Lean Principles to Optimize Instrument Utilization for Spine Surgery in an Academic Medical Center

Lunardini, David; Arington, Richard; Canacari, Elena; Gamboa, Kelly A; Wagner, Katiri; McGuire, Kevin J.

doi:10.1097/brs.0000000000000480

Cited by 52 publications

(42 citation statements)

References 9 publications

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“…Other groups have identified other areas of OR waste and have successfully implemented changes leading to substantial cost savings. For example, studies by Lunardini et al 17 and Farrokhi et al 18 demonstrated how LSS methods can increase OR efficiency by reducing unnecessary instrumentation, thereby decreasing setup times and leading to cost savings.…”

Section: Discussionmentioning

confidence: 99%

Perioperative Anesthesia Lean Implementation Is Associated With Increased Operative Efficiency in Posterior Cervical Surgeries at a HighVolume Spine Center

et al. 2020

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Objective: Lean management strategies aim to increase efficiency by eliminating waste or by improving processes to optimize value. The operating room (OR) is an arena where these strategies can be implemented. We assessed changes in OR efficiency after the application of lean methodology on perioperative anesthesia associated with posterior cervical spine surgeries. Methods: We utilized pre-and post-lean study design to identify inefficiencies during the perioperative anesthesia process and implemented strategies to improve the process. Patient characteristics were recorded to assess for differences between the 2 groups (group 1, prelean; group 2, post-lean). In the pre-lean period, key steps in the perioperative anesthesia process were identified that were amenable to lean implementation. The time required for each identified key step was recorded by an independent study coordinator. The times for each step were then compared between the groups utilizing univariate analyses. Results: After lean implementation, there was a significant decrease in overall perioperative anesthesia process time (88.4 ± 4.7 minutes vs. 76.2 ± 3.2 minutes, p = 0.04). This was driven by significant decreases in the steps: transport and setup (10.4 ± 0.8 minutes vs. 8.0 ± 0.7 minutes, p = 0.03) and positioning (20.8 ± 2.1 minutes vs. 15.7 ± 1.3 minutes, p = 0.046). Of note, the total time spent in the OR was lower for group 2 (270.1 ± 14.6 minutes vs. 252.8 ± 14.1 minutes) but the result was not statistically significant, even when adjusting for number of operated levels. Conclusion: Lean methodology may be successfully applied to posterior cervical spine surgery whereby improvements in the perioperative anesthetic process are associated with significantly increased OR efficiency.

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Section: Discussionmentioning

confidence: 99%

Perioperative Anesthesia Lean Implementation Is Associated With Increased Operative Efficiency in Posterior Cervical Surgeries at a HighVolume Spine Center

et al. 2020

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“…introduced “process improvement systems” to better assess routines/efficiency/uniformity for implanting spinal instrumentation, while reducing costs (without overhead to the hospital, differentiated from charges that include overhead) in an urban level 1 academic medical center. [ 6 ] Of 38 spinal procedures performed by both spinal orthopedists and spinal neurosurgeons, only 89 (58%) of the instruments were used at least once. Therefore, 63 (41%) of the instruments not being used were removed from the set; this reduced not only the weight of the instrumentation “boats” by 17.5 lbs, but also saved $41,000/year.…”

Section: Discussionmentioning

confidence: 99%

“…later documented that educating spinal surgeons (requiring only 2 lectures) could reduce operative waste from occurring in 45.5% (January–April 2010) to 16% (May–December 2010) of single-level ACDF cases, while also reducing the overall cost of wasted/explanted devices from 20% to 5.8%. [ 6 ] In order to reduce the costs of operative waste and explore nine reasons for operative waste occurring during all spinal procedures at a single institution, we initiated a two-pronged surgeon-education program in 2012 and followed its impact over the subsequent 2 years (2013, 2014).…”

Section: Introductionmentioning

confidence: 99%

Operative costs, reasons for operative waste, and vendor credit replacement in spinal surgery

Epstein¹,

Roberts²,

Collins³

2015

Surg Neurol Int

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Background:In 2012, Epstein et al. documented that educating spinal surgeons reduced the cost of operative waste (explanted devices: placed but removed prior to closure) occurring during anterior cervical diskectomy/fusion from 20% to 5.8%.[5] This prompted the development of a two-pronged spine surgeon-education program (2012-2014) aimed at decreasing operative costs for waste, and reducing the nine reasons for operative waste.Methods:The spine surgeon-education program involved posting the data for operative costs of waste and the nine reasons for operative waste over the neurosurgery/orthopedic scrub sinks every quarter. These data were compared for 2012 (latter 10 months), 2013 (12 months), and 2014 (first 9 months) (e.g. data were normalized). Savings from a 2013 Vendor Credit Replacement program were also calculated.Results:From 2012 to 2013 and 2014, spinal operative costs for waste were, respectively reduced by 64.7% and 61% for orthopedics, and 49.4% and 45.2% for neurosurgery. Although reduced by the program, the major reason for operative waste for all 3 years remained surgeon-related factors (e.g. 159.6, to 67, and 96, respectively). Alternatively, the eight other reasons for operative waste were reduced from 68.4 (2012) to 12 (2013) and finally to zero by 2014. Additionally, the Vendor Replacement program for 2013 netted $78,564.Conclusions:The spine surgeon-education program reduced the costs/reasons for operative waste for 2012 to lower levels by 2013 and 2014. Although the major cost/reasons for operative waste were attributed to surgeon-related factors, these declined while the other eight reasons for operative waste were reduced to zero by 2014.

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“…Hicks, McGovern, Prior, and Smith (2015) applied lean principles to the design of healthcare facilities and demonstrated the applicability and efficiency of the lean principles. Lunardini et al (2014) optimized instruments' utilization in a spine surgery medical center by employing lean principles. Aqlan and Ali (2014) integrated lean principles, failure mode and effects analysis (FMEA), and fuzzy analysis for improving risk assessment process in a chemical plant.…”

Section: Definition and Key Assumptions Of Leanmentioning

confidence: 99%

Performance optimization of integrated resilience engineering and lean production principles

Azadeh

Yazdanparast

Zadeh

et al. 2017

Expert Systems with Applications

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This paper conducts performance assessment from integrated resilience engineering (IRE) and lean production points of view. This is the first study that evaluates the impact of integrated resilience engineering (IRE) on lean production principles. Second, this study considers integrated impact of lean production by a unique intelligent algorithm. The proposed algorithm is composed of radial basis function (RBF), multi-layer perceptron (MLP) and adaptive neuro-fuzzy inference system (ANFIS). Moreover, the algorithm is capable of handling both crisp and fuzzy data due to the existence of intelligent approach. The proposed algorithm is equipped with verification and validation mechanism through conventional regression, statistical methods and data envelopment analysis. To demonstrate the applicability of the study, a real-world pipe manufacturer is considered as our case study. The results showed that "pull system" and "fault tolerant" among lean and IRE factors,

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Lean Principles to Optimize Instrument Utilization for Spine Surgery in an Academic Medical Center

Abstract: 4.

Cited by 52 publications

References 9 publications

Perioperative Anesthesia Lean Implementation Is Associated With Increased Operative Efficiency in Posterior Cervical Surgeries at a HighVolume Spine Center

Perioperative Anesthesia Lean Implementation Is Associated With Increased Operative Efficiency in Posterior Cervical Surgeries at a HighVolume Spine Center

Operative costs, reasons for operative waste, and vendor credit replacement in spinal surgery

Performance optimization of integrated resilience engineering and lean production principles

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