Operating Rooms (ORs) generate the largest revenues and losses in a hospital. Without the prompt supply of sterile surgical trays from the Sterile Processing Department (SPD), the OR would not be able to perform surgeries to its busy schedule. Nevertheless, little emphasis has been brought in the medical literature to research on surgical instrument processing in the medical literature. The present study was done applies an Enhanced Kaizen Event (EKE) in the SPD of a rural hospital to identify sources of waste and minimize non-value-added steps in the SPD processes. The EKE consisted of three successive Plan-Do-Check-Act (PDCA) cycles, which focused on improvements at the departmental level first, then at an area level, and finally at the station level. The EKE yielded an improved streamlined workflow and a new design for the SPD layout, one of its areas, and a workstation. This paper aims at building a methodology, including identified steps. Results exhibited a 35% reduction in travel distance by the staff, eliminating non-value-added processes, reducing errors in the sterilization process, and eliminating cross-contamination for sterilized materials.

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Purpose: This research aimed to reduce the turnover time (non-operative time) in the operating room (OR) at a US Northwestern hospital.  Design/methodology/approach: Data collection consisted of observation and interviews of the aides, circulating nurses, and surgical techs to identify causes of delays and long turnovers. It was determined that the turnover could be divided into two stages: cleaning the room and setting up for the next surgery. The research team met with the staff (aides) to create a standard operating procedure for the cleaning stage. It was decided to create an agile standard procedure that would allow the process to be completed the same way effectively with any number of people ranging from 1 to 3. The flexibility accounts for the number of people who are to complete the procedure and considers that some of them are only available during portions of the cleaning stage due to multiple turnovers or duties.Findings:  The agile cleaning procedure reduced the cleaning time by 2.2 minutes (15.7% of the total time) and the standard deviation by 3.30 minutes. A decrease in variability represents more consistent turnovers, creating more predictable times for scheduling surgeries in the future.Originality/value: This research proposes a novel approach to standardized work that quickly adapts to the number of workers available. The agile standardized work procedure (ASWP) allows the process to be completed the same way every time effectively with any number of people.

This research was motivated by the nurses’ decision-making process in the current emergency department (ED) triage process in the United States. It explores how continuous vital signs monitoring can be integrated into the ED. The article presents four shortcomings on current ED triage systems and proposes a new conceptual clinical decision support model that exploits the benefits of combining wireless wearable devices with Multi-Attribute Utility Theory to address those shortcomings. A literature review was conducted using various engineering and medical research databases, analyzing current practices and identifying potential improvement opportunities. The results from the literature review show that advancements in wireless wearable devices provide opportunities to enhance current ED processes by monitoring patients while they wait after triage and, therefore, reduce the risk of an adverse event. A dynamic mathematical decision support model to prioritize patients is presented, creating a feedback loop in the ED. The coupling of wearable devices (to collect data) with decision theory (to synthesize and organize the information) can assist in reducing sources of uncertainty inherent to ED systems. The authors also address the feasibility of the proposed conceptual model.

Purpose: Process improvement in service industries, like the registration process in a hospital, can be achieved with the application of lean principles. In this specific case, lean principles were essential to analyze and improve patient satisfaction in a hospital in Montana. The clinics involved in the study included pediatrics (P), internal medicine (IM), and cardiology/pulmonary (CP). The purpose of this study was to address difficulties regarding patient satisfaction on the registration and check-in processes.Design/methodology/approach: Direct observations and patient surveys were initially made to understand the processes and identify the initial causes of dissatisfaction. A value stream map (VSM) was then used to break down even further the complexity of the patient flow. A Fishbone diagram and a concept map were completed to get to the root of the dissatisfaction.Findings: The information obtained from the lean tools showed that patients questioned the need for having a central registration in combination with the check-in process when this combination generates duplications of steps that cause unwanted delays. Several recommendations were explored by the engineering team to mitigate these delays and improve the registration process reducing the number of patients complaints by 40%.Practical implications: This project illustrated the application of Lean principles to resolve issues regarding a central registration format in a healthcare facility.Originality/value: A concept map was used as a tool that helps business organizations in the development of creative and new ways of looking and solving process deficiencies.

Work Related Musculoskeletal Disorders (WMSDs) can be a result of complex interactions between physical, psychosocial, biological, and individual characteristics. However, the evidence on specific associations is still inconclusive. A previous study conducted at a Sterile Processing Department (SPD) in a local hospital established an association between perceived job demands and adverse body postures. However, causal inferences were not possible to establish given the study design. Consequently, the objective of this study was to determine if perception of mental workload causes workers to use more risky body postures. Objective and subjective assessment tools (REBA and NASA-TLX scores) were used as indicators of body postures and mental workload. The findings indicated that there is a positive relationship between the perception of workload (NASA-TLX scores) and adverse body postures (REBA scores) suggesting that people tend to adopt more awkward postures when they feel they are in a rush condition or they have more things to do

Discrete 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.

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