Instrument Readiness: An Important Link to Patient Safety

Frictions as Barriers to Perioperative Alignment

“…For class 2 and class 3, frictions representing basic functions at the SPD-OR interface were perceived by the majority of nurses as the primary issues influencing OR performance (Table 2). 23,25,26,30,[38][39][40] These frictions could be viewed as basic "blocking and tackling" at the SPD-OR interface. In addition, incomplete case carts were perceived by more than 90% of class 3 respondents and 46% of class 2 respondents as having a negative effect on OR performance ( Table 2).…”

“…23,[30][31][32] To examine the functioning of this critical perioperative interface, we adapt the concept of "frictions" from the supply chain management literature. The SPD occupies 190 QUALITY MANAGEMENT IN HEALTH CARE/VOLUME 23, ISSUE 3, JULY-SEPTEMBER 2014 a critical position in determining how information and materials flow within the perioperative system and because of this, the performance of SPD is a key rate-limiting factor affecting OR performance.…”

“…25,26 Frictions are critical operational issues that must be confronted by hospitals because their cumulative impact on quality and efficiency can be substantial. 23,27,30,31 McNamara's 30 "chain of instrument readiness" describes 8 steps and dozens of subprocesses representing the daily coordination between the SPD and the OR of thousands of surgical instruments, supply items, and equipment necessary to successfully complete surgical cases. The SPD is primarily responsible for ensuring that the right equipment is provided for the right surgical case, at the right time, and that this equipment is safe to use (ie, functional and sterile).…”

“…23,25,26,28,[38][39][40] Although an SPD is perhaps not the most visible department in the perioperative environment, a hospital could not function without its services. 23,30 The supply chain management literature demonstrates that as system complexity increases so does the relative degree of friction in the system. Departmental functioning of the SPD is a patient safety issue because the rapidly increasing volume and complexity of surgical instrumentation means that SPD staff must be highly competent to understand the nuances of hundreds of different sterilization procedures for increasingly complex instrumentation.…”

Bar Code‐Based Management to Enhance Efficiency of a Sterile Supply Unit in Singapore

“…Then, personnel in the sterile‐storage department are able to retrieve information about these instruments from the system and replenish the stock to predetermined par levels on the following day. These processes help ensure instrument availability to the surgical team in the specialized ORs 11 . The team had Phase 3 in place by March 2014.…”