By David Taylor III
Rising health care costs and increasing demands for waste reduction and improved organization-wide efficiency are driving hospital administrators and departmental leaders to seek new opportunities to cut costs and improve their profit margins. It is estimated that nearly one-third (30%) of health care costs are lost to wasted efforts, costing $49 billion a year.1 Specifically, inefficiencies in the operating room (OR) and sterile processing departments (SPDs) can cost health care organizations tens of thousands of dollars in wasted effort, and far more if negative patient outcomes arise.
It is critical for health care organizations to enhance their daily workflows by consistently evaluating opportunities and working collaboratively with key stakeholders on process improvement (PI) initiatives. Instrument tray optimization is one notable practice that not only adds significant dollars to the organization’s bottom line, but also reduced workload for both SPD and OR professionals. Tray optimization streamlines instruments more effectively to reduce the number of instruments opened and used with each surgical procedure, which subsequently helps eliminate the need for costly and time-consuming processing of duplicate and unused devices. SP professionals – along with surgeons from all specialties – play a shared and significant role in this process.
While organizations strive to provide surgeons with the tools they need to perform their procedures safely, effectively and efficiently, many health systems and facilities struggle daily to provide adequate instrumentation levels to support the rising number of surgical procedures. Along with the soaring surgical volumes, the number of instruments in a single set has grown significantly, with some sets having hundreds of instruments, which require time (and money) to properly inspect, clean, process, wrap, sterilize, store and deliver for patient use (SPD’s responsibility), and set up, account for, maintain, and prepare for delivery back to the SPD (OR’s responsibility). The OR is also responsible for keeping track of the instruments used during surgical procedures. All instruments must be counted and accounted for before an incision is made, during the procedure, when a cavity and skin are closed, and the procedure is completed. All instruments must be counted, regardless of whether they were used during the procedure. Accounting for instrumentation is time consuming for both the OR circulator and scrub technician. When one considers that the average surgical procedure requires a minimum of three instrument counts (and, in some circumstances, additional counts), the benefits of instrument set optimization become clear.
Literature shows that in a single procedure only 13-21.9% of instruments are used.2 If the average instrument set contains 100 instruments, for example, one can see how much time is wasted accounting for unused (78-87%) instruments. Note: According to literature, it costs between $0.51 and $0.77 to clean, package and sterilize a single instrument in the U.S., and European studies cite those costs between $0.59 to $11.52.3 -5When one considers that most costs are associated with unused instruments, it can be surmised that the SPD and OR teams could benefit from working more collaboratively and effectively to optimize instrument trays.
If an organization reduces its instrument size by half, it will not only allow more time for the surgical team to focus on the patient and procedure (instead of extra instruments) but also reduce set-up and tear-down times, make point-of-use treatment more efficient, lighten instrument tray weights) increase an organization’s instrument set inventory by being able to repurpose extra instruments, and reduce time needed to reassemble and process instrument sets in the SPD.
Many health care organizations base their inventory counts and instrument usage solely on manually estimations, which is not only laborious but can also prove inaccurate. Automated or computer-based container and instrument/tray tracking systems, when combined with manual processes, are more robust and effective at helping organizations attain more accurate data. Sharing this data with surgeons can be a powerful tool in getting their buy-in and helping them understand how more streamlined instrument trays benefit the OR, SPD and the patients being treated.
Conclusion
Health care organizations are increasingly pressured to deliver high-quality, affordable care and services. Focused instrument tray optimization is one way to avoid unnecessary costs and process waste and keep day-to-day operations running more smoothly in the OR and SPD. Both departments must understand which instruments are needed for each surgical procedure and then work collaboratively to reduce redundant devices that typically go unused. Positive results may include faster OR setup, counts and tear down; improved instrument counts during procedures; more on-time procedure starts; faster set turnover times; increased quantity of instrument sets and replacement devices; improved instrument and set quality (maintenance); faster reprocessing times (pretreatment, decontamination, inspection, assembly, sterilization); reduced instrument set weights (not to exceed 25-pound weight limit, which includes the container); and enhanced patient safety by allowing surgical staff to focus more on the patient and procedure instead of the instruments in the tray.
David Taylor III, MSN, RN, CNOR, is an independent hospital and ambulatory surgery center consultant and the principal of Resolute Advisory Group LLC, in San Antonio, Texas. He has served as an HSPA contributing author since 2019.
References
1. https://orthospinenews.com/2018/12/10/the-49-billion-year-of-waste-in-healthcare-spending-we-can-solve/
2. https://pubmed.ncbi.nlm.nih.gov/30846251/
3. Adler S, Scherrer M, Ruckauer KD, Daschner FD. “Comparison of economic and environmental impacts between disposable and reusable instruments used for laparoscopic cholecystectomy.” Surg Endosc 2005;19:268e272.
4. Demoulin L, Kesteloot K, Penninckx F. “A cost comparison of disposable vs reusable instruments in laparoscopic cholecystectomy.” Surg Endosc 1996;10:520e525.
5. Prat F, Spieler JF, Paci S, et al. “Reliability, cost-effectiveness, and safety of reuse of ancillary devices for ERCP.” Gastrointest Endosc 2004;60:246e252
