Application of Lean Methodology for Improved Quality and Efficiency in Operating Room Instrument Availability

Abstract

Advances in surgical instrumentation allow surgeons to treat patients with less morbidity and shorter recovery time. However, the increasing complexity also adds to surgical risk, and to operating room supply chain burden. To improve the quality and efficiency of operating room instrument availability, we developed and validated a Lean 5S approach consisting of sort (determining instrument usage and waste), simplify (removing unnecessary instruments), sweep (confirm availability of needed instruments), standardize (all trays the same for a given procedure), and self-discipline (monitor success). The primary outcome was reduction in unnecessary instruments delivered to the operating room. As a secondary analysis, we evaluated the effect of the Lean instrument intervention on surgery times. We reduced the number of instruments for minimally invasive spine surgery by 70% (from 197 to 58), and setup time decreased 37% (13.1-8.2 min, p = .0015). We also report subsequent validation of the approach on deep brain stimulator cases. We conclude that complex surgical procedures offer opportunities for substantial waste reduction, simplification, and quality improvement, with potential institutional annual cost savings of $2.8 million. We demonstrate that Lean methodology can improve quality at lower cost.

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

“…5 Farrokhi and colleagues estimated potential savings of up to $2.8 million a year, with a 70% reduction in instrument processing for all surgical procedures at Virginia Mason Medical Center, a 300-bed hospital with 24 operating rooms. 12 The higher cost saving estimates when compared with our base case estimate are due in large part to the inclusion of a broader range of surgical procedures, 5,12 and inclusion of overhead costs. 12 Wannemuehler and colleagues estimated annual savings of $850 in sterile processing costs and a further $1468.99 savings in instrument purchasing costs associated with reducing an adenotonsillectomy tray.…”

“…Our per instrument processing cost was also lower than that of Farrokhi and colleagues, with a per instrument processing cost of US$0.77. 12 Their estimate incorporated indirect costs, which accounts for some of the discrepancy when compared with our per instrument cost.…”

“…8 Farrokhi and colleagues compared processes before and after tray optimization and found that a 70% reduction in the number of instruments for minimally invasive spine surgery (197 to 58), decreased set up time by 37% (from 13.1 to 8.2 min, p = 0.0015). 12 Tray reduction may also result in adverse consequences such as the need, albeit infrequently, to retrieve instruments that are not on the surgical trays during procedures. Making a tray readily accessible in the operating room to be opened when extra instruments are required is a precautionary measure that can ensure clinical outcomes are not adversely affected.…”

Streamlining variability in hospital charges for standard thyroidectomy: Developing a strategy to decrease waste

“…This knowledge and active participation helped to decrease the need for unnecessary instruments and make the OR process more efficient. 10 Regularly reviewing and revising preference cards helped to bridge the gap between OR nursing communication and real-time surgeon intraoperative requirements. Improve OR time efficiency by selecting the most appropriate operative setting for cases.…”

Impact of the Japanese 5S management method on patients’ and caretakers’ satisfaction: a quasi-experimental study in Senegal

“…The impact of 5S, often combined with other lean methods, has been researched in the health sectors of the United States (10–13), India (14), Jordan (15), Sri Lanka (16), and Senegal (17). However, little is known about its impact on healthcare-service users.…”