter recently completed the Rice Innovation Fellows program and is working on establishing a startup company called Bionostic to commercialize ATLAS. Run by Rice’s Liu Idea Lab for Innovation and Entrepreneurship (Lilie), the program trains doctoral students and postdoctoral researchers to translate their research into breakthrough solutions for real-world problems.

Kyle Judah, Lilie executive director, said “a pre-requisite for bringing research beyond the bench is to be deeply passionate about the problem space, and Carter is the perfect example of an exceptionally driven and committed engineer willing this idea into reality.”

Models that are both realistic and practical make possible research that would otherwise take longer and be costlier to undertake.

“ATLAS makes it easier to study one of the most dangerous aspects of cancer,” King said.