Large Instrument Trays: Legacy or Necessity?

What percentage of instruments that are opened in a tray would you estimate end up being used during each surgery?  On the other hand, how often is there an instrument that you need, but that isn’t in the room, so the circulator has to leave to find it?

The answers to these questions have significant ramifications, in terms of both cost and efficiency in the operating room.  Studies have found actual instrument usage to be less than 10-25% of the instruments that are opened in trays for a given surgery.  When you consider the incremental cost of reprocessing each instrument, on the order of $0.51 to $1.07, the numbers escalate quickly at centers with high surgical case volume.  In fact, a 2013 publication from Virginia Mason Medical Center estimated potential institutional savings of up to $2.8 million per year with a 70% reduction in the number of instruments processed.

It’s important to consider the other implications of excess instrumentation during surgery.  Don’t forget that all of these extra instruments have to be transported to the OR and counted multiple times before, during, and at the end of a case by surgical techs.  That incurs both physical impact on personnel, as well as time expense that may add to surgical duration or turnover between cases. Anything that draws attention away from patient care activities or adds to the length of surgery has the potential to compromise patient safety or outcomes.  And by lengthening the duration of the case and turnover time, fewer aggregate cases are done each day, which impacts the hospital financially.

Inevitably, though, it is still a common occurrence for a necessary instrument to not be present, or for the instrument condition to be subpar, in the trays picked for the case.  Each of those episodes has the potential to delay the case progression and increase the number of OR door openings, which has been associated with a higher risk for postoperative complications.  Undoubtedly, the unnecessary processing of upwards of 75-90% of instruments in a tray with each case results in progressive degradation of the instrument quality, leading to the expensive need to replace the instrument entirely.

So what’s the solution to this significant contributor of surgical expense?  Rather than anecdotal evaluations of changes that need to be made for ‘legacy’ instrument trays, it’s time for data-driven rationalization to optimize this portion of the surgical process.  There are cost savings there that are real and immediate.

Sources:

Farrokhi FR, Gunther M, Williams B, Blackmore CC. Application of Lean Methodology for Improved Quality and Efficiency in Operating Room Instrument Availability. J Healthc Qual. 2015 Sep-Oct;37(5):277-86.

Stockert EW, Langerman A. Assessing the magnitude and costs of intraoperative inefficiencies attributable to surgical instrument trays. J Am Coll Surg. 2014 Oct;219(4):646-55.