72: Cost reduction techniques in the operating suite: Surgical tray optimization

Abstract

OBJECTIVES: The American College of Obstetricians and Gynecologists supports vaginal hysterectomy as the safest and most costeffective route. While the cost-benefit ratio is favorable, there are still opportunities to optimize efficiency and contain cost. Several studies have highlighted the low instrument utilization within surgical trays, which leading to increased processing costs and surgical case setup time. Other risks related to excess surgical instruments include a reduction in instrument longevity from preventable wear-and-tear, increased risk for tray assembly errors, and strain placed on operating suite staff from tray weight. A previous study in gynecologic surgery reported as few as 13% of surgical instruments on a vaginal surgery tray were used. We aimed to evaluate the instrument usage within our vaginal hysterectomy trays to reduce unnecessary instruments without compromising high quality, safe patient care. Further, we estimated cost savings from the development of a "minor gynecology" tray that could replace the vaginal hysterectomy tray previously used for benign outpatient vaginal cases. MATERIALS AND METHODS: The Female Pelvic Medicine and Reconstructive Surgeons (FPRMS) and operating suite staff first eliminated extraneous instruments based on clinical experience. Following that initial reduction, the Surgical Quality Committee initiated a formal audit of surgical instrument usage. The vaginal hysterectomy tray was used for major benign gynecology cases, including vaginal hysterectomy with and without pelvic reconstruction, urogenital and rectovaginal fistulas approached vaginally, and vaginal mesh removal. Minor gynecology cases included isolated anterior or posterior repairs, Bartholin cyst/labial lesions, urethral diverticulum, and midurethral sling placement or revision. Cost of sterile processing and packaging was estimated to be $0.51/instrument based on published data. RESULTS: The standard vaginal hysterectomy tray contains 67 instruments. This was reduced to 48 instruments in the minor gynecology tray. Processing costs were estimated to be $34.17/vaginal hysterectomy tray and $24.48/minor gynecology tray. Instrument usage for the vaginal hysterectomy tray averaged 66%, which is higher than what has been reported by other studies in gynecology. In 2015, four FPRMS specialists at our institution performed 844 cases. The cost to process the instruments for those cases would have been $28,839.48 prior to the development of the minor gynecology tray. Estimating that the minor gynecology tray could be used for 20% of those cases, we achieved a cost savings of 5.7% ($1637.61). CONCLUSION: Healthcare costs related to set-up, processing and packaging of unused surgical instruments can be reduced when surgeons and operating suite staff work together to identify opportunities to reduce inefficiencies. Cost savings are likely underestimated due to the surgeon-and operating suite staffdriven initiative to reduce the number of instruments in each tray prior to the formal audit. The development of...

Management of ophthalmic surgical instruments and processes optimization: mixed method study

“…In financial terms, it can be noticed that the re-assessment of the amount of pieces belonging to trays and surgical feasibility with application of linear programming made 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 The findings involving rationalization in the use of materials, cost reduction and increase of surgical procedures converge with the results of other study that assessed the efficiency in the use of the surgery room to reduce costs (20) .…”

“…The literature on re-assessment of instruments in trays is mostly exclusively based on the observation of their use in a surgery sample and field observation (10,(18)(19)(20) , however, in one study (18) more similar to the present one, where a multidisciplinary group of specialists was formed to analyze pediatric surgery trays, average reduction of 27.8% was reported. This study corroborates our findins and the relevance of this multiprofessional discussion.…”

“…Reduction in the amount of instruments in ophthalmic surgery trays led to re-assessment of investments and improvement in safety to the surgical patient, ensuring availability of instruments at the right time for each procedure. Moreover, rationalization of the number of instruments per tray can have substantial impact on their processing costs with reduction in the stock of materials not used and those that need continuous processing (10,17,20) . Assessment of processes is an important tool to reduce costs in health services, where inefficient surgical routine can compromise safety of care and generate waste (19)(20) .…”

Approaches to the rationalization of surgical instrument trays: scoping review and research agenda

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Approaches to the rationalization of surgical instrument trays: Scoping review and research agenda

“…It is noteworthy that STD is used differently by authors following LP and EA approaches. In LP, STD is the basis for continuous improvement, being sought in all steps of STR [57,60]; in EA, STD corresponds to the last step of an STR analysis [66,67].…”