Comparing surgical trays with redundant instruments with trays with reduced instruments: a cost analysis

Abstract

I n 2015, total health care expenditures in Canada were estimated at $219 billion.1 Although hospitals represented the largest category of expenditures at 29.5%, this proportion has been steadily decreasing over the last 2 decades. The decline is due in part to provincial and territorial policies to promote cost cutting in hospitals. In Ontario, activity-based funding in the form of Health-Based Allocation Models has been implemented to promote quality care and incentivize increased efficiency.2,3 Similar funding initiatives have previously been implemented in British Columbia and Alberta. 4 As a result, hospitals are keen to identify areas of potential cost savings.Surgical tray redundancy is recognized as a difficulty in surgical units. [5][6][7][8] At one hospital, a review of 49 procedures and 247 trays within 4 surgical specialties (otolaryngology, plastic surgery, bariatric surgery and neurosurgery) showed that rates of instrument use varied from 13.0% to 21.9%. 7After surgery, sterile processing personnel decontaminate instruments through manual cleaning. Personnel assemble standardized trays by packing instruments onto trays, which are then washed and sterilized in a washer-disinfector machine for the next surgical procedure. Since all instruments in an opened tray require sterile processing, unused instruments incur potentially avoidable costs. In a previous study, we conducted a review of instruments on surgical trays in the otolaryngology departments of St. Joseph's Health Care London and the London Health Sciences Centre, London, Ont. 9 We found that the average tray use ranged from 20.1% to 51.7%, suggesting substantial redundancy. We have proposed streamlined trays -"reduced trays" -that would reduce the number of instruments by more than 50%. In this study, our objective was to perform an economic evaluation of streamlined trays to quantify the potential cost savings that may result from implementing the reduced trays. Background: When prearranged standard surgical trays contain instruments that are repeatedly unused, the redundancy can result in unnecessary health care costs. Our objective was to estimate potential savings by performing an economic evaluation comparing the cost of surgical trays with redundant instruments with surgical trays with reduced instruments ("reduced trays").

Reducing instruments in a vitrectomy surgical tray: cost savings and results from a major academic hospital

“…These values were calculated through estimations and analysis of CSP labor costs, instrument depreciation, CSP department utilities, and repair costs. Elements of their methodology have been cited by several other studies [5]. Since the study was performed, the CSP department sterilizes approximately 57% more instruments per year and granular data on the elements included in the study could not be obtained.…”

“…Surgical trays that contain unused instruments can lead to unnecessary costs for hospitals [1][2][3]. Specifically, unused instruments undergo sterilization between each case, resulting in both direct labor costs and more rapid wear and tear of instruments [1,2,4,5]. In addition, unpacking large trays can add to case turnover time and increase time spent counting items both before and after each case [2,4,5].…”

“…Specifically, unused instruments undergo sterilization between each case, resulting in both direct labor costs and more rapid wear and tear of instruments [1,2,4,5]. In addition, unpacking large trays can add to case turnover time and increase time spent counting items both before and after each case [2,4,5]. As a result, reducing instrument tray size by eliminating unused or rarely used instruments may represent a cost savings opportunity.…”

“…For instance, a 70% instrument reduction in surgical trays used for both minimally invasive spine surgery and deep brain stimulation surgery demonstrated a cost savings of approximately $60,000 per year [2]. A study from Canada demonstrated that reducing redundant instruments from trays for five common otolaryngology procedures saved an estimated CAD 13,000 annually [5]. Additional cost savings can be seen by avoiding instrument purchase and replacement costs through reduced surgical trays and delaying wear and tear of instruments [6].…”

Surgical Instrument Optimization to Reduce Instrument Processing and Operating Room Setup Time

“…A cost analysis of the intervention found that moderate savings in direct tray costs could be achieved by reducing surgical tray redundancy. 8 Time savings associated with this intervention have not previously been quantified. The aim of this study is to evaluate the effects that tray optimization has had on reprocessing time in the central processing department (CPD) and on setup time in the OR.…”