As hospitals and health systems continue to work to manage costs while maintaining quality, I’ve found that surgical tray standardization remains an untapped resource for many organizations. As surgeons request instruments based on their individual preferences, the size of surgical trays continues to grow. And as the number of instruments on a surgical tray grows (often due to changing preferences and new surgeons), the use of those instruments rapidly declines, creating unnecessary costs to purchase, process and manage the instruments. One study found that up to 87% of reusable instruments on surgical trays often go unused.
I had the opportunity to work with a large, academic medical center on the West Coast that was interested in standardizing their highest utilized surgical instrument trays in orthopedic and gynecology. We were able to reduce the items in trays by 27%, creating an annual savings of more than $50,000. Interested in doing the same? Here’s what you need to know.
Principles of tray management
Surgical instrument trays, when configured properly, provide a minimum set of required instruments to perform the highest number of procedures within a specialty.
Evaluating and standardizing the instruments in the trays provides value in many ways, including saving staff time to prepare and maintain the trays, reducing expenses to sterilize the instruments and purchase replacements and providing safer handling and lighter trays for transporting.
Tray management is centered on answering four main questions:
- Which instruments should be included?
- In what quantities?
- What surgical procedures will the tray be used on?
- How many trays of each type should be held in inventory?
In the case of the West Coast academic medical center, I began to determine which instruments should be included by partnering with the manager of value analysis and the sterile processing manager to determine common usage patterns of instrument trays in orthopedics and gynecology. We observed directly (one of the best ways) and analyzed at the surgery schedule, preference cards, SPD reports and repair logs.
Armed with the usage patterns, the value analysis manager, sterile processing manager and I met with scrub techs and service line leaders to gather their insights on the instrumentation use and needs that exist intra-operatively. When asked what instruments were rarely used, many started sharing their insights
It was time to begin the process of sorting our data and standardizing trays. It’s important to only have the instruments in each tray that are used over 90% of the time; however, not every instrument must be used frequently for its presence to be critical in a surgical case. There are certain instruments that must always be available in the OR for patient safety in the event of rare or unexpected events. Additionally, the tray quantities were assessed. This was done with daily case volume information.
In this example, the academic medical center had three locations which provided even more variance in tray configurations and possibly hundreds of preference cards among surgeons across the locations. From preference cards, we learned what procedures used which trays. It was time to bring orthopedic and gynecology surgeons into the discussion.
We leveraged actual instrument usage data from sterile processing software to recommend the removal of unused instruments from a given tray through analytics based on lean methodology approaches. Similar trays were compared to determine overlap or redundancy and identify opportunities for consolidation – similar procedures could use the same tray. The surgeons reviewed the list and made final recommendations. Trust was built with the surgeons by using a consistent methodology. Trays were evaluated and changed in phases so that tweaks could be made as needed and patient care would not be compromised.
As a result of the tray management activities, the academic medical center removed more than 75,000 instruments from its orthopedic trays and more than 16,000 instruments from its gynecology trays. Additionally, we consolidated 28 trays to 10 trays. For example, the previous Ortho Hand Tray had 108 instruments and was adjusted to 88. This tray was utilized 1,207 times per year. By removing 20 instruments, the organization saved almost $15,000 in 12 months. In another example, each location had its own version of a Basic Bone and Arthrotomy trays. After collaborating they realized these trays were repetitive and decided to make one Large Bone Tray that was consistent across locations, reducing from five different trays that took 399 instruments to build to one tray that takes 79 instruments to build.
The removed instruments are now available in SPD inventory to be utilized for peel-packed instruments or repurposed for other trays when instruments are lost or broken. Removing infrequently used instruments from the trays and creating peel-packed items is cost-effective because it saves the infrequently used instruments from constant, unnecessary reprocessing, which carries labor and equipment costs and contributes to instrument depreciation.
Estimated cost savings of the new leaner trays was calculated based upon per instrument sterilization, processing, instrument replacement costs and instrument depreciation. We calculated that eliminating one instrument from a tray, used 2,000 times a year, would save $920. The removal of these instruments yielded an estimated cost savings of nearly $55,000.
In conclusion, these results demonstrate an opportunity for a reorganization of instrument delivery that results in significant cost savings. Lean methodology improves efficiency in instrument tray usage, reduces hospital costs while encouraging surgeon and staff participation through continuous process improvement. Moving forward at this hospital, adding instruments to trays is a formal process that is managed by an instrument oversight committee. Surgical administrations nationwide could benefit from evaluating and examining surgical instrument trays. Consistent reassessment is needed to achieve both cost savings and sustainable practices.
About the author: Elizabeth Shoaf, RN, Vizient consulting director, has 20 years of experience in the health care industry. Her areas of expertise and professional skills include coordinating quality improvement initiatives, project management, and staff development. Prior to joining Vizient, Elizabeth spent 10 years at Wake Forest Baptist Medical Center where she served as perioperative clinical educator/quality and resource manager, directing 18 training programs and producing over 200 new RNs into the intraoperative setting.