The Impact of Breast Lumpectomy Tray Utilization on Cost Savings

Malone, Emily; Baldwin, Jason; Richman, Joshua S.; Lancaster, Rachael; Krontiras, Helen; Parker, Catherine C.

doi:10.1016/j.jss.2018.06.063

Cited by 20 publications

(18 citation statements)

References 14 publications

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“…Since there is great pressure to reduce waste and cost in healthcare [24], the reprocessing of reusable instruments has grown, resulting in increased workload at the SPDs [2]. Some researchers have focused on surgical tray optimization by reducing the instruments present on surgical trays or by creating trays for specific procedures [2,3,7,23,25,26]. Nevertheless, little emphasis has been brought to surgical instrument processing research in the medical literature [27].…”

Section: Introductionmentioning

confidence: 99%

An Enhanced Kaizen Event in a Sterile Processing Department of a Rural Hospital: A Case Study

Nino

Chipperfield

Valladares

et al. 2020

IJERPH

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Operating Rooms (ORs) generate the largest revenues and losses in a hospital. Without the prompt supply of sterile surgical trays from the Sterile Processing Department (SPD), the OR would not be able to perform surgeries to its busy schedule. Nevertheless, little emphasis has been brought in the medical literature to research on surgical instrument processing in the medical literature. The present study was done applies an Enhanced Kaizen Event (EKE) in the SPD of a rural hospital to identify sources of waste and minimize non-value-added steps in the SPD processes. The EKE consisted of three successive Plan-Do-Check-Act (PDCA) cycles, which focused on improvements at the departmental level first, then at an area level, and finally at the station level. The EKE yielded an improved streamlined workflow and a new design for the SPD layout, one of its areas, and a workstation. This paper aims at building a methodology, including identified steps. Results exhibited a 35% reduction in travel distance by the staff, eliminating non-value-added processes, reducing errors in the sterilization process, and eliminating cross-contamination for sterilized materials.

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Section: Introductionmentioning

confidence: 99%

An Enhanced Kaizen Event in a Sterile Processing Department of a Rural Hospital: A Case Study

Nino

Chipperfield

Valladares

et al. 2020

IJERPH

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“…This QI study demonstrates that surgeon-led elimination of redundant or rarely used instruments from surgical instrument trays was associated with reduced OR direct costs over time without a change in stakeholder satisfaction. While this has been previously demonstrated primarily across other surgical specialties, Oto–head and neck surgery trays often continue to be designed with redundant, unused instruments to prepare for a wide variety of surgical preferences as well as diverse operative needs . Keeping instruments that may be necessary only in rare circumstances on every surgical tray leads to excess instrument processing and wear and tear of the instrument despite a lack of use, as well as increased tray processing and setup time .…”

Section: Discussionmentioning

confidence: 99%

“…Surgical instrument trays have traditionally been designed to be comprehensive, often resulting in redundancies; studies report only 13.0% to 51.7% instrument utilization in each case . Given the cost of instrument processing from washing, sterilizing, repacking, carrying, and reopening instruments, efforts primarily among surgical services such as gynecologic, pediatric, thoracic, and oncologic surgery have supported the hypothesis that reducing surgical tray redundancy is associated with decreased hospital expenditure . The primary objectives of this quality improvement (QI) study were to (1) optimize head and neck surgical instrument trays for surgical procedures performed at a single large academic tertiary care center and (2) quantify the outcome on OR direct costs.…”

Section: Introductionmentioning

confidence: 99%

Association of Operating Room Costs With Head and Neck Surgical Instrumentation Optimization

Yalamanchi

Miller

Prout

et al. 2022

JAMA Otolaryngol Head Neck Surg

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In an era of increasing health care expenditure, reduction of redundant head and neck surgical instrumentation may minimize waste.OBJECTIVE To (1) optimize head and neck surgical instrument trays at a single large academic tertiary care center and (2) identify associated direct cost savings. DESIGN, SETTING, AND PARTICIPANTSThis prospective quality improvement initiative was conducted at an academic tertiary care medical center from July 2017 through July 2021. Participants were a multidisciplinary surgical quality team consisting of head and neck surgeons, operating room nurses, surgical technicians, and supply chain analysts. MAIN OUTCOMES AND MEASURESThe 4 primary surgical instrument trays (major otolaryngology [Oto], Oto plastics, direct laryngoscopy, and microdirect laryngoscopy) used in all head and neck procedures were reviewed by 10 head and neck surgical faculty with detailed case observation of instrument utilization performed by trained operating room nurses and surgical technologists. Instruments used in less than 40% of cases were excluded from surgical trays, and novel instrument trays were established based on faculty feedback and utilization. Data on instrument processing, utilization, and associated institutional direct costs were prospectively collected over a 3-year period. The primary outcome measure was change in operating room direct costs. Surgeon satisfaction with the quality improvement intervention was the secondary outcome. Direct cost savings were identified as a function of surgical volume, labor and supply costs, and instrument depreciation.RESULTS More than 1500 eligible surgical cases were reviewed during the preintervention period. Of the 149 instruments in the major Oto tray, only 118 (79%) instruments were used in more than 40% of cases. There were 58 (49%) and 32 (21%) instruments in this tray that were used in more than 40% of neck dissections and sentinel lymph node biopsies, respectively. Resulting intervention included development of a streamlined major Oto tray with 118 instruments and novel neck dissection and sentinel lymph node biopsy trays. Similar processes were applied to the remaining head and neck trays, with a total of 257 instruments removed. Over a 3-year postintervention period, streamlined surgical trays were used 9284 times with direct cost savings of $228 338 (95% CI, $227 817-$228 854). Overall surgeon satisfaction with the optimized head and neck surgical trays was 100%. CONCLUSIONS AND RELEVANCEIn this quality improvement study, surgeon-led elimination of redundant or rarely used instruments from surgical instrument trays was associated with reduced operating room direct costs while maintaining stakeholder satisfaction.

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“…Improvements in (ii) are related to actions before (open and check STs) and after (replace instruments in STs and check again) the procedure takes place in the OR. There is an economic aspect to this improvement as well; however, most authors associate it with reduction in time to setup [55,4] and count instruments [38], and errors handling instruments to surgeons [56]. Improvements in (iii) are ergonomic.…”

Section: Charting the Datamentioning

confidence: 99%

“…The analysis of healthcare supply chains reveals several opportunities for improvements in processes often deemed secondary. One such process is the sterilization and assembly of surgical trays, with improvement initiatives usually targeted at the rationalization or optimization of tray contents [4].…”

Section: Introductionmentioning

confidence: 99%

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

Santos

Fogliatto

Zani

et al. 2020

Preprint

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Background Surgical Tray Rationalization (STR) consists of a systematic reduction in the quantity of surgical instruments to perform specific procedures without compromising patient safety, while reducing losses in the sterilization and assembly of trays. STR is one example of initiatives to improve process performance that have been widely reported in industrial settings, but only recently have gained popularity in healthcare organizations. Methods We conduct a scoping review of the literature aiming at identifying and mapping available evidence on the topic of surgical tray management. Five methodological stages are implemented and reported; they are: identifying research questions, identifying relevant studies, study selection, charting the data, and collating, summarizing and reporting the results. Results We reviewed forty-eight articles on STR, which were grouped according to their main proposed approaches: expert analysis, lean practices, and mathematical programming. We identify the most frequently used techniques within each approach and point to their potential contributions to operational and economic dimensions of STR. We also consolidate our findings proposing a roadmap to STR, with four generic steps (prepare, rationalize, implement, and consolidate) and recommended associated techniques. Conclusions To the best of our knowledge, ours is the first study that reviews and systematizes the existing literature on the subject of STR. Our study closes with the proposition of directions for future research, which are presented as nine research questions associated with the four generic steps proposed in the STR roadmap.

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The Impact of Breast Lumpectomy Tray Utilization on Cost Savings

Cited by 20 publications

References 14 publications

An Enhanced Kaizen Event in a Sterile Processing Department of a Rural Hospital: A Case Study

An Enhanced Kaizen Event in a Sterile Processing Department of a Rural Hospital: A Case Study

Association of Operating Room Costs With Head and Neck Surgical Instrumentation Optimization

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

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