Radiofrequency Identification Track for Tray Optimization: An Instrument Utilization Pilot Study in Surgical Oncology.

Surgical instrument tray reduction attempts to minimize intraoperative inefficiency and processing costs. Previous reduction methods relied on trained observers manually recording instrument use (i.e. human ethnography), and surgeon and/or staff recall, which are imprecise and inherently limited. We aimed to determine the feasibility of radiofrequency identification (RFID)-based intraoperative instrument tracking as an effective means of instrument reduction. Instrument trays were tagged with unique RFID tags. A RFID reader tracked instruments passing near RFID antennas during 15 breast operations performed by a single surgeon; ethnography was performed concurrently. Instruments without recorded use were eliminated, and 10 additional cases were performed utilizing the reduced tray. Logistic regression was used to estimate odds of instrument use across cases. Cohen's Kappa estimated agreement between RFID and ethnography. Over 15 cases, 37 unique instruments were used (median 23 instruments/case). A mean 0.64 (median = 0, range = 0-3) new instruments were added per case; odds of instrument use did not change between cases (OR = 1.02, 95%CI 1.00-1.05). Over 15 cases, all instruments marked as used by ethnography were recorded by RFID tracking; 7 RFID-tracked instruments were never recorded by ethnography. Tray size was reduced 40%. None of the 25 eliminated instruments were required in 10 subsequent cases. Cohen's Kappa comparing RFID data and ethnography over all cases was 0.82 (95%CI 0.79-0.86), indicating near perfect agreement between methodologies. Intraoperative RFID instrument tracking is a feasible, data-driven method for surgical tray reduction. Overall, RFID tracking represents a scalable, systematic, and efficient method of optimizing instrument supply across procedures.

Olivere LA ，Hill IT ，Thomas SM ，Codd PJ ，Rosenberger LH ... -  《-》

Data analysis of vascular surgery instrument trays yielded large cost and efficiency savings.

Knowles M ，Gay SS ，Konchan SK ，Mendes R ，Rath S ，Deshpande V ，Farber MA ，Wood BC ... -  《-》

Decreasing operating room costs via reduction of surgical instruments.

Rising costs in health care demand waste reduction and improved efficiency throughout the hospital. Surgeons have an important role in regard to the number of instruments used in procedures. Previous studies have demonstrated instrument maintenance and sterilization cost approximately $0.51-$0.77 per instrument and found that only 13-21.9% of instruments opened are used. The aim of the study was to reduce the surgical trays so that more than 50% of the instruments are used leading to a cost savings of at least 20% per tray. This was begun with the minor urology tray which is primarily used for orchiopexy and hernia repair. This was a single-site, prospective study. A Plan, Do, Study, Act cycle was used. A multidisciplinary team including urologists, surgical technicians, and a central processing department representative was developed. Inguinal orchiopexy with hernia, scrotal orchiopexy, and inguinal hernia cases were randomly chosen to count the total instruments used in each procedure. The exact instruments were recorded every third case to obtain a sample of variable patients and surgeon preferences. The percentage of utilization was calculated, and a list of instruments used was created. Those not used or used less than 20% of the time were removed. The new list was reviewed with the option to add or eliminate instruments. The approved reduced list was then implemented as the genitourinary (GU) minor tray. Finally, the instruments used in 10 inguinal orchiopexy with hernia cases, 10 scrotal orchiopexy cases, and 10 inguinal hernia cases were counted. The percentage of utilization was calculated. This process was then replicated in other surgical trays. The GU minor instrument tray was reduced from 57 to 35 instruments, a 39% reduction in size. Scrotal orchiopexy uses the least instruments (16.9), a utilization percentage of 48.3% after reduction. Inguinal orchiopexy with hernia repair uses the most number of instruments (25.1) with 71.7% utilization after reduction, compared with 43% before reduction. Using the cost analysis performed by Stockert and Langerman, $11.22 was saved during each procedure; this translates to a cost savings of $3489.42 annually. After reduction, only 10% of the cases required an extra instrument to be opened. Three other surgical trays were reduced using the same method, yielding a potential savings of $14,588. Baseline data demonstrates low average instrument utilization rangin from 21.1% to 49.1% per case. It is estimated that each instrument costs from $0.51 to $3.19. Decreasing the number of instruments opened with each surgical procedure is a viable way to decrease costs and efficiency in the operating room. Initially, the GU minor tray was successfully reduced by 39%, followed by the other surgical trays. A multidisciplinary approach is critical for success. This study showed an excellent opportunity for cost savings by decreasing reusable waste in the operating room.

Nast K ，Swords KA 《-》

Surgical tray optimization as a simple means to decrease perioperative costs.

Health care spending in the US remains excessively high. Aside from complicated, large-scale efforts at health care cost reduction, there are still relatively simple ways in which individual hospitals can cut unnecessary costs from everyday operations. Inspired by recent publications, our group sought to decrease the costs associated with surgical instrument processing at a large, multihospital academic center. This was a single-site observational study conducted at a large academic medical center. At the study start, all attending surgeons within the section of pediatric surgery agreed to standardize the pediatric surgery trays and to eliminate instruments that were deemed unnecessary from each tray. A multidisciplinary start-up meeting was held, and this meeting included stakeholders from central sterile processing, operating room nursing, scrub technicians, and materials management along with all five pediatric surgeons. Each tray was addressed individually. Instruments were eliminated from trays only if there was unanimous agreement among all the surgeons in the group. If no instruments in a given surgical tray were deemed necessary, the entire tray was eliminated from sterile processing rotation. Feedback questionnaires were drafted by the multidisciplinary team that participated in the start-up meeting. Surgeons were allowed to request for certain instruments to be placed back into the trays at any time, and the questionnaires also allowed for free-hand comments. Surgical kit preparation time was obtained from the institutional barcode scanning system. The cost per second of sterile processing labor was calculated using regional median salary for sterile processing technicians in the state of Connecticut. Using the pediatric surgery section as the model unit, this method was then applied to pediatric urology, neurosurgery, spine surgery, and orthopedics. The pediatric surgery section eliminated an average of 59.5% of instruments per tray, resulting in an overall reduction of 1826 (39.5%) instruments from rotation, 45,856 fewer instruments processed per year, and nine trays eliminated completely from regular rotation. Processing time for six commonly used trays was reduced by an average of 28.7%. The urology section eliminated 18 trays from regular rotation and 179 (10.1%) instruments in total. Pediatric orthopedics, neurosurgery, and spine sections eliminated 708 (17.1%), 560 (92.7%), and 31 (32.2%) instruments, respectively, resulting in approximately 18,804 fewer instruments processed per year. Among all five surgical sections, annual instrument cost avoidance after tray optimization was estimated at $53,193 to $531,929 using average instrument life spans ranging from 1-10 y. Negative feedback and requests for instrument replacement were both minimal on feedback questionnaires. Surgical tray optimization represents a relatively simple microsystem improvement that could result in significant hospital cost reduction. Although difficult to quantify, other gains from surgical kit optimization include decreased weight per tray, decreased materials cost, and decreased labor required to count, decontaminate, and pack surgical trays.

Farrelly JS ，Clemons C ，Witkins S ，Hall W ，Christison-Lagay ER ，Ozgediz DE ，Cowles RA ，Stitelman DH ，Caty MG ... -  《-》

Reducing cost and improving operating room efficiency: examination of surgical instrument processing.

Operating room efficiency can be compromised because of surgical instrument processing delays. We observed that many instruments in a standardized tray were not routinely used during thyroid and parathyroid surgery at our institution. Our objective was to create a streamlined instrument tray to optimize operative efficiency and cost. Head and neck surgical instrument trays were evaluated by operating room team leaders. Instruments were identified as either necessary or unnecessary based on use during thyroidectomies and parathyroidectomies. The operating room preparation time, tray weights, number of trays, and number of instruments were recorded for the original and new surgical trays. Cost savings were calculated using estimated reprocessing cost of $0.51 per instrument. Three of 13 head and neck trays were converted to thyroidectomy and parathyroidectomy trays. The starting head and neck surgical set was reduced from two trays with 98 total instruments to one tray with 36 instruments. Tray weight decreased from 27 pounds to 10 pounds. Tray preparation time decreased from 8 min to 3 min. The new tray saved $31.62 ($49.98 to $18.36) per operation in reprocessing costs. Projected annual savings with hospitalwide implementation is over $28,000.00 for instrument processing alone. Unmeasured hospital savings include decreased instrument wear and replacement frequency, quicker operating room setup, and decreased decontamination costs. Optimizing surgical trays can reduce cost, physical strain, preparation time, decontamination time, and processing times, and streamlining trays is an effective strategy for hospitals to reduce costs and increase operating room efficiency.

Dyas AR ，Lovell KM ，Balentine CJ ，Wang TN ，Porterfield JR Jr ，Chen H ，Lindeman BM ... -  《-》