Instrument Trays Research Articles

Utilization Fraction of Ambulatory Hand Procedures: Cost-Reduction Through Surgical Instrument Tray Optimization.

Our objective is to evaluate the utilization fraction (UF) of surgical instruments during a commonly performed ambulatory hand surgery case as an avenue for cost reduction, increased operating room efficiency, and systems quality improvement. The total number of instruments opened at the start of the case was recorded followed by instruments being divided into those used and not used during the procedure. Total sterile processing costs were estimated at $1.56 per instrument according to data from our institution's central sterilization processing (CSP) department. Nineteen hand procedures performed by 2 surgeons were included in this study. An average of 120.1 ± 10.9 instruments were opened at the start of each case, while an average of 12.6 ± 5.4 instruments were used per case (Figure 1). This yielded an UF of 10.7% ± 4.8%. Using our internal CSP estimate, we calculated an annual cost of $16 863 to reprocess the current hand tray (Figure 2). Using literature data, this cost ranged from $5 513 to $34 484 annually. The same cost calculations were performed for the theoretical optimized tray (incorporating instruments used at least 20% of the time when opened) containing 23.2 instruments. The annual reprocessing cost of this new tray according to CSP data was $3 260, demonstrating a cost-reduction of $13 603 or 80.7% (Figure 2). Evaluation of pre- and peri-operative processes is a valuable technique to mitigate increasing healthcare costs and reduce unnecessary healthcare spending, with broad applicability to multiple surgical subspecialties and procedures.

EDI&S SO08 A novel approach to environmentally sustainable surgical theatre by rationalising surgical instrument set – a qualitative analysis

Abstract Background The surgical theatres are a major source of hospital waste generation. The NHS has set a net zero supply chain target by 2045. This aim is supported by the RCS intercollegiate green theatre checklist to reduce the environmental impact of operating theatres. One key area identified in this process, that will support the net-zero target is surgical instrument tray rationalisation. Laparoscopic cholecystectomy was identified as one of the most common surgical procedures performed in England. The purpose of this study was to demonstrate the impact of rationalising the number of surgical instruments, enabling surgeons to drive towards net zero surgery. Method Our Trust participated in this study, in collaboration with NHS England sustainable procurement team and the innovation agency. Total 58 cholecystectomies performed across two sites, Pinderfields and Dewsbury were included in this prospective audit undertaken from January – March 2023. The surgical tray checklists were used to record the actual instrument usage and noted the redundant and supplementary instruments. This data presented to a surgical advisory group, who agreed on routine instruments and proposed removal of redundant. A green pilot tray was approved and used for cholecystectomy. Qualitative questionnaire feedback was collected from surgeons and operation theatre staff from both sites. Results The instrument use matrix revealed almost 50% instruments from the previously used major tray were never used in any of the 58 cholecystectomy surgeries performed. Subsequently, based on the use matrix data, we switched from using major tray containing 84 instruments, to a reduced size tray containing 46 instruments including re-usable metal ports. Survey results revealed tray rationalisation led to easier and faster surgery preparation, improved efficiency and a reduction in waste, thereby reducing the cost to the Trust. It was also noted that having a smaller tray means less time to count instruments during the surgical pause. Conclusion The results of tray rationalisation are very positive and have demonstrated cost savings, carbon reduction and time saved preparing for surgery and the post-operative instrument count. This pilot study has shown that by making the surgical set smaller, savings have been achieved from a reduction of slots required per machine cycle for decontamination. Tray rationalisation goes some way towards the net goal of zero carbon surgery and delivering a sustainable future.

Surgical Tray Optimization in the Setting of Cleft Lip and Palate Reconstruction: Implications for Operative Cost and Efficiency.

To assess surgical instrument usage in cleft lip (CL) and cleft palate (CP) surgery and create an optimized surgical tray with an associated cost-savings analysis. Prospective, observational study. Single institution, 6-month prospective review. A total of 10 primary CL surgeries and 10 primary CP surgeries were included in this study. Complete lists of surgical instruments utilized in CL and CP surgeries were collected. The average instrument UFs were 26.0% for CL and 22.6% for CP. The estimated costs were $33.15 to $290.29 for the original CL surgical tray and $10.20 to $63.80 for the optimized tray. For CP, the original tray's cost was estimated at $38.25 to $319.00, and the optimized tray at $9.18 to $57.42. This demonstrates a cost reduction of $22.95 to $226.49 for CL and $29.07 to 261.58 for CP. The idealized surgical instrument tray could contribute to reducing healthcare expenditures and promoting operating room efficiency, patient safety, and environmentally friendlier operating theaters.

Surgical instrument tray optimization process at a university hospital: A comprehensive overview

ObjectiveThis study presents the results of a surgical instrument tray optimization process implemented across all surgical specialties within the largest university hospital in Denmark. MethodsData was extracted from a comprehensive instrument optimization process including all Operating Rooms at Aarhus University Hospital. Adopting a holistic perspective, the optimization process, involved aligning instrument trays across various surgical specialties. This included: a) Reduction in number of instruments, b) Consolidation or separation of trays, c) Modularization - introducing modular trays for specific purposes, and d) Standardization - standardizing commonly used instruments across specialties. Instruments per tray, total number of instruments, and changes in the number of trays were compared against existing tray contents to identify discipline-specific changes. ResultsSome specialties made substantial alterations to tray structures, while others primarily reduced number of instruments in existing trays. Across all specialties, optimization resulted in 17 % decrease in number of tray types (p = 0.01, 95%CI:1.0–6.8), 1 % increase in total number of trays (p = 0.36, 95%CI:-11.9–4.8), 18 % decrease in number of instruments per tray (p = 0.0002, 95%CI: 3.2–7.6) and 16 % reduction in total number of instruments for all specialties (p < 0.0001, 95%CI:404–758). ConclusionThis study underscores complexity of instrument tray design. The approach employed at Aarhus University Hospital, involving interdisciplinary experts in an iterative design process, demonstrated the feasibility of redesigning instrument trays with significant reduction in content. Additionally, data suggests that reducing the number of instruments could lead to a decrease in workload within the Central Sterile Supply Specialty. This presents opportunity to minimize wasted resources and streamlining cleaning processes for unused instruments.

Optimising Surgical Instrument Trays for Sustainability and Patient Safety by Combining Actual Instrument Usage and Expert Recommendations

Annually, over 300 million surgeries occur globally, requiring numerous surgical instruments. However, many instruments on the tray are returned to the central sterile supply department (CSSD) unused, creating an unsustainable pattern of unnecessary consumption. To address this, we developed a method for optimising surgical instrument trays (SITs) that is straightforward to implement in other hospitals. This optimisation aims to enhance patient safety and sustainability and to improve working conditions and reduce costs. We identified actual instrument usage (IU) in the operating room (OR) and obtained expert recommendations (ERs). Data from both methods were combined in a computer model (CM) to adjust the SITs. The performance of the adjusted SITs was assessed over a year. IU of three different SITs was collected during 16 procedures (mean = 28.4%, SD = 6.4%). Combining IU and ERs resulted in a 36.7% reduction in instruments and a 31.3% weight reduction. These measures contribute to reducing the carbon footprint and enhancing sustainability. During the evaluation of the new SIT contents (n = 7 procedures), mean IU increased from 28.4% (SD = 6.4%) to 46.5% (SD = 11.0%), with no missing instruments during surgery. A one-year follow-up showed no need for further alterations. Combining both methods yields better results than using them individually, efficiently reducing unnecessary items in SITs without compromising patient safety.

662 A Sustainable Laparoscopic Cholecystectomy Tray

Abstract Aim The aim was to develop and trial a systematic methodology in order to streamline laparoscopic cholecystectomy trays across all sub-specialties in Leeds Teaching Hospitals Trust (LTHT), and to inform rationalisation principles nationally in partnership with NHS England’s sustainability team. Method 70 laparoscopic cholecystectomies across all sub-specialties were independently observed and audited for instrument usage at LTHT from January to March 2023. The findings were summarised and a usage heatmap was developed. A subsequent ‘hackathon’ event was held in the form of a consensus session with key stakeholders from each sub-specialty to agree a proposed single instrument tray. Carbon and financial savings calculations were then undertaken to measure the impact of the changes. Results Audit results demonstrated an average of 112 instruments across four separate trays opened. The heat map demonstrated 42% of items were used from 0-5% of procedures. The hackathon event agreed a consolidated single tray of 65 items. With over 800 laparoscopic cholecystectomies taking place in LTHT per year predicted financial savings in sterilisation costs were over £22,000 and over 3 tonnes of CO2e annually. Conclusions Tray rationalisation and standardisation has significant financial and carbon savings and can be extrapolated to many types of procedures. Sustainable change is vital to meet NHS net zero targets and requires urgent attention. Stakeholder engagement was crucial to ensure changes were agreeable and would be sustained. Following the successfully trialled methodology and implementation NHS England have produced a guide for other trusts to implement similar changes.

D49. Utilization Fraction of Ambulatory Hand Procedures: Cost Reduction through Surgical Instrument Tray Optimization

D49. Utilization Fraction of Ambulatory Hand Procedures: Cost Reduction through Surgical Instrument Tray Optimization

Investigation of the perceptions of operating theatre nurses and central sterile supply department technicians regarding the barriers and facilitators of surgical instrument counts and tray management in the operating theatre

BackgroundProper surgical equipment management is essential for ensuring patient safety in the operating theater (OT). Despite existing protocols, errors persist, leading to severe complications and emotional distress. This study aimed to investigate the perceptions of OT nurses and Central Sterile Supply Department (CSSD) technicians regarding barriers and facilitators of instrument counts and tray management. MethodsA multicenter cross-sectional, descriptive study was carried out using a SurveyMonkey conducted with a purposive sample of 52 participants of OT Nurses and CSSD technician from three hospitals in Saudi Arabia and the United Arab Emirates (UAE). The data were analyzed using frequencies and percentages, and to explore the relationship between the demographic variables and participants' overall perception scores, a chi-square test was employed. ResultsData analysis revealed that participant perceptions varied by years in the profession (p = 0.31) and gender (p = 0.003). About 52 % agreed that current policies are clear, while 36.5 % were uncertain. The majority (40.4 %) believed the current tray couldn't reduce OT costs. Participants disagreed with the lack of training (42.3 %) and communication issues during handover (38.5 %). Confidence in the current protocol was low (40.4 %), and 46.2 % agreed that a new protocol would impact OT operations. Alarmingly, 84.6 % of participants had a negative overall perception, indicating widespread concerns. ConclusionThese findings lay the groundwork for implementing a revised protocol for surgical tray management. Understanding healthcare professionals' perspectives will aid in identifying strategies to overcome barriers, enhancing instrument management practices, improving patient safety, and optimizing OT efficiency.

Carbon Footprint of Minor Foot and Ankle Surgery: A Randomized Controlled Trial.

Climate change poses a substantial threat to human health, and operating rooms (ORs) have an outsized environmental impact. The Program for Research in Sustainable Medicine (PRiSM) designed a protocol for minor foot and ankle surgery intended to reduce waste, streamline instrument trays, and minimize laundry. We conducted a randomized controlled trial to compare the carbon footprint of procedures performed using the PRiSM protocol vs a traditional protocol. Forty adult patients undergoing foreign body removal, hammertoe correction, toe amputation, hardware removal, mass excision, or gastrocnemius recession were randomized to the PRiSM or our "Traditional" protocol. The PRiSM protocol used a smaller instrument tray, fewer drapes and towels, and minimal positioning blankets. No changes were made to surgical site preparation or operative techniques. Environmental impact was estimated using the carbon footprint, measured in kilograms of carbon dioxide equivalents (CO2e). Emissions associated with OR waste, instrument processing, and laundry were calculated. On average, PRiSM cases had a smaller carbon footprint than Traditional cases (17.3 kg CO2e [SD = 3.2] vs 20.6 kg CO2e [SD = 2.0], P < .001). Waste-associated emissions from PRiSM cases were reduced (16.0 kg CO2e [SD = 2.7] vs 18.4 kg CO2e [SD = 1.8], P = .002), as were modeled instrument processing-related emissions (0.34 vs 0.91 kg CO2e). One superficial surgical site infection occurred in each group. We found a small but statistically significant reduction in the environmental impact of minor foot and ankle surgery when using the PRiSM vs Traditional protocol. The environmental impact of these cases was dominated by plastic waste-related emissions. Orthopaedic surgeons should think critically about what components of their surgical setup are truly necessary for patient care, as minor changes in product utilization can have significant impacts on waste and greenhouse gas emissions. Level I, randomized controlled trial.

An Efficiency Model for Decreasing Operative Room Turnover Time for Total Joint Arthroplasties.

Despite an increased demand for total joint arthroplasty (TJA), rising health-care costs and bundling of payments by payers have shifted the focus to improving operating room (OR) efficiency. This study aimed to assess the efficacy of an efficiency model that optimized instrument trays on decreasing OR turnover time (TOT) and the benefits made possible by this improved efficiency. All primary TJA procedures performed by a single fellowship-trained surgeon from January 2022 to August 2023 were reviewed. The surgeon partnered with Zimmer Biomet to condense the total knee and total hip arthroplasty instrument trays from seven to three trays each. Patient in OR time and patient out of OR times were collected and used to calculate TOT. Mean TOTs pre-efficiency model implementation (January - October 2022) and post-efficiency model implementation (March - August 2023) were compared. Annual cost savings were calculated based on an average cost per one minute of OR time of $47.99 and an average cost for the Sterile Processing Department (SPD) to process a single TJA tray of $79.41. Following implementation of the efficiency model, the average OR TOT significantly decreased by 19 minutes (P < 0.0001), a greater than 44% reduction in TOT. At this surgeon's current case volume, conservatively estimated at 280 primary TJA cases per year, annual savings in OR and SPD processing costs were $169,597 and $88,939, respectively. Moreover, this led to increased case volume per operative day. A small-scale intervention such as optimizing instrument trays for TJA is a valuable and sustainable solution to improve efficiency in the OR by decreasing OR TOT, thereby generating considerable cost-savings and opportunity to increase surgical volume.

A two-step approach to create and evaluate an optimization method for surgical instrument trays to reduce their environmental impact

ObjectiveThis study combines Integer Linear Programming (ILP) and carbon footprint analysis based on the Life Cycle Assessment (LCA) method to reduce the carbon footprint of surgical instrument trays and their use. Materials and methodsA case study was carried out quantifying the instrument usage during the radical hysterectomy procedure. Using LCA we modelled the carbon footprint of the instrument trays, cradle to grave. The resulting carbon footprint data were used as input for an ILP model. The ILP model aims for an environmentally optimized composition of surgical instrument trays, without influencing patient safety, and optimizes composition based on different utilization rates. ResultsInstrument usage for the radical hysterectomy procedure was 54%. The LCA showed that with 99.5% of the total carbon footprint, the use phase in which the surgical trays are cleaned and sterilized is the biggest contributor. The ILP showed that for the radical hysterectomy procedure, an annual reduction in emission of 230 kgCO2-eq (46%) can be achieved by optimizing the trays. DiscussionThe results of this study show that the carbon footprint of surgical instrument trays is mainly impacted by the surgical tray size and number of used trays. Implementing the proposed method and environmentally optimizing surgical trays requires a multidisciplinary team, including surgeons, OR scrub nurses and those who have knowledge of LCA and ILP. ConclusionA combined method of ILP and LCA is suitable to provide insights on how to optimize surgical instrument trays with the objective to reduce the carbon footprint of these trays.

Decontamination of a robot used to reprocess reusable surgical instruments

Using robots to handle medical devices in the decontamination area of the Central Sterile Supply Department (CSSD) can reduce risks and address staff shortages. The gripper design must allow reliable cleaning using standard CSSD procedures to avoid build-up of biofilms and possible cross-contamination between different instrument trays and the gripper's functionality. This study explores the design of the robot's gripper regarding cleanability, aiming to determine whether successful cleaning can be achieved even after prolonged drying for a working shift of 8h. We optimized a gripper for cleanability and used it to assess the spread of different test soils depending on different forms of motion. Subsequently, we analysed the cleanability using sheep's blood as test soil, reprocessing the gripper in different assembly configurations after 4 and 8h of drying, and measuring residual protein. Based on our investigations, we documented the spread of contamination depending on the type of motion of the gripper's components. Sheep's blood exhibited the highest dispersion among the test soils, permeating through thin crevices. Importantly, all samples displayed residual protein levels below the warning threshold, irrespective of drying time and gripper disassembly or cleaning position. Cleaning in a device-specific optimized position achieved results comparable to cleaning the disassembled individual components. These findings indicate that cleaning even after one working shift of 8h and without the labour-intensive disassembly of the gripper is feasible, supporting the future use of robots to handle contaminated medical devices in the CSSD decontamination area.

Implementation of a Colorectal Surgical Site Infection Prevention Bundle and Checklist: A Quality Improvement Project.

After noting an elevated surgical site infection rate in 2019 associated with colorectal surgeries, leaders at two Central Virginia health system hospitals convened an interdisciplinary team to audit current practices and research infection prevention strategies. After identifying a lack of standardization in care processes for colorectal surgery patients and reviewing the literature on colorectal bundles, the team created a bundle focusing on the use of antibiotics, chlorhexidine gluconate wipes or baths, separate closing instrument trays, nasal decolonization, bowel preparation, and maintaining patient normothermia. After synthesis and stakeholder input, the team implemented the colorectal bundle along with a checklist for all users to complete to ensure compliance and standardization of practice and for auditing purposes. Implementation results were positive: the total number of colorectal infections decreased from nine in 2020 to three in 2021. Education was critical to securing staff member engagement for successful implementation of and compliance with the bundle.

A Prospective Evaluation of Cost and Space Utilization Following Implementation of an Intelligent Delivery Platform for Forefoot Single-use Implants and Instrumentation in the ASC Setting

Category: Midfoot/Forefoot; Other Introduction/Purpose: The transition of the US healthcare system from a fee-for-service model to a value-based care model calls for a deeper evaluation of patient care in order to uphold quality and efficiency. Sterile-packed single-use instruments have been introduced as a tool to help facilities streamline operating room logistics and reduce sterilization needs and requirements thus reducing cost, time, and valuable shelf space. With the added intelligent delivery platform, procedure mapping (physician specific stocking of implants) and automatic restocking is now possible1-3. The purpose of this study was to examine the efficiencies of cost savings and reduction of shelf space required for storage of an intelligent delivery platform (Pulse Intelligent Delivery Platform, Stryker, Memphis, TN) with single-use surgery-ready forefoot implants. Methods: A total of 19 cases were performed during a 3-month period (August to November 2022) at a single ambulatory surgery center. Instrument tray reduction was tabulated and compared to the number of trays typically utilized using reusable instruments. Tray management time was evaluated clinically by direct observation. A cost analysis of reprocessed instrumentation trays was then performed looking at sterilization, surgical delay, and instrumentation costs per tray and then compared to pricing for the sterile instrument kits. The instrument, sterilization, and case delay costs/tray at the facility were calculated2. A comparison of space utilization was also performed between the two groups (reprocessed trays versus sterile kits). Results: There was a substantial decrease in the need for reusable instrument trays by 80%. 70% of cases did not require even one tray of reusable instruments to be opened. The delivery platform was shown to lower instrument tray cost per case by 74.25%. Space was also evaluated, and the sterile kits were found to have an 85.9% reduction in space when compared to the reprocessed trays2,3. Conclusion: A forefoot single-use surgery ready intelligent delivery platform has been shown to effectively lower overall instrument tray cost per case by 74.25% in a highly efficient ASC. In addition, an 85.9% reduction in shelf space per tray was also seen comparing reprocessed instrumentation to sterile instrument kits. Pricing is variable per facility, and sterilization and usage processes vary1-6. However, we believe that sterile kits can be more cost effective than reprocessed sets. In addition, space can be saved with the use of sterile instrument kits adding to the established benefits of the delivery platform of procedure mapping and automatic restocking1-3.

A comparison of two CNN-based instrument detection approaches for automated surgical assistance systems

Abstract The shortage of operating room technicians has led to a growing demand for automated systems in the OR to maintain the quality of care. Robotic scrub nurse (RSN) systems are increasingly being developed, which perform tasks such as handling instruments and documenting the surgery. While research has focused on detecting instruments in the hands of surgical staff or recognizing surgical phases, there is a lack of research on detecting instruments on the instrument tray. Therefore, this study proposes and evaluates two distinct methodologies for instrument detection on the OR table using the deep learning approaches YOLOv5 and Mask R-CNN. The performance of the two approaches has been evaluated on 18 YOLOv5 models and twelve Mask R-CNN models, mainly differing in model size. Two sets of instruments were used to assess generalizability of the models. The results show a mean average precision (mAP) score of 0.978 for YOLOv5 and 0.846 for Mask R-CNN on the test dataset comprising three classes. An mAP of 0.874 and 0.707 have been computed respectively for the test dataset including six classes. The study provides a comparison of the performance of two suitable approaches for instrument detection on the instrument tray in the OR to enhance the development of RSN systems.

Simulating a sterilization processing department to evaluate block schedules and tray configurations

AbstractDiscrete event simulation is a well‐established tool for examining the effect of different operating room (OR) block schedules on various performance metrics within the OR suite and adjacent units. However, one unit that has rarely been studied is the sterilization processing department (SPD), which cleans and assembles reusable OR instruments. As part of a larger research study, we developed a series of OR block assignment models that sought to reduce the workload of the SPD and developed a tray optimization model to reduce the number of instruments on increasingly bloated instrument trays. While initial numerical experiments were promising, a comprehensive simulation model of the OR and SPD was needed to more thoroughly examine how potential changes to the block schedule and/or more efficient tray configurations could improve SPD processing times. In this article, we incorporate the SPD into an existing simulation model of an OR suite, which is the first of its kind, and examine the effect that different block schedules and tray configurations have on SPD processing times. Simulation results confirm earlier numerical computations. Furthermore, simulation results suggest that more efficient instrument tray configurations are a much better and more viable method for improving SPD processing time than reconfiguring block schedules.

Reducing the carbon footprint in carpal tunnel surgery inside the operating room with a lean and green model: a comparative study.

The primary aim of our study was to assess the environmental impact of moving from a standard to a lean and green model for a carpal tunnel decompression. We objectively measured the clinical waste generated, the number of single use items and the number of sterile instruments required for a standard procedure, and then moved to smaller instrument trays, smaller drapes and fewer disposables. These two models were compared for waste generation, financial costs and carbon footprint. Information prospectively collected on seven patients in the standard model and 103 patients in the lean and green model in two hospitals over a 15-month period, demonstrated a reduction in CO2 emissions of 80%, clinical waste reduction of 65%, and an average aggregate cost saving of 66%. The lean and green model can deliver a safe, efficient, cost-effective and sustainable service for patients undergoing carpal tunnel decompression.Level of evidence: III.

Adapting lean methodology towards surgical tray rationalisation in inguinoscrotal day case surgery in the republic of Ireland

Lean methodologies have been used successfully in both industry and healthcare to reduce waste. Theoperating room (OR) and central supplies department (CSD) are areas associated with high hospital costs. The aim of this study was to employ Lean methodologies to support the rationalisation of surgical trays in paediatric inguinoscrotal surgery in order to reduce instrument wastage, processing times and overall costs in a European setting. This was a prospective, pilot observation and implementation study using Lean methodology including DMAIC (Define, Measure, Analyse, Improve and Control) cycles. Relevant tray set-up included trays for boys ≥12 months age undergoing open elective inguinoscrotal surgery. A comparative analysis of two phases, pre and post-standardization was then carried out with respect to operating times, instrument set-up times, tray weights, and costs. Instruments that were used <40% of the time were eliminated from the surgical tray. Rationalization of the inguinoscrotal tray led to a 34.7% reduction in tray size, with a concomitant time-reduction of >2min per case. The average overall instrument utilisation rate increased from 56% to 80% across users. Cost savings were projected at €5380.40 per annum based on current changes. There were no differences in operative time, or adverse outcomes. At the hospital level, the reduction in variation, and rationalisation of this single surgical tray could lead to both operational (Tray assembly process; Operating rooms; Ergonomic functionality) as well as economic (Sterilisation; Instrument repair; Purchases) financial and ergonomic improvements for the healthcare system. The reduction in time taken to count and sterilise instruments can lead to a potential manpower saving involving a redistribution of activities to other areas which may require them. Surgical tray rationalisation is emerging Lean concept with overlap across a number of specialities, and represents a technique by which to manage costs, and improve supply chain efficiency without any adverse effect in patient healthcare outcomes.

Data-Driven Surgical Tray Optimization to Improve Operating Room Efficiency

Improving Operating Room Efficiency After each surgery in a hospital, every reusable instrument that has entered the operating room must be sterilized before it can be used again. Hospitals spend several million dollars a year on this sterilization process, instrument tray assembly, and instrument repurchase costs. However, 70%–80% of instruments that enter the operating room are not used at a large majority of hospitals resulting in wastage of millions of dollars. For a medium-sized hospital, approximately $4–$7 million are spent on the sterilization process. Across more than 5,000 hospitals in the United States, several billion dollars per year are wasted on unnecessary sterilization. Researchers at UNC Kenan-Flagler Business School, with partners from healthcare technology firm Operative Flow Technologies, have developed an algorithm that uses detailed data of instruments used to create optimized instrument tray configuration. The algorithm creates trays informed by historical usage of instruments to reduce unused instruments in trays significantly. This algorithm scales for hundreds of trays, thousands of instruments, and thousands of surgeries and can be applied to major healthcare systems. At one implementation, the number of unused instruments was reduced by 54%. Their solution has subsequently been implemented at multiple healthcare systems leading to several million dollars of cost savings for the hospitals.

Optimizing spine surgery instrument trays to immediately increase efficiency and reduce costs in the operating room

BackgroundOver-crowded surgical trays result in perioperative inefficiency and unnecessary costs. While methodologies to reduce the size of surgical trays have been described in the literature, they each have their own drawbacks. In this study, we compared three methods: (1) clinician review (CR), (2) mathematical programming (MP), and (3) a novel hybrid model (HM) based on surveys and cost analysis. While CR and MP are well documented, CR can yield suboptimal reductions and MP can be laborious and technically challenging. We hypothesized our easy-to-implement HM would result in a reduction of surgical instruments in both the laminectomy tray (LT) and basic neurosurgery tray (BNT) that is comparable to CR and MP. MethodsThree approaches were tested: CR, MP, and HM. We interviewed 5 neurosurgeons and 3 orthopedic surgeons, at our institution, who performed a total of 5437 spine cases, requiring the use of the LT and BNT over a 4-year (2017–2021) period. In CR, surgeons suggested which surgical instruments should be removed. MP was performed via the mathematical analysis of 25 observations of the use of a LT and BNT tray. The HM was performed via a structured survey of the surgeons’ estimated instrument usage, followed by a cost-based inflection point analysis. ResultsThe CR, MP, and HM approaches resulted in a total instrument reduction of 41%, 35%, and 38%, respectively, corresponding to total cost savings per annum of $50,211.20, $46,348.80, and $44,417.60, respectively. ConclusionsWhile hospitals continue to examine perioperative services for potential inefficiencies, surgical inventory will be increasingly scrutinized. Despite MP being the most accurate methodology to do so, our results suggest that savings were similar across all three methods. CR and HM are significantly less laborious and thus are practical alternatives.