The Surgical Instrumentation Paradox

There are many people in surgical services, including surgeons and members of the OR team, who are unaware of the magnitude of the excess instrumentation problem and its repercussions.

If you work in the OR, you have undoubtedly noted that there are far more trays and instruments transported and opened for cases than are actually used, but few have taken an in-depth look at the downstream effects and unsustainable nature of this problem.

This issue is present at most (if not all) hospitals across the country, as has been well-established by dozens of articles in peer-reviewed journals. These publications span all surgical specialties and hospital settings, the full spectrum of procedure types, across pediatric and adult services lines.

They have consistently demonstrated low usage (typically less than 20-30%) of instruments that are opened for a given surgery. Many of those articles, as well as other editorials, have described the implications of the problem, not the least of which are the financial, but also effects on personnel, processing quality and patient safety.

As experts in this field with a proven solution, we get asked on a regular basis, “our hospital definitely has this issue- what is the source of the problem?”

Here comes the paradox- in an effort to address a growing need for instrument availability over time (related to surgical volume growth, addition of surgeons to the hospital, increased sterile processing turnaround, etc.), it has been much easier for instruments to get added to trays, and for additional trays to get added to preference cards rather than address the root cause of the problem. The motivation for that ‘quick fix’ is well-intentioned: to ensure that everything that may be needed for that surgery is there; however, there are many negative, expensive, and labor-intensive consequences to that approach over time.

The situation has now reached a point where sterile processing departments at almost every hospital across the country are stretched well beyond capacity. Ultimately, this means that, despite spending an exorbitant – but avoidable – amount on purchasing and processing of surgical instruments, hospitals are faced with worsening attrition in these departments, leading to costly recruitment and training, potential compromises in processing quality that may impact patient safety, delays and lengthening of turnover time between cases, as well as a constraint on the ability to grow their surgical volume.

Let’s look at the problem in more detail in order to better understand the solution:

The solution is therefore based on the following concept:

Reduce the number of instruments per tray AND number of trays per case
Decrease the time needed to process the instruments for each case, thereby improving the throughput time in sterile processing
Reduce the number of copies needed for each tray as a result of the faster turnaround time in processing the instruments

Then what are the components of an optimal solution?

Utilize actual instrument usage data collected at the point-of-care (i.e., in the operating room) to know which instruments need to be present for which cases and surgeons, based on their preferences and empiric benchmark usage data
Match the number of copies of those optimized trays to the current surgical volume (and have the ability to project what the needs would be for growth of certain services lines and/or procedures)
Analyze existing tray inventory, break down trays that are no longer needed, and make those instruments (along with those removed in the reduction process) available for re-allocation

The benefits are then clear:

Reduce the need to re-purchase instruments on the basis of having available the surplus that was removed
Reduce the time and expense associated with sterile processing [the 70-80%] of instruments that were opened but not used during surgery
Reduce the space requirements needed for storage of instrument trays and potentially re-allocate that valuable hospital square footage for revenue-generating activities
Improve the quality of processing those instruments, thereby improving compliance and patient safety
Relieve constraints on case scheduling due to tray availability and enable the ability for growth of surgical volume

Let’s talk about getting started- how can a solution based on actual usage data be practically implemented? That is where the power of data analytics comes in. As a result of successfully implementing our solution at multiple hospitals across the country, OpFlow is able to leverage usage data collected at an individual instrument type and quantity level, stratified by instrument tray, procedure, surgeon, and service line in our national benchmarks.

Before even stepping foot inside your facility, we can compare your existing tray configurations and preference cards to our national benchmarks and generate a projected reduction potential for your hospital.

That provides us with a head start, once we are on-site collecting usage data specific to your surgeons and procedures, in the streamlined, efficient system designed within our platform and service.

We then see the process through to successful completion and deployment of your optimized tray configurations via our proven methods to ensure patient safety and continuity of your surgical workflow.

Get started with opflow

Ben WoodDecember 9, 2021

The Surgical Instrumentation Paradox

There are many people in surgical services, including surgeons and members of the OR team, who are unaware of the magnitude of the excess instrumentation problem and its repercussions.

If you work in the OR, you have undoubtedly noted that there are far more trays and instruments transported and opened for cases than are actually used, but few have taken an in-depth look at the downstream effects and unsustainable nature of this problem.

As experts in this field with a proven solution, we get asked on a regular basis, “our hospital definitely has this issue- what is the source of the problem?”

Let’s look at the problem in more detail in order to better understand the solution:

The solution is therefore based on the following concept:

Reduce the number of instruments per tray AND number of trays per case

Decrease the time needed to process the instruments for each case, thereby improving the throughput time in sterile processing

Reduce the number of copies needed for each tray as a result of the faster turnaround time in processing the instruments

Then what are the components of an optimal solution?

Utilize actual instrument usage data collected at the point-of-care (i.e., in the operating room) to know which instruments need to be present for which cases and surgeons, based on their preferences and empiric benchmark usage data

Match the number of copies of those optimized trays to the current surgical volume (and have the ability to project what the needs would be for growth of certain services lines and/or procedures)

Analyze existing tray inventory, break down trays that are no longer needed, and make those instruments (along with those removed in the reduction process) available for re-allocation

The benefits are then clear:

Reduce the need to re-purchase instruments on the basis of having available the surplus that was removed

Reduce the time and expense associated with sterile processing [the 70-80%] of instruments that were opened but not used during surgery

Reduce the space requirements needed for storage of instrument trays and potentially re-allocate that valuable hospital square footage for revenue-generating activities

Improve the quality of processing those instruments, thereby improving compliance and patient safety

Relieve constraints on case scheduling due to tray availability and enable the ability for growth of surgical volume

Before even stepping foot inside your facility, we can compare your existing tray configurations and preference cards to our national benchmarks and generate a projected reduction potential for your hospital.

That provides us with a head start, once we are on-site collecting usage data specific to your surgeons and procedures, in the streamlined, efficient system designed within our platform and service.

We then see the process through to successful completion and deployment of your optimized tray configurations via our proven methods to ensure patient safety and continuity of your surgical workflow.