Impact of Lean on surgical instrument reduction: Less is more

Wannemuehler, Todd J.; Elghouche, Alhasan N.; Kokoska, Mimi S.; Deig, Christopher R.; Matt, Bruce H.

doi:10.1002/lary.25407

Cited by 32 publications

(45 citation statements)

References 6 publications

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“…Em estudo com o objetivo de reduzir a quantidade de instrumentais nos conjuntos de adenoamigdalectomia, que eram frequentemente usados por vários cirurgiões, utilizou-se um método prospectivo de melhoria da qualidade pelo Lean Six Sigma, sendo realizado um mapeamento de fluxo desses instrumentais quanto ao seu uso e processamento. Após a intervenção, foi possível reduzir de 52 para 24 instrumentais de adenoamigdalectomia, com redução do tempo de montagem desses conjuntos de 8,4 para 4,7 minutos (p<0001) e decréscimo de 44% no custo de montagem dos instrumentais, representando uma estimativa de redução de custos de US$ 1.468,99 por conjunto 13 .…”

Section: Discussionunclassified

“…Vale considerar que, nesse mesmo estudo, foram avaliados 700 procedimentos de adenotonsilectomias em um ano e utilizados 850 conjuntos de instrumentais processados no mesmo ano, sendo que os alvos das intervenções para a redução dos custos pelo método Lean foram: tempo perdido entre os passos do processamento dos instrumentais, transporte de componentes desnecessários, instrumentais supérfluos e não utilizados durante o procedimento, atividades desnecessárias dos componentes de processamento e processamento desnecessário dos instrumentais não utilizados 13 .…”

Section: Discussionunclassified

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Critérios para avaliação de novas tecnologias para esterilização

Graziano

Laranjeira

Silva³

et al. 2017

Rev SOBECC

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Objetivo: Discorrer sobre critérios e métodos que devem nortear a avaliação de novas tecnologias para esterilização. Método: Estudo de revisão narrativamediado pela busca e interpretação da legislação nacional relacionada aos processos de esterilização, normas técnicas e documentos que embasam os aspectosconstrutivos, funcionais e da segurança das tecnologias para esterilização. Resultados: Foram discutidos tópicos relevantes à segurança dos processos de esterilização,como a prova de esterilidade, simulação do ciclo nas piores condições de carga, compatibilidade com sistemas de barreira estéril, testes de biocompatibilidade,controle de processos e avaliação econômica. Conclusão: Os resultados beneficiarão diretamente três segmentos principais; os fabricantes, no desenvolvimentoe na solicitação de registro de novas tecnologias para esterilização; a Agência Nacional de Vigilância Sanitária, na adoção oficial de uma lista de exigênciasjunto ao fabricante no momento de petição de registro de novos equipamentos; e os serviços de saúde, no consumo de novas tecnologias para esterilização.

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Section: Discussionunclassified

Critérios para avaliação de novas tecnologias para esterilização

Graziano

Laranjeira

Silva³

et al. 2017

Rev SOBECC

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“…This has recently been shown in the otolaryngology literature, with a significant 1-minute reduction in operating room turnover before and after reducing the number of instruments on the adenotonsillectomy tray. 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.…”

Section: Limitationsmentioning

confidence: 99%

“…After implementing reduction in the adenotonsillectomy tray, Wannemuehler and colleagues found that the extra tray was accessed 3.6% of the time and that 93.75% of surgeons and other personnel were satisfied with the reductions. 8 An extra tray would attenuate tray reduction cost savings slightly, owing to the need for sterile processing of the extra tray.…”

Section: Limitationsmentioning

confidence: 99%

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

et al. 2016

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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").

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