Where are my instruments? Hazards in delivery of surgical instruments

Wauben, L.S.G.L.; Eijk, Anne C. van der; Vernooij, Alex S N; Meeuwsen, F.C.; Elst, Maarten van der; Hoeijmans, V; Dankelman, Jenny; Dobbelsteen, John J. van den

doi:10.1007/s00464-015-4537-7

Cited by 16 publications

(9 citation statements)

References 25 publications

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“…The tray management time involves everything outside of the OR and central sterilization department. Guedon et al [13] estimated 355 minutes dedicated to set management per case. No variance was provided, so a 20% coefficient of variation was imputed for a standard deviation of 71 minutes.…”

Section: Probability Distributions For Each Activity Variablementioning

confidence: 99%

“…New techniques and technologies that foster greater efficiency, reduce unanticipated spending, and minimize patient complications will be critical to accommodate the continuing growth in healthcare utilization along with the associated resource requirements. For example, streamlining the surgical instrumentation is commonly emphasized for improving efficiency in the OR as well as hospital operations and would greatly support TKA in the outpatient setting by reducing the need for handling, storage, and sterilization of instruments [8,9,13].…”

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confidence: 99%

“…The OR staff responsible for setup and cleanup of the instruments could also realize significant time savings for case turnover [19], which has been an important focus of many studies for improving hospital efficiencies and OR utilization [9e11,22]. Finally, traditional instrument sets for TKA are typically loaned to the facility by a manufacturer, and the logistics associated with managing the intake, processing, and transport can be a substantial burden [13,23].…”

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confidence: 99%

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Logistical and Economic Advantages of Sterile-Packed, Single-Use Instruments for Total Knee Arthroplasty

Goldberg¹,

Maltry

Ahuja

et al. 2019

The Journal of Arthroplasty

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Keywords:total knee arthroplasty sterilization single-use instruments postdischarge complications efficiency and economic benefits a b s t r a c t Background: Total knee arthroplasty (TKA) is well established as a clinically successful and cost-effective procedure. The transition of the US healthcare system from a fee-for-service model to a value-based care model requires careful examination of patient care to ensure both quality and efficiency. Sterile-packed, single-use instruments have been introduced as a tool to help streamline the operating room (OR) logistics while reducing sterilization requirements. The aim of this study was to examine the potential logistic and economic benefits of single-use instruments compared to traditional, reusable instruments for TKA. Methods: Four variables related to TKA costs and logistics were modeled in this study: OR turnover time tray sterilization, tray management time, and 90-day infection rates. Model input data for traditional instruments and single-use instruments were based on peer-reviewed literature. A total of 200 sites and 500 cases per site were simulated using the Monte-Carlo-Technique. Results: The median total cost savings with single-use instruments was $994 per case. The largest driver for cost savings was tray sterilization. Sites with higher staff wages and sterilization costs had a larger probability of realizing greater cost savings with adoption of single-use instruments. In cases using single-use instruments, up to 51% of operating days could have accommodated an additional procedure due to the time savings in OR turnover. Conclusion: This cost modeling study observed significant potential for logistical and economic improvements in TKA with single-use vs reusable instruments. Although few studies have been conducted to measure the impact of single-use instruments in practice, the results of these simulations motivate further investigation.

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Section: Probability Distributions For Each Activity Variablementioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Logistical and Economic Advantages of Sterile-Packed, Single-Use Instruments for Total Knee Arthroplasty

Goldberg¹,

Maltry

Ahuja

et al. 2019

The Journal of Arthroplasty

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“…23 The unavailability of instruments during an intervention has been recognized to cause delays and stress in the OR, which can lead to additional patient risk. 24 Instruments are unavailable, for instance, if the tray contains a defective instrument and this is needed by the surgeon. Usually, instruments are labelled as defective during an intervention by the scrub nurse.…”

Section: Introductionmentioning

confidence: 99%

Design and evaluation of an eye tracking support system for the scrub nurse

Unger

Black

Fischer

et al. 2018

Robotics Computer Surgery

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“…Besides the fact that this entire process of sterilisation, delivery and use of surgical instruments is time consuming, it also represents an important aspect of performing safe surgery. A previous study has shown that there is a large amount of hazards throughout the entire delivery process of surgical instruments 15. The unavailability of surgical instruments represented around 40% of equipment-related incidents in the OR 16 17.…”

Section: Introductionmentioning

confidence: 99%

Just-in-time delivery of sterilised surgical instruments

et al. 2016

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The unavailability of the required surgical instruments at the start of a procedure is undesirable. It causes delays and stress in the operating room (OR), which can lead to additional risks for the patients. Issues with availability of surgical instruments may become visible just before the start of the procedure but are induced earlier in the delivery process. Therefore, efficient and safe supply chain management is essential. Just in time (JIT) is a concept widely applied in industrial sectors to improve efficiency and quality. The aim of this study is to design a JIT process for the delivery of surgical instruments and to assess the potential risks. The JIT delivery process of surgical instruments was designed for a Dutch hospital working with an external Central Sterile Supply Department (CSSD). Hazards (ie, sources of potential adverse events) were identified according to the Healthcare Failure Mode and Effects Analysis (HFMEA) methodology. The risks of applying JIT principles to the delivery of surgical instruments were compared to the risks involved with the current situation of the hospital at the time of this study (supply-driven delivery). The results showed that the total (high-)risk score of the JIT situation was similar to that of the current situation, although the number of (high-risk) hazards was slightly higher. However, almost half of the hazards were ‘controlled’ (when actions to remove the hazard were taken later in the process), in contrast to the current situation in which only about 10% of the (high-risk) hazards were ‘controlled’. The JIT delivery of surgical instruments is expected to present less risks compared to the current situation. The multiple requirements for information technology support and a higher level of trust between the CSSD and OR department should be taken into account in order to improve the supply chain management of surgical instruments.

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Where are my instruments? Hazards in delivery of surgical instruments

Cited by 16 publications

References 25 publications

Logistical and Economic Advantages of Sterile-Packed, Single-Use Instruments for Total Knee Arthroplasty

Logistical and Economic Advantages of Sterile-Packed, Single-Use Instruments for Total Knee Arthroplasty

Design and evaluation of an eye tracking support system for the scrub nurse

Just-in-time delivery of sterilised surgical instruments

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