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Tanvir Anzum KM, Kibria MG. A conceptual model for evaluating readiness for lean practices using a fuzzy logic approach: A case study in Bangladeshi healthcare institutes. Heliyon 2024; 10:e36356. [PMID: 39281540 PMCID: PMC11395749 DOI: 10.1016/j.heliyon.2024.e36356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 07/28/2024] [Accepted: 08/14/2024] [Indexed: 09/18/2024] Open
Abstract
In the realm of healthcare, an imperative necessity for all, institutions are increasingly recognizing the advantages of adopting lean strategies to enhance performance. Lean implementation in healthcare can lead to significant improvements in efficiency, patient care, and overall institutional performance. This paper aims to assess the readiness levels for implementing lean practices in healthcare institutes in Bangladesh, employing a fuzzy logic approach. The construction of a conceptual model is grounded in literature review and expert opinions, incorporating critical enablers, criteria, and attributes identified from extensive research. Factors measured include leadership commitment, workforce capability, operational processes, technological infrastructure, and organizational culture, each pivotal in determining readiness for lean implementation. The fuzzy logic approach is particularly useful in this context due to its ability to handle uncertainty and imprecision, which are common in complex environments like healthcare. This methodology not only provides a clear picture of current capabilities but also highlights specific areas that need enhancement, paving the way for more targeted and effective lean interventions. Data sourced from consultations with experts in three prominent hospitals in Bangladesh forms the basis of the analysis, enabling a detailed examination of readiness levels. The model's application of fuzzy logic facilitates a comprehensive assessment, revealing 12 critical attributes across the hospitals that require attention. Interestingly, the evaluation identifies varying levels of readiness, with two hospitals demonstrating moderate readiness and one showing a lower level. This conceptual approach has significant potential to assist top management in healthcare companies by providing a structured framework to prioritize crucial areas for improvement. By accurately assessing readiness levels and pinpointing weaker aspects before implementing lean strategies, this study aims to transform the healthcare industry. Ultimately, its implementation has the potential to enhance organizational performance and elevate standards in patient care, contributing to improved healthcare delivery in Bangladesh and beyond.
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Affiliation(s)
- Kazi Md Tanvir Anzum
- Department of Industrial Engineering and Management, Khulna University of Engineering & Technology, Khulna, 9203, Bangladesh
| | - Md Golam Kibria
- Department of Industrial Engineering and Management, Khulna University of Engineering & Technology, Khulna, 9203, Bangladesh
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Pillay L, Winkel KD, Kariotis T. Developing the green operating room: exploring barriers and opportunities to reducing operating room waste. Med J Aust 2024; 221:279-284. [PMID: 39039604 DOI: 10.5694/mja2.52394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 06/11/2024] [Indexed: 07/24/2024]
Abstract
The Australian health care system contributes 7% of the national greenhouse gas emission footprint and generates massive waste streams annually. Operating rooms are a particular hotspot, generating at least 20% of the total hospital waste. A systematic search of several global academic databases was conducted in mid-2022 (articles from 1992 to 2022) for peer-reviewed research relevant to waste management in the operating rooms. We then used thematic analysis to enumerate and characterise the strategies and barriers to sustainable waste management in the operating room. The waste reduction strategies focused on avoidance of high carbon products; correct waste segregation and reduced overage; reusing, reprocessing, and repurposing devices; and improved recycling. The first barrier identified was a constrained interpretation of the concept of "first do not harm", ingrained in surgeons' practices, in prioritising single-use surgical products. The second barrier was ineffective or insufficient waste education. The third barrier was the immediate cost of implementing waste management compared with the long term realisation of environmental and economic benefits. The last barrier to implementing institutional practice change was the lack of policies and regulations at the local hospital, federal and international levels. We also evaluated the knowledge gaps in current surgical waste research, including lack of benchmarking data and standardised regulations concerning reusable or reprocessed devices, as well as the methods used to promote pro-sustainability behavioural change.
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Affiliation(s)
| | - Kenneth D Winkel
- Centre for Health Policy, University of Melbourne, Melbourne, VIC
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Kanabar B, Piparva KG, Pandya D, Kanabar RB. The Impact and Challenges of the Implementation of 5S Methodology in Healthcare Settings: A Systematic Review. Cureus 2024; 16:e64634. [PMID: 39149689 PMCID: PMC11326763 DOI: 10.7759/cureus.64634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2024] [Indexed: 08/17/2024] Open
Abstract
The 5S methodology, rooted in lean manufacturing principles, has been adopted in healthcare settings to improve organization, efficiency, and quality. This systematic review aimed to synthesize the literature on the implementation of the 5S methodology in healthcare, its impact, and factors influencing successful implementation. A comprehensive literature search was conducted in PubMed, Google Scholar, and Cochrane databases for original studies on the implementation of the 5S methodology in healthcare settings. Studies were screened based on inclusion and exclusion criteria, and data were extracted on study characteristics, implementation details, outcomes, and key findings. Six studies met the inclusion criteria, spanning various healthcare settings, including hospitals, clinics, and laboratories. The studies reported positive outcomes associated with implementing the 5S methodology, such as improved workplace organization and cleanliness, increased utilization of healthcare services, enhanced staff satisfaction and motivation, and reduced waste and non-conformities. Critical success factors included commitment from top management, staff involvement, continuous monitoring, and adequate training. However, challenges were noted, including limited resources, small sample sizes, and difficulty assessing long-term sustainability. The implementation of the 5S methodology in healthcare settings can lead to improved organization, efficiency, and quality. However, successful implementation requires addressing critical factors such as leadership commitment, staff engagement, continuous monitoring, and training. Future research should focus on larger-scale implementation studies, long-term assessments, quantitative and qualitative evaluations, and cost-effectiveness analyses to strengthen the evidence base and inform best practices.
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Affiliation(s)
- Bhavesh Kanabar
- Preventive and Social Medicine, Pandit Deendayal Upadhyay (PDU) Government Medical College, Rajkot, IND
| | - Kiran G Piparva
- Pharamacology, All India Institutes of Medical Sciences (AIIMS), Rajkot, IND
| | - Dhruvin Pandya
- Medicine, Pandit Deendayal Upadhyay (PDU) Government Medical College, Rajkot, IND
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Raad M, Virani S, Vinay S, Housden P. Creating Novel Standards for Datapoints on an Elective Orthopaedic Theatre List Document. Malays Orthop J 2024; 18:10-17. [PMID: 39130507 PMCID: PMC11315948 DOI: 10.5704/moj.2407.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 12/17/2023] [Indexed: 08/13/2024] Open
Abstract
Introduction Orthopaedic theatre lists are an important tool which must convey essential information to all staff to run an effective and safe theatre list. However, there are no set standards or guidelines on the components of an Orthopaedic theatre list. The objective of this study is to formulate guidelines for elective Orthopaedic theatre lists which improve efficiency and reduce errors. Materials and Methods We looked at 326 elective Orthopaedic theatre lists from October to November 2018. Various factors such as: theatre and patient demographics, surgical team, type of anaesthesia, Surgery, acronyms and finally extra information such as allergies. Additionally, a survey was distributed to a variety of theatre staff to understand their requirements from a theatre list. Thereafter, we created a proforma for waiting list coordinators. Subsequently, we re-audited six more weeks of theatre lists (255) from November to December 2019. Results The orthopaedic consultant in charge was noted for 100% of patients compared to 85% previously. There was an improvement in documenting the required anaesthesia such as noting 14.5% required spinal compared to 0.3% previously. Prosthesis/equipment was mentioned for 34% of patients compared to 23%. Fluoroscopy was noted as being required for 25% of patients compared to 11%. Conclusion We believe standards should be in place in order for us to follow to ensure we carry out safe and efficient Orthopaedic theatre lists, and these standards should entail the parameters we have audited. The 'William Harvey theatre list standard' should be used as a gold standard for all elective Orthopaedic theatre lists.
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Affiliation(s)
- M Raad
- Department of Trauma and Orthopaedics, William Harvey Hospital, Ashford, United Kingdom
| | - S Virani
- Department of Trauma and Orthopaedics, William Harvey Hospital, Ashford, United Kingdom
| | - S Vinay
- Department of Trauma and Orthopaedics, William Harvey Hospital, Ashford, United Kingdom
| | - P Housden
- Department of Trauma and Orthopaedics, William Harvey Hospital, Ashford, United Kingdom
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Ahmed Z, Zargaran A, Zargaran D, Davies J, Ponniah A, Butler P, Mosahebi A. Fostering innovation and sustainable thinking in surgery: an evaluation of a surgical hackathon. Ann R Coll Surg Engl 2024; 106:504-508. [PMID: 38563072 PMCID: PMC11214851 DOI: 10.1308/rcsann.2024.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION Surgery represents a major source of carbon emissions, with numerous initiatives promoting more sustainable practices. Healthcare innovation and the development of a digitally capable workforce are fundamental in leveraging technologies to tackle challenges, including sustainability in surgery. METHODS A surgical hackathon was organised with three major themes: (1) how to make surgery greener, (2) the future of plastic surgery in 10 years, and (3) improving healthcare outcomes using machine learning. Lectures were given on sustainability and innovation using the problem, innovation, market size, strategy and team (PIMST) framework to support their presentations, as well as technological support to translate ideas into simulations or minimum viable products. Pre- and post-event questionnaires were circulated to participants. RESULTS Most attendees were medical students (65%), although doctors and engineers were also present. There was a significant increase in delegates' confidence in approaching innovation in surgery (+20%, p < 0.001). Reducing waste packaging (70%), promoting recyclable material usage (56%) and the social media dimension of public perceptions towards plastic surgery (40%) were reported as the most important issues arising from the hackathon. The top three prizes went to initiatives promoting an artificial intelligence-enhanced operative pathway, instrument sterilisation and an educational platform to teach students research and innovation skills. CONCLUSIONS Surgical hackathons can result in significant improvements in confidence in approaching innovation, as well as raising awareness of important healthcare challenges. Future innovation events may build on this to continue to empower the future workforce to leverage technologies to tackle healthcare challenges such as sustainability.
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Affiliation(s)
- Z Ahmed
- University College London, UK
| | | | | | - J Davies
- UCL Global Business School for Health, UK
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Sappey-Marinier E, Beel W, Bonnin MP, Aït-Si-Selmi T. Better operating room efficiency and reduced staff demand: Individualised versus off-the-shelf total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38864156 DOI: 10.1002/ksa.12233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/24/2024] [Accepted: 04/27/2024] [Indexed: 06/13/2024]
Abstract
PURPOSE The purpose of this pilot cross-sectional study was to compare the operating room (OR) efficiency and intraoperative staff task load when performing individualised versus off-the-shelf (OTS) total knee arthroplasty (TKA). METHODS A consecutive series of 28 patients randomised (1:1) to receive either OTS TKA or individualised TKA were included. The OR staff workload was assessed with the NASA Task Load Index (TLX), a subjective grading system assessing mental demand, physical demand, temporal demand, performance, effort and frustration on a scale from 0 (very low) to 20 (very high). The time for patient preparation, surgical time, closure and total OR time was recorded to assess OR efficiency. Effect sizes of differences between OTS and individualised TKA were expressed as mean differences (MDs) with 95% confidence intervals (CIs). RESULTS Patients in both cohorts were similar in age (OTS vs. individualised TKA (median [IQR]), 67 [63-76] vs. 71 [68-79]; p = 0.207) and body mass index (BMI) (29 [24-33] vs. 29 [26-31]; p = 0.807), and there were no significant differences in other preoperative characteristics. The OR staff perceived individualised TKA as less demanding than OTS TKA: Individualised TKA was rated significantly better across the six domains of the NASA TLX: mental demand by 5.6 points, physical demand by 6.3 points, temporal demand by 5.3 points, performance by 3.6 points, effort by 5.9 points and frustration by 5.8 points. Individualised TKA resulted in statistically significantly shorter mean total OR time (MD, 10 min; p = 0.018). CONCLUSION The staff in the OR found that individualised TKA is less mentally, physically and temporally demanding than OTS TKA. The average total time spent in the OR during individualised TKA is 10 min less than during OTS TKA. CLINICAL TRIAL REGISTRATION This study constitutes a part of a larger registered randomised controlled trial comparing patient satisfaction following OTS versus individualised TKA (NCT04460989). LEVEL OF EVIDENCE Level III.
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Affiliation(s)
| | - Wouter Beel
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
| | - Michel P Bonnin
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
| | - Tarik Aït-Si-Selmi
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
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Huang WJ, Zhang MW, Li BY, Wang XH, Zhang CH, Yu JG. 5S management improves the service quality in the outpatient-emergency pharmacy: from management process optimisation to staff capacity enhancement. Eur J Hosp Pharm 2024; 31:259-266. [PMID: 36424124 DOI: 10.1136/ejhpharm-2022-003449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 11/15/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE As a high-efficiency demanding department in a hospital, the outpatient pharmacy has a great need for quality improvement to provide superior medical service for patients. Little is known about the application of 5S management in a hospital pharmacy department. The aim of this study was to evaluate the impacts of 5S management on pharmaceutical service quality and staff capacity in the outpatient-emergency pharmacy. METHODS We carried out a 5S project in the outpatient-emergency pharmacy at a local hospital that involved processes including waste elimination, workplace standardisation, and optimisation of workflow and staff quality, and then evaluated the effects of the project. RESULTS The equipment and items in the outpatient-emergency pharmacy were sorted. All the drugs were categorised and put in order. The redesigned workspace and standardised workflow during the project improved the accuracy and efficiency of drug dispensing. The satisfaction rate of patients regarding the pharmaceutical service quality in the outpatient-emergency pharmacy was elevated, as well as the satisfaction rate of pharmacists about their work experiences. The optimisation of objective conditions also stimulated a positive working attitude and professional ability promotion of pharmacists in the outpatient-emergency pharmacy. CONCLUSIONS In this study, the 5S management method has proven useful for quality and efficiency improvement in the outpatient-emergency pharmacy, and could be generalised to other departments in a hospital, which provides further evidence of the advantages of the Lean tool in healthcare system management.
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Affiliation(s)
- Wen-Jing Huang
- Department of Pharmacy, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, Xuhui, China
- Institute of Hospital Service Management, China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, Xuhui, China
| | - Meng-Wan Zhang
- Department of Pharmacy, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, Xuhui, China
- Institute of Hospital Service Management, China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, Xuhui, China
| | - Bei-Yi Li
- Department of Pharmacy, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, Xuhui, China
- Institute of Hospital Service Management, China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, Xuhui, China
| | - Xiao-Hui Wang
- Department of Pharmacy, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, Xuhui, China
- Institute of Hospital Service Management, China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, Xuhui, China
| | - Chu-Han Zhang
- Department of Pharmacy, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, Xuhui, China
- Institute of Hospital Service Management, China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, Xuhui, China
| | - Jian-Guang Yu
- Department of Pharmacy, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, Xuhui, China
- Institute of Hospital Service Management, China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, Xuhui, China
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Tang J, Zhuang M, Lin P, Wang Z, Zhao J. Application study of surgical instruments information management system in sports medicine specialty. Sci Rep 2024; 14:6167. [PMID: 38486009 PMCID: PMC10940630 DOI: 10.1038/s41598-024-56809-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 03/11/2024] [Indexed: 03/18/2024] Open
Abstract
The management of surgical instruments is related to the safety and efficiency of surgical operations, and a surgical instruments information management system (SIIMS) has been developed. The aim of the current study is to explore the application value of the SIIMS in sports medicine specialty. A set of self-developed SIIMS for sports medicine surgeries was applied to the study. The application value of the SIIMS was verified by comparing the safety and efficiency of instrument manipulation before and after its application, with instrument accidents, instrument repair rate, instrument scrap rate and instrument use efficiency as indicators. Through the application of the SIIMS, the incidence of surgical instrument accidents decreased from 3.7 times to 1.8 times (P = 0.02), the number of instrument repair decreased from 7.7 times to 2.9 times (P = 0.00), and the number of scrapped instruments decreased from 5.1 to 2.3 (P = 0.03), when referred to per thousand operations. Before and after the application of the SIIMS, the average instrument use efficiency was 74.0% ± 3.3% and 88.2% ± 4.4%, respectively, with statistically significant difference (P = 0.00). The application of the SIIMS in sports medicine specialty is helpful to the fine management of surgical instruments, improve surgical safety and instrument use efficiency.
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Affiliation(s)
- Jin Tang
- The Operating Theater, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai, China
| | - Min Zhuang
- The Operating Theater, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai, China.
| | - Ping Lin
- The Operating Theater, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai, China
| | - Zichen Wang
- The Operating Theater, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai, China
| | - Jinzhong Zhao
- The Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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George RE, Bay CC, Shaffrey EC, Wirth PJ, Rao VK. A Day in the Life of a Surgical Instrument: The Cycle of Sterilization. ANNALS OF SURGERY OPEN 2024; 5:e381. [PMID: 38883953 PMCID: PMC11175864 DOI: 10.1097/as9.0000000000000381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/03/2024] [Indexed: 06/18/2024] Open
Abstract
Surgeons must be confident that the instruments they use do not pose risk of infection to patients due to bioburden or contamination. Despite this importance, surgeons are not necessarily aware of the steps required to ensure that an instrument has been properly sterilized, processed, and prepared for the next operation. At the end of an operation, instruments must be transported to the sterile processing unit. There, instruments are decontaminated before being sterilized by heat, chemical, or radiation-based methods. Following this, they are stored before being brought back into use. This review highlights the intricacies of the processing of surgical instruments at the conclusion of an operation so that they are ready for the next one.
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Affiliation(s)
- Robert E George
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin - Madison, Madison, WI
| | - Caroline C Bay
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin - Madison, Madison, WI
| | - Ellen C Shaffrey
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin - Madison, Madison, WI
| | - Peter J Wirth
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin - Madison, Madison, WI
| | - Venkat K Rao
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin - Madison, Madison, WI
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Aquino R, Pham TX, Duong PAT. Quality Improvement Report: Improving Retrieval Time for CT Supplies by Using 5S. Radiographics 2024; 44:e230105. [PMID: 38300814 DOI: 10.1148/rg.230105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
The CT supply room is a critical resource in the imaging workflow. However, the supply room for the two CT scanners at our cancer center, one of which is used for our busy interventional service, was disorganized, and the time spent searching for the appropriate equipment could potentially lead to delays in service and contribute to patient safety risks. The purpose of this project was to reduce the time to find supplies and to increase the satisfaction of CT technologists and medical providers by reorganizing and clearly labeling supplies using "lean" principles. A multidisciplinary team was assembled to reorganize the CT storage using lean 5S methodology (sort, set in order, shine, standardize, and sustain). Baseline and postintervention analysis of the impact of supply reorganization and labeling was performed using three methods: (a) the time recorded for a supply retrieval scavenger hunt, (b) a spaghetti diagram of participant movement during the scavenger hunt, and (c) satisfaction surveys of radiologists and staff. Seven radiology residents participated in the timed supply retrieval scavenger hunt before and after the intervention. Spaghetti diagrams demonstrated a reduction in redundant foot traffic for supply retrieval after the intervention. There was a 61.7% decrease in the average time to retrieve the 10 items in the scavenger hunt (P < .01). Satisfaction surveys after the intervention had statistically significant positive responses compared with those before the intervention. ©RSNA, 2024.
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Affiliation(s)
- Rebekah Aquino
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 N Medical Dr, Rm 1A071, Salt Lake City, UT 84132 (R.A., T.X.P.); and Department of Radiology, NYU Langone, New York City, NY (P.A.T.D.)
| | - Theresa X Pham
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 N Medical Dr, Rm 1A071, Salt Lake City, UT 84132 (R.A., T.X.P.); and Department of Radiology, NYU Langone, New York City, NY (P.A.T.D.)
| | - Phuong-Anh T Duong
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 N Medical Dr, Rm 1A071, Salt Lake City, UT 84132 (R.A., T.X.P.); and Department of Radiology, NYU Langone, New York City, NY (P.A.T.D.)
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Hamberis AO, Gray ML. Cost and value of office-based facial plastic and reconstructive surgery procedures. World J Otorhinolaryngol Head Neck Surg 2023; 9:257-261. [PMID: 37780678 PMCID: PMC10541161 DOI: 10.1002/wjo2.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 05/24/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction This chapter will provide an overview of factors affecting the cost of office-based procedures in Facial Plastics and Reconstructive Surgery (FPRS), and will discuss the value of office-based interventions. Material and Methods An in-depth literature review was conducted using multiple primary and secondary sources. Literature from multiple disciplines was included in the review, including otolaryngology, anesthesiology, surgery, public health, and economics. Discussion/Conclusions A wide variety of procedures can be performed in an FPRS office. Large upfront costs to the office include laser, electrocautery and surgical equipment. These investments will yield an initial negative cost margin until sufficient case volume is achieved. It is often in the best interest of the patient to perform a procedure in-office and avoid the facility and anesthesia fees associated with a surgical center or hospital. Costs and reimbursements vary greatly across regions and facilities. Additionally, overall cost depends on payer mix, procedures performed, and productivity of the practice. The scarcity of literature on this topic as it applies specifically to FPRS indicates that further research is needed to elucidate the value of common facial plastics procedures in an office-based setting.
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Affiliation(s)
- Alexandra O. Hamberis
- Department of Otolaryngology–Head and Neck SurgeryIcahn School of Medicine at Mount SinaiNew YorkUSA
| | - Mingyang L. Gray
- Department of Otolaryngology–Head and Neck SurgeryIcahn School of Medicine at Mount SinaiNew YorkUSA
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Balch JA, Krebs JR, Filiberto AC, Montgomery WG, Berkow LC, Upchurch GR, Loftus TJ. Methods and evaluation metrics for reducing material waste in the operating room: a scoping review. Surgery 2023:S0039-6060(23)00257-X. [PMID: 37277308 DOI: 10.1016/j.surg.2023.04.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/21/2023] [Accepted: 04/27/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Operating rooms contribute up to 70% of total hospital waste. Although multiple studies have demonstrated reduced waste through targeted interventions, few examine processes. This scoping review highlights methods of study design, outcome assessment, and sustainability practices of operating room waste reduction strategies employed by surgeons. METHODS Embase, PubMed, and Web of Science were screened for operating room-specific waste-reduction interventions. Waste was defined as hazardous and non-hazardous disposable material and energy consumption. Study-specific elements were tabulated by study design, evaluation metrics, strengths, limitations, and barriers to implementation in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. RESULTS A total of 38 articles were analyzed. Among them, 74% of studies had pre- versus postintervention designs, and 21% used quality improvement instruments. No studies used an implementation framework. The vast majority (92%) of studies measured cost as an outcome, whereas others included disposable waste by weight, hospital energy consumption, and stakeholder perspectives. The most common intervention was instrument tray optimization. Common barriers to implementation included lack of stakeholder buy-in, knowledge gaps, data capture, additional staff time, need for hospital or federal policies, and funding. Intervention sustainability was discussed in few studies (23%) and included regular waste audits, hospital policy change, and educational initiatives. Common methodologic limitations included limited outcome evaluation, narrow scope of intervention, and inability to capture indirect costs. CONCLUSION Appraisal of quality improvement and implementation methods are critical for developing sustainable interventions for reducing operating room waste. Universal evaluation metrics and methodologies may aid in both quantifying the impact of waste reduction initiatives and understanding their implementation in clinical practice.
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Affiliation(s)
- Jeremy A Balch
- University of Florida, Department of Surgery, Gainesville, FL
| | | | | | | | - Lauren C Berkow
- University of Florida, Department of Anesthesiology, Gainesville, FL
| | | | - Tyler J Loftus
- University of Florida, Department of Surgery, Gainesville, FL.
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Belhouari S, Toor J, Abbas A, Lex JR, Mercier MR, Larouche J. Optimizing spine surgery instrument trays to immediately increase efficiency and reduce costs in the operating room. NORTH AMERICAN SPINE SOCIETY JOURNAL 2023; 14:100208. [PMID: 37124067 PMCID: PMC10130344 DOI: 10.1016/j.xnsj.2023.100208] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 02/18/2023] [Accepted: 02/20/2023] [Indexed: 05/02/2023]
Abstract
Background Over-crowded surgical trays result in perioperative inefficiency and unnecessary costs. While methodologies to reduce the size of surgical trays have been described in the literature, they each have their own drawbacks. In this study, we compared three methods: (1) clinician review (CR), (2) mathematical programming (MP), and (3) a novel hybrid model (HM) based on surveys and cost analysis. While CR and MP are well documented, CR can yield suboptimal reductions and MP can be laborious and technically challenging. We hypothesized our easy-to-implement HM would result in a reduction of surgical instruments in both the laminectomy tray (LT) and basic neurosurgery tray (BNT) that is comparable to CR and MP. Methods Three approaches were tested: CR, MP, and HM. We interviewed 5 neurosurgeons and 3 orthopedic surgeons, at our institution, who performed a total of 5437 spine cases, requiring the use of the LT and BNT over a 4-year (2017-2021) period. In CR, surgeons suggested which surgical instruments should be removed. MP was performed via the mathematical analysis of 25 observations of the use of a LT and BNT tray. The HM was performed via a structured survey of the surgeons' estimated instrument usage, followed by a cost-based inflection point analysis. Results The CR, MP, and HM approaches resulted in a total instrument reduction of 41%, 35%, and 38%, respectively, corresponding to total cost savings per annum of $50,211.20, $46,348.80, and $44,417.60, respectively. Conclusions While hospitals continue to examine perioperative services for potential inefficiencies, surgical inventory will be increasingly scrutinized. Despite MP being the most accurate methodology to do so, our results suggest that savings were similar across all three methods. CR and HM are significantly less laborious and thus are practical alternatives.
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Affiliation(s)
- Setti Belhouari
- Temerty Faculty of Medicine, University of Toronto, 149 College St, 5th Floor, Toronto, Ontario, Canada
- Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Jay Toor
- Temerty Faculty of Medicine, University of Toronto, 149 College St, 5th Floor, Toronto, Ontario, Canada
- Division of Orthopaedics, Department of Surgery, University of Toronto, 149 College St, 5th Floor, Toronto, Ontario, Canada
| | - Aazad Abbas
- Temerty Faculty of Medicine, University of Toronto, 149 College St, 5th Floor, Toronto, Ontario, Canada
- Division of Orthopaedics, Department of Surgery, University of Toronto, 149 College St, 5th Floor, Toronto, Ontario, Canada
| | - Johnathan R. Lex
- Temerty Faculty of Medicine, University of Toronto, 149 College St, 5th Floor, Toronto, Ontario, Canada
- Division of Orthopaedics, Department of Surgery, University of Toronto, 149 College St, 5th Floor, Toronto, Ontario, Canada
| | - Michael R. Mercier
- Temerty Faculty of Medicine, University of Toronto, 149 College St, 5th Floor, Toronto, Ontario, Canada
- Division of Orthopaedics, Department of Surgery, University of Toronto, 149 College St, 5th Floor, Toronto, Ontario, Canada
- Corresponding author. Department of Surgery, University of Toronto, 149 College Street, 5th Floor, Toronto, ON, Canada, M5T 1P5. Tel.:+1 413-426-4472.
| | - Jeremie Larouche
- Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Division of Orthopaedics, Department of Surgery, University of Toronto, 149 College St, 5th Floor, Toronto, Ontario, Canada
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14
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von Schudnat C, Schoeneberg KP, Albors-Garrigos J, Lahmann B, De-Miguel-Molina M. The Economic Impact of Standardization and Digitalization in the Operating Room: A Systematic Literature Review. J Med Syst 2023; 47:55. [PMID: 37129717 DOI: 10.1007/s10916-023-01945-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 03/29/2023] [Indexed: 05/03/2023]
Abstract
Hospital face increased resource constraints and competition. This escalates the need for efficiency optimization especially in resource-intense areas, such as the Operating Room (OR). Efficiency cannot happen at expenses of patient outcomes. Innovative digital support systems (DSS) have been introduced into the market to support established standardization methods of intraoperative workflows further. This review aimed to analyze whether applied standardization methods and implemented DSS of intraoperative surgical workflows lead to increasing efficiency and demonstrate economic improvements. A systematic review of intraoperative surgical workflows standardization and digitalization was performed. Journal articles and reviews from 2000 to 2023 were retrieved from EBSCO, PubMed, and Scopus databases, as well as the internal database of Johnson & Johnson. 17 articles showed a significant increase in efficiency through standardization, which led to cost reductions between $70.20 to $3,516 per case without negatively impacting quality. Five additional articles on DSS demonstrated a significant positive impact on efficiency and quality. Reduction in OR-time between 6 to 22% per case was one main contributor. No literature on DSS revealed any correlated economic impact. Selected standardization methods and introduced DSS for intraoperative surgical workflows effectively increase efficiency while maintaining or even improving quality. Demonstrated cost-effectiveness of non-digital standardization methods across surgical areas requires more research on complex and resource-intensive procedures and the economic value of DSS to support hospital management's strategic decisions to overcome the increasing economic burden.
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Affiliation(s)
- Christian von Schudnat
- Department of Business Organization, Faculty of Business Management, Universitat Politecnica de Valencia, Cami de Vera, s/n, 46022, Valencia, Spain.
| | - Klaus-Peter Schoeneberg
- Department of Economic and Social Sciences, Berliner Hochschule für Technik, Berlin, Luxemburger Str. 10, 13353, Berlin, Germany
| | - Jose Albors-Garrigos
- Department of Business Organization, Faculty of Business Management, Universitat Politecnica de Valencia, Cami de Vera, s/n, 46022, Valencia, Spain
| | - Benjamin Lahmann
- Department of Statistics and Operation Analysis, Faculty of Business and Economics, Mendel University Brno, Zemědělská 1, 61300, Brno, Czech Republic
| | - María De-Miguel-Molina
- Department of Business Organization, Faculty of Business Management, Universitat Politecnica de Valencia, Cami de Vera, s/n, 46022, Valencia, Spain
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15
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Levy BE, Wilt WS, Johnson J, Wallace H, Ballert E, Newcomb M, Cavatassi W, Harris A. Procedure-Based Telehealth Utilization in General Surgery. Am J Med Qual 2023; 38:154-159. [PMID: 37125671 DOI: 10.1097/jmq.0000000000000122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The authors hypothesize that standardized telehealth (TH) scheduling processes will improve TH utilization without increasing adverse events. Fifty visits preimplementation and 67 visits postimplementation were audited from June 2021 to January 2022. Both leadership and frontline stakeholders were engaged to identify current workflows and potential interventions targeting outpatient elective procedures. Process mapping outlined current TH scheduling workflows. Outcomes related to TH completion, cost, and TH scheduling were collected after implementation. Preimplementation TH scheduling rate was 32%. The intervention required TH postoperative appointments to be scheduled in clinic at the time of surgery scheduling with TH being the default postsurgical appointment for a standardized list of eligible procedures. Following implementation, 95% of patients undergoing eligible procedures had TH follow-up. This provided improved access to surgical follow-up care, by reducing travel needs to the Veterans Affairs facility. Secondarily, this intervention increased clinic appointment availability and resulted in possible increased revenue for billable visits. Standardizing TH scheduling based on the procedure improves the utilization of TH resulting in improved clinic efficiency and increased revenue, without increasing adverse events.
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Affiliation(s)
- Brittany E Levy
- Department of General Surgery, University of Kentucky, Lexington, KY
| | - Wesley S Wilt
- Department of General Surgery, University of Kentucky, Lexington, KY
| | | | | | - Erik Ballert
- Department of General Surgery, University of Kentucky, Lexington, KY
- Lexington Veteran's Affairs Medical Center, Lexington, KY
| | - Melissa Newcomb
- Department of General Surgery, University of Kentucky, Lexington, KY
- Lexington Veteran's Affairs Medical Center, Lexington, KY
| | - William Cavatassi
- Department of General Surgery, University of Kentucky, Lexington, KY
- Lexington Veteran's Affairs Medical Center, Lexington, KY
| | - Andrew Harris
- Lexington Veteran's Affairs Medical Center, Lexington, KY
- Department of Urology, University of Kentucky, Lexington, KY
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16
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Dorante MI, Barron SL, Jones L, Freniere BB, Guo L. Utilization Fraction of Reduction Mammoplasty Instrument Sets: Cost Savings and Efficiency Opportunities. Ann Plast Surg 2023; 90:S130-S134. [PMID: 36752537 DOI: 10.1097/sap.0000000000003361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
PURPOSE Healthcare spending will account for 20% of US gross domestic product by 2028. One strategy to address rising costs is evaluating the utilization fraction (UF) of surgical trays. Utilization fraction averages between 13% and 27% among surgical specialties, yet data from plastic surgery are lacking. METHODS This prospective observational study assessed UF of surgical instruments in all reduction mammoplasty performed at 2 sites in the same healthcare system over a 6-month period. Site 1 is a tertiary hospital and site 2, an outpatient surgical center. Utilization fraction was calculated as percent fraction of used, or if operating surgeons touched them, to opened instruments. A new surgical tray was created by removing instruments not used in 20% of cases. Reprocessing costs and savings were calculated using published reprocessing figures of $0.10 to $0.51 per instrument. Descriptive statistics and parametric variables reported as mean ± standard deviation. Unpaired Student t test was performed to determine statistical significance of findings ( P < 0.05). RESULTS Four plastic surgeons performed 37 procedures, 11 at site 1 and 26 at site 2. At site 1, 112 instruments are opened in one tray with 53 unique and 59 duplicates. At site 2, 155 instruments are opened in 2 trays with 58 unique, 20 shared, and 77 duplicates. Instrument user did not vary by site ( P = 0.446), with 19 ± 3 instruments and 17 ± 3 instruments used per case; however, UF varied significantly ( P < 0.0001) with average UF of 16.6% ± 2.8% and 11.5% ± 1.7% at sites 1 and 2, respectively. Estimated reprocessing costs per case are currently $11.20 to $57.12 at site 1 and $15.50 to $79.05 at site 2, with unused instruments accounting for $9.34 to 47.64 and $13.72 to $69.96, respectively. The new surgical tray includes 32 instruments, 18 unique and 14 duplicates, with estimated reprocessing cost of $3.20 to $16.32 per case. Adoption would reduce reprocessing costs by approximately $8.00 to $40.80 and $12.30 to $62.73 per case at sites 1 and 2, respectively. CONCLUSIONS Despite studying a single, but common, plastic surgery procedure, our findings reveal consistency in excessive appropriation of instruments between sites with values similar to those in the literature. These findings exemplify a cost-saving opportunity at our institution and chance to optimize UF for other high-volume plastic surgery procedures.
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Affiliation(s)
- Miguel I Dorante
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Lahey Hospital and Medical Center, Burlington
| | | | | | - Brian B Freniere
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Lahey Hospital and Medical Center, Burlington
| | - Lifei Guo
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Lahey Hospital and Medical Center, Burlington
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17
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Cunningham AJ, Krakauer K, Schofield C, Kenron D, Krishnaswami S. Reducing Disposable Surgical Items: Decreasing Environmental Impact and Costs at a Children's Hospital, A Pilot Study. J Surg Res 2023; 288:309-314. [PMID: 37058987 DOI: 10.1016/j.jss.2023.02.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 01/21/2023] [Accepted: 02/18/2023] [Indexed: 04/16/2023]
Abstract
INTRODUCTION United States landfill waste generated in the operating room (OR) is estimated to be three billion tons per year. The goal of this study was to analyze the environmental and fiscal impact of right-sizing surgical supplies at a medium-sized children's hospital using lean methodology to reduce physical waste generated in the operating room. METHODS A multidisciplinary task force was created to reduce waste in the OR of an academic children's hospital. A single-center case study, proof-of-concept, and scalability analysis of operative waste reduction was performed. Surgical packs were identified as a target. Pack utilization was monitored during an initial pilot analysis for 12 d then followed by a focused 3-week period, capturing all unused items by participating surgical services. Items discarded in more than 85% of cases were excluded in subsequent preformed packs. RESULTS Pilot review identified 46 items in 113 procedures for removal from surgical packs. Subsequent 3-week analysis focusing on two surgical services, and 359 procedures identified a potential $1,111.88 savings with elimination of minimally used items. Over 1 y, removal of all minimally used items from seven surgical services diverted two tons of plastic landfill waste, saved $27,503 in surgical pack acquisition-costs, and prevented the theoretical loss of $13,824 in wasted supplies. Additional purchasing analysis has resulted in another $70,000 of savings through supply chain streamlining. Application of this process nationally could prevent >6000 tons of waste in the United States per year. CONCLUSIONS Application of a simple iterative process to reduce waste in the OR can result in substantial waste diversion and cost savings. Broad adoption of such a process to reduce OR waste could greatly reduce the environmental impact of surgical care.
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Affiliation(s)
- Aaron J Cunningham
- Division of Pediatric Surgery, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon.
| | - Kelsi Krakauer
- Division of Pediatric Surgery, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon
| | - Corie Schofield
- Division of Pediatric Surgery, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon
| | - Daniel Kenron
- Division of Pediatric Surgery, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon
| | - Sanjay Krishnaswami
- Division of Pediatric Surgery, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon
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18
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Herlihy E, Antao B, Fawaz A, McDermott J, Patterson K, Nason G, O'Kelly F. Adapting lean methodology towards surgical tray rationalisation in inguinoscrotal day case surgery in the republic of Ireland. J Pediatr Urol 2023:S1477-5131(23)00107-9. [PMID: 37029012 DOI: 10.1016/j.jpurol.2023.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 02/13/2023] [Accepted: 03/16/2023] [Indexed: 04/09/2023]
Abstract
INTRODUCTION Lean methodologies have been used successfully in both industry and healthcare to reduce waste. The operating room (OR) and central supplies department (CSD) are areas associated with high hospital costs. The aim of this study was to employ Lean methodologies to support the rationalisation of surgical trays in paediatric inguinoscrotal surgery in order to reduce instrument wastage, processing times and overall costs in a European setting. METHODS This was a prospective, pilot observation and implementation study using Lean methodology including DMAIC (Define, Measure, Analyse, Improve and Control) cycles. Relevant tray set-up included trays for boys ≥12 months age undergoing open elective inguinoscrotal surgery. A comparative analysis of two phases, pre and post-standardization was then carried out with respect to operating times, instrument set-up times, tray weights, and costs. Instruments that were used <40% of the time were eliminated from the surgical tray. RESULTS Rationalization of the inguinoscrotal tray led to a 34.7% reduction in tray size, with a concomitant time-reduction of >2 min per case. The average overall instrument utilisation rate increased from 56% to 80% across users. Cost savings were projected at €5380.40 per annum based on current changes. There were no differences in operative time, or adverse outcomes. DISCUSSION At the hospital level, the reduction in variation, and rationalisation of this single surgical tray could lead to both operational (Tray assembly process; Operating rooms; Ergonomic functionality) as well as economic (Sterilisation; Instrument repair; Purchases) financial and ergonomic improvements for the healthcare system. The reduction in time taken to count and sterilise instruments can lead to a potential manpower saving involving a redistribution of activities to other areas which may require them. CONCLUSION Surgical tray rationalisation is emerging Lean concept with overlap across a number of specialities, and represents a technique by which to manage costs, and improve supply chain efficiency without any adverse effect in patient healthcare outcomes.
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Affiliation(s)
- E Herlihy
- Division of Paediatric Surgical Services, Beacon Hospital and University College Dublin, Ireland
| | - B Antao
- Division of Paediatric Surgical Services, Beacon Hospital and University College Dublin, Ireland; Department of Paediatric Surgery, Childrens Health Ireland, Crumlin, Dublin, Ireland
| | - A Fawaz
- Division of Paediatric Surgical Services, Beacon Hospital and University College Dublin, Ireland
| | - J McDermott
- Division of Paediatric Surgical Services, Beacon Hospital and University College Dublin, Ireland
| | - K Patterson
- Department of Urological Surgery and Renal Transplantation, Beaumont Hospital, Dublin, Ireland
| | - G Nason
- Department of Urological Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - F O'Kelly
- Division of Paediatric Surgical Services, Beacon Hospital and University College Dublin, Ireland; Division of Surgical Affairs, Royal College of Surgeons in Ireland, Dublin, Ireland.
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19
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Calò P, Catena F, Corsaro D, Costantini L, Falez F, Moretti B, Parrinello V, Romanini E, Spinarelli A, Vaccaro G, Venneri F. Optimisation of perioperative procedural factors to reduce the risk of surgical site infection in patients undergoing surgery: a systematic review. DISCOVER HEALTH SYSTEMS 2023; 2:6. [PMID: 37520513 PMCID: PMC9924866 DOI: 10.1007/s44250-023-00019-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 01/26/2023] [Indexed: 02/15/2023]
Abstract
Surgical site infections (SSI) are the leading cause of hospital readmission after surgical procedures with significant impact on post-operative morbidity and mortality. Modifiable risk factors for SSI include procedural aspects, which include the possibility of instrument contamination, the duration of the operation, the number of people present and the traffic in the room and the ventilation system of the operating theatre.The aim of this systematic review was to provide literature evidence on the relationship between features of surgical procedure sets and the frequency of SSI in patients undergoing surgical treatment, and to analyse how time frames of perioperative processes and operating theatre traffic vary in relation to the features of the procedure sets use, in order tooptimise infection control in OT. The results of the systematic review brought to light observational studies that can be divided into two categories: evidence of purely clinical significance and evidence of mainly organisational, managerial and financial significance. These two systems are largely interconnected, and reciprocally influence each other. The decision to use disposable devices and instruments has been accompanied by a lower incidence in surgical site infections and surgical revisions for remediation. A concomitant reduction in post-operative functional recovery time has also been observed. Also, the rationalisation of traditional surgical sets has also been observed in conjunction with outcomes of clinical significance.
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Affiliation(s)
- P. Calò
- University Teaching Hospital of Cagliari and Surgical Department at University of Cagliari, Cagliari, Italy
| | - F. Catena
- Department General and Emergency Surgery at Bufalini Hospital, Cesena, Italy
| | - D. Corsaro
- International Research at BHAVE, Via GiambattistaVico 1, 00196 Rome, Italy
| | - L. Costantini
- Department of Medical and Surgical Sciences, School of Community Medicine and Primary Care, University of Modena and Reggio Emilia, Modena, Italy
| | - F. Falez
- Department of Orthopaedics ASL Roma 1 and Director UOC Orthopaedics Hospital San Filippo Neri, Rome, Italy
| | - B. Moretti
- Orthopedics and Traumatology Complex Operative Unit, University Teaching Hospital of Bari Polyclinic, Bari, Italy
| | - V. Parrinello
- Operative Unit of Quality and Clinical Risk Manager at “G.Rodolico-San Marco” University Teaching Hospital in Catania, Catania, Italy
| | - E. Romanini
- SIOT Guidelines Commission, Rome, Italy
- Complex Operative Unit of Orthopedics and Traumatology at University Teaching Hospital of Bari Polyclinic, Bari, Italy
| | - A. Spinarelli
- Operative Unit of Orthopedics and Traumatology at University Teaching Hospital of Bari Polyclinic, Bari, Italy
| | - G. Vaccaro
- Social, Epidemiological and Outcome Research at BHAVE, Via Giambattista Vico 1, 00196 Rome, Italy
- Sociologist UO Education and Health Promotion, Asp Catania, Via Santa Maria la Grande 5, 95124 Catania, Italy
| | - F. Venneri
- Simple Structure Clinical Risk and Surgical Emergency in Florence, Florence, Italy
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Sanchez A, Herrera L, Teixeira A, Mogollon I, Inchausti C, Gibson D, Stuart M, Crespo M. Robotic surgery: financial impact of surgical trays optimization in bariatric and thoracic surgery. J Robot Surg 2023; 17:163-167. [PMID: 35429331 DOI: 10.1007/s11701-022-01412-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 04/03/2022] [Indexed: 10/18/2022]
Abstract
The incorporation of new technologies in the surgical field, such as the robotic da Vinci System, has made it possible to offer a series of advantages to the patient and the surgeon, with important benefits for both. However, cost continues to be a limiting factor to the adoption of this technology. The development of strategies to maximize the measures that can lead to reduced expenses is a key factor to improve cost-benefit ratio. According to some studies, more than 50% of the costs of a surgical procedure are related to materials and medical supplies, which is why any measure aimed at optimizing their use is pertinent. Our institution, the Orlando Regional Medical Center (ORMC), created a working group whose main purpose is to optimize the Robotic OR process. Their first step was to optimize the surgical trays, and this was carried out in four stages: observation, modification, trial period, and cost analysis. The specialties involved in this initiative were Bariatric and Thoracic Surgeries. Once the optimization process ended, the number of laparoscopic/thoracoscopy instruments in the trays decreased by 63 and 87% for bariatric and thoracic surgery, respectively; and the number of conventional surgery instruments was also reduced by 47 and 64%, for the same specialties, respectively. The financial analysis concluded that implementing this measure will lead to an estimated six-figure savings per year.
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Affiliation(s)
- Alexis Sanchez
- Corporate Director Robotic Surgery Program, Orlando Health, Orlando, FL, USA
| | - Luis Herrera
- Cardiothoracic Surgeon, Rod Taylor Thoracic Cancer Care Center, Orlando Health, Orlando, FL, USA
| | - Andre Teixeira
- Bariatric Surgeon, Weight Loss and Bariatric Surgery Institute, Orlando Health, Orlando, FL, USA
| | - Ivan Mogollon
- Research Fellow, Robotic Surgery Program ORMC, Orlando Health, 52 W Underwood St, Orlando, FL, USA.
| | - Cristina Inchausti
- Research Fellow, Robotic Surgery Program ORMC, Orlando Health, 52 W Underwood St, Orlando, FL, USA
| | - Desrene Gibson
- Bachelor of Science in Nursing, Registered Nurse, Certified Perioperative Nurse, Orlando Health, Orlando, FL, USA
| | - Mary Stuart
- Certified Registered Central Service Technician, Orlando Health, Orlando, FL, USA
| | - Matthew Crespo
- Certified Registered Central Service Technician, Orlando Health, Orlando, FL, USA
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21
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Sullivan GA, Petit HJ, Reiter AJ, Westrick JC, Hu A, Dunn JB, Gulack BC, Shah AN, Dsida R, Raval MV. Environmental Impact and Cost Savings of Operating Room Quality Improvement Initiatives: A Scoping Review. J Am Coll Surg 2023; 236:411-423. [PMID: 36648269 DOI: 10.1097/xcs.0000000000000478] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Operating rooms are major contributors to a hospital's carbon footprint due to the large volumes of resources consumed and waste produced. The objective of this study was to identify quality improvement initiatives that aimed to reduce the environmental impact of the operating room while decreasing costs. STUDY DESIGN A literature search was performed using PubMed, Scopus, CINAHL, and Google Scholar and included broad terms for "operating room," "costs," and "environment" or "sustainability." The "triple bottom line" framework, which considers the environmental, financial, and social impacts of interventions to guide decision making, was used to inform data extraction. The studies were then categorized using the 5 "Rs" of sustainability-refuse, reduce, reuse, repurpose, and recycle-and the impacts were discussed using the triple bottom line framework. RESULTS A total of 23 unique quality improvement initiatives describing 28 interventions were included. Interventions were categorized as "refuse" (n = 11; 39.3%), "reduce" (n = 8; 28.6%), "reuse" (n = 3; 10.7%), and "recycle" (n = 6; 21.4%). While methods of measuring environmental impact and cost savings varied greatly among studies, potential annual cost savings ranged from $873 (intervention: education on diverting recyclable materials from sharps containers; environmental impact: 11.4 kg sharps waste diverted per month) to $694,141 (intervention: education to reduce regulated medical waste; environmental impact: 30% reduction in regulated medical waste). CONCLUSIONS Quality improvement initiatives that reduce both cost and environmental impact have been successfully implemented across a variety of centers both nationally and globally. Surgeons, healthcare practitioners, and administrators interested in environmental stewardship and working toward a culture of sustainability may consider similar interventions in their institutions.
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Affiliation(s)
- Gwyneth A Sullivan
- From the Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine (Sullivan, Reiter, Hu, Raval)
- the Division of Pediatric Surgery, Department of Surgery (Sullivan, Petit)
| | - Hayley J Petit
- the Division of Pediatric Surgery, Department of Surgery (Sullivan, Petit)
| | - Audra J Reiter
- From the Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine (Sullivan, Reiter, Hu, Raval)
| | - Jennifer C Westrick
- the Library of Rush Medical Center (Westrick), Rush University Medical Center, Chicago, IL
| | - Andrew Hu
- From the Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine (Sullivan, Reiter, Hu, Raval)
| | - Jennifer B Dunn
- the Chemical and Biological Engineering, Northwestern University, Evanston, IL (Dunn)
| | - Brian C Gulack
- From the Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine (Sullivan, Reiter, Hu, Raval)
- the Department of Anesthesiology (Dsida), Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL
- the Division of Pediatric Surgery, Department of Surgery (Sullivan, Petit)
- the Library of Rush Medical Center (Westrick), Rush University Medical Center, Chicago, IL
- the Chemical and Biological Engineering, Northwestern University, Evanston, IL (Dunn)
| | - Ami N Shah
- From the Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine (Sullivan, Reiter, Hu, Raval)
- the Department of Anesthesiology (Dsida), Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL
- the Division of Pediatric Surgery, Department of Surgery (Sullivan, Petit)
- the Library of Rush Medical Center (Westrick), Rush University Medical Center, Chicago, IL
- the Chemical and Biological Engineering, Northwestern University, Evanston, IL (Dunn)
| | - Richard Dsida
- the Department of Anesthesiology (Dsida), Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL
| | - Mehul V Raval
- From the Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine (Sullivan, Reiter, Hu, Raval)
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22
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Toor J, Shah A, Abbas A, Du JT, Kennedy E. Standardization of laparoscopic trays using an inventory optimization model to produce immediate cost savings and efficiency gains. PLoS One 2022; 17:e0276377. [PMID: 36580456 PMCID: PMC9799292 DOI: 10.1371/journal.pone.0276377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 10/05/2022] [Indexed: 12/30/2022] Open
Abstract
Perioperative services comprise a large portion of hospital budgets; the procurement and processing of surgical inventories can be an area for optimization in operational inefficiency. Surgical instrument trays can be customized as procedure-specific or standardized as trays that can be used in numerous procedure types. We conducted an interventional study to determine the cost savings from standardizing laparoscopic surgery instrument trays. A single-period inventory optimization model was used to determine the configuration of a standardized laparoscopic (SL) tray and its minimal stock quantity (MSQ). Utilization of instruments on the general surgery, gynecology, and gynecological oncology trays was recorded, and daily demand for trays (mean, SD) was assessed using daily operating room (OR) case lists. Pre- and post-intervention costs were evaluated by reviewing procurement data and quantifying medical device reprocessing (MDR) and OR processes. The SL tray was trialled in the OR to test clinical safety and user satisfaction. Prior to standardization, the customized trays had a total inventory size of 391 instruments (mean instruments per tray: 17, range: 12-22). Daily demand was an MSQ of 23 trays. This corresponded to a procurement cost of $322,160 and reprocessing cost of $41,725. The SL tray (mean instruments per tray: 15, mean trays/day: 9.2 ± 3.2) had an MSQ of 17 trays/day. The total inventory decreased to 255 instruments, corresponding to a procurement cost of $266,900 with savings of $55,260 and reprocessing cost of $41,562 with savings of $163/year. After 33 trial surgeries, user satisfaction improved from 50% to 97% (p < .05). Standardization to a single SL tray using the inventory optimization model led to increased efficiency, satisfaction, and significant savings through aggregating specific service demands. The inventory optimization model could provide custom solutions for various institutions with the potential for large-scale financial savings. Thus, future work using this model at different centres will be necessary to validate these results.
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Affiliation(s)
- Jay Toor
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
| | - Ajay Shah
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Aazad Abbas
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jin Tong Du
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Erin Kennedy
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of General Surgery, Sinai Health, Toronto, Ontario, Canada
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Helmkamp JK, Le E, Hill I, Hein R, Mithani S, Codd P, Richard M. Addressing Surgical Instrument Oversupply: A Focused Literature Review and Case-Study in Orthopedic Hand Surgery. Hand (N Y) 2022; 17:1250-1256. [PMID: 34098770 PMCID: PMC9608286 DOI: 10.1177/15589447211017233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Instrument oversupply drives cost in the operating room (OR). We review previously reported methodologies for surgical instrument reduction and report a pilot methodology for optimizing instrument supply via ethnographic instrument tracking of thumb carpometacarpal (CMC) arthroplasties. Additionally, we report a cost analysis of instrument oversupply and potential savings of tray optimization methods. METHODS Instrument utilization was tracked over 8 CMC arthroplasties conducted by 2 surgeons at an ambulatory surgery center of a large academic hospital. An optimized supply methodology was designed. A cost analysis was conducted using health-system-specific data and previously published research. RESULTS After tracking instrument use in 8 CMC arthroplasties, a cumulative total of 59 out of the 120 instruments in the Hand & Foot (H&F) tray were used in at least 1 case. Two instruments were used in all cases, and another 20 instruments were used in at least 50% of the cases. Using a reduced tray with 59 instruments, potential cost savings for tray reduction in 60 cases were estimated to be $2086 without peel-packing and $2356 with peel-packing. The estimated cost savings were lower than those reported in literature due to a reduced scope and exclusion of OR time cost in the analysis. CONCLUSIONS Instrument oversupply drives cost at our institution's ambulatory surgery center. Ethnography is a cost-effective method to track instrument utilization and determine optimal tray composition for small services but is not scalable to large health systems. The time and cost required to observe sufficient surgeries to enable supply reduction to motivate the need for more efficient methods to determine instrument utility.
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Affiliation(s)
| | - Elliot Le
- Duke University School of Medicine, Durham, NC, USA
| | - Ian Hill
- Duke University, Durham, NC, USA
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SARTINI MARINA, PATRONE CARLOTTA, SPAGNOLO ANNAMARIA, SCHINCA ELISA, OTTRIA GIANLUCA, DUPONT CHIARA, ALESSIO-MAZZOLA MATTIA, BRAGAZZI NICOLALUIGI, CRISTINA MARIALUISA. The management of healthcare-related infections through lean methodology: systematic review and meta-analysis of observational studies. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2022; 63:E464-E475. [PMID: 36415303 PMCID: PMC9648549 DOI: 10.15167/2421-4248/jpmh2022.63.3.2661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/13/2022] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Lean is largely applied to the health sector and on the healthcare-associated infections (HAI). However, a few results on the improvement of the outcome have been reported in literature. The purpose of this study is to analyze if the lean application can reduce the HAI rate. METHODS A comprehensive search was performed on PubMed/Medline, Scopus, CINAHL, Cochrane, Embase, and Google Scholar databases using various combinations of the following keywords: "lean" and "infection". Inclusion criteria were: 1) research articles with quantitative data and relevant information on lean methodology and its impact on healthcare infections; 2) prospective studies. The risk of bias and the study quality was independently assessed by two researchers using the "The National Institutes of Health (NIH) quality assessment tool for before-after (Pre-Post) study with no control group". The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines has been used. 22 studies were included in the present meta-analysis. RESULTS Lean application demonstrated a significant protective role on healthcare-associated infections rate (RR 0.50; 95% C.I.: 0.38-0.66) with significant impact on central line-associated bloodstream infections (CLABSIs) (RR 0.47; 95% C.I.: 0.28-0.82). CONCLUSIONS Lean has a positive impact on the decreasing of HAIs and on the improvement of compliance and satisfaction of the staff.
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Affiliation(s)
- MARINA SARTINI
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- S.S.D. U.O. Hospital Hygiene, E.O. Ospedali Galliera, Genoa, Italy
| | - CARLOTTA PATRONE
- Department of Directorate, Office Innovation, Development and Lean Application, E.O. Ospedali Galliera, Genoa, Italy
| | - ANNA MARIA SPAGNOLO
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- S.S.D. U.O. Hospital Hygiene, E.O. Ospedali Galliera, Genoa, Italy
| | - ELISA SCHINCA
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- S.S.D. U.O. Hospital Hygiene, E.O. Ospedali Galliera, Genoa, Italy
| | - GIANLUCA OTTRIA
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- S.S.D. U.O. Hospital Hygiene, E.O. Ospedali Galliera, Genoa, Italy
| | - CHIARA DUPONT
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | | | - NICOLA LUIGI BRAGAZZI
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON, Canada
| | - MARIA LUISA CRISTINA
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- S.S.D. U.O. Hospital Hygiene, E.O. Ospedali Galliera, Genoa, Italy
- Correspondence: Maria-Luisa Cristina, Dep. Health Sciences, University of Genoa, Via A. Pastore 1 – 16132 Genova. Phone +39 010 3538883 - E-mail ;
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Lean Six Sigma in Healthcare: A Systematic Literature Review on Motivations and Benefits. Processes (Basel) 2022. [DOI: 10.3390/pr10101910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
While Lean Six Sigma (LSS) has been applied extensively in healthcare organisations, there has been limited research on the trends of LSS application in healthcare in recent years. This paper aims to present the key motivations and benefits of LSS in healthcare with a view to highlighting the types of problems that LSS in healthcare can aid in solving. The authors used a systematic literature review (SLR) approach to achieving the article’s purpose. Peer-reviewed journal articles published between 2011 and 2021 are considered to achieve the study objectives. The systematic review helped the authors to identify the evolution, benefits, and motivations for LSS in healthcare. This work includes directions for managers and healthcare professionals in healthcare organisations to embark on a focused LSS journey aligned with the strategic objectives. This study is perhaps one of the most comprehensive SLRs covering a vital agenda of LSS in healthcare. This study provides all the deliverables of LSS for its successful deployment in healthcare.
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Shaw A, Chan YY, Arora HC, Aguilar JB, Schechter J, Gong EM, Chu DI, Yerkes EB, Matoka DJ, Seager CM, Bowen DK, Lindgren BW, Liu DB, Maizels M, Cheng EY, Johnson EK. Streamlining surgical trays for common pediatric urology Procedures: A quality improvement initiative. J Pediatr Urol 2022; 18:412.e1-412.e7. [PMID: 35811279 DOI: 10.1016/j.jpurol.2022.06.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/16/2022] [Accepted: 06/22/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Procedures involving the external genitalia are the most common pediatric urologic operations. Our group identified excess instrumentation for these cases to be a potential cause of operating room (OR) inefficiency at our large, freestanding pediatric hospital. This quality improvement (QI) initiative aimed to streamline surgical instrumentation for the most-performed pediatric urologic procedures at our hospital. MATERIAL AND METHODS Six Sigma DMAIC methodology (Define, Measure, Analyze, Improve, Control) guided this multidisciplinary, iterative QI effort. A stakeholder team utilized data review, direct observations, and multiple in-person discussions to create a new "Groin-Penis Tray" (GPT) to replace a larger tray for the 90 most common pediatric urologic procedures. Suture preference cards and expectations about which sutures would be opened for each case were updated. The primary outcome was estimated yearly cost-avoidance due to reduced sterile processing. Additional outcomes included: instruments opened/case, % cases with complete trays, Mayo stand set-up time, and % cases with unused sutures. Balancing measures included: total median OR time and tray weights. Baseline and post-implementation measures were characterized and compared. RESULTS A QI professional, 10 pediatric urologists, 2 pediatric urology fellows, and multiple OR and sterile processing staff members participated. The Summary Figure compares baseline and post-implementation measurements. The number of instruments opened/case decreased from 146 to 65. Annual sterile reprocessing costs decreased by >$51,000. Median Mayo stand set-up time decreased from 7.3 to 3.5 min (p < 0.001). The number of cases with complete trays increased from 7/20 (35%) to 11/20 (55%, p = 0.34). The new GPT is 2.7 kg lighter than the prior tray. Median OR time remained stable (baseline: 91 min; post-implementation: 102 min, p = 0.44). The number of cases with suture waste decreased from 78% to 0% immediately post-implementation but increased to 40% one year later. DISCUSSION This systematic, iterative QI process spanned the course of ∼2 years, including planning, building, and updating new trays, then assessing longer-term success via the control phase. The new GPT is used for most pediatric urologic procedures at our hospital, and benefits include sterile reprocessing cost savings and ergonomics. Our team gained valuable experience related to assessing QI project scope, determining key stakeholders and roles, and strategies for sustainability that we will apply to future initiatives. CONCLUSIONS Streamlining surgical trays for common pediatric urologic procedures at a large freestanding children's hospital using established QI methodology reduced OR cost by >$51,000/year and Mayo stand set-up times without compromising balancing measures.
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Affiliation(s)
- Allison Shaw
- Center for Quality & Safety, Ann & Robert H. Lurie Children's Hospital, 225 East Chicago Avenue, Chicago, IL 60611, USA.
| | - Yvonne Y Chan
- Division of Urology, Ann & Robert H. Lurie Children's Hospital, 225 East Chicago Avenue, Box 24, Chicago, IL 60611, USA.
| | - Hans C Arora
- Division of Urology, Ann & Robert H. Lurie Children's Hospital, 225 East Chicago Avenue, Box 24, Chicago, IL 60611, USA.
| | - Jazmina B Aguilar
- Procedural Services, Ann & Robert H. Lurie Children's Hospital, 225 East Chicago Avenue, Chicago, IL 60611, USA.
| | - Jamie Schechter
- Procedural Services, Ann & Robert H. Lurie Children's Hospital, 225 East Chicago Avenue, Chicago, IL 60611, USA.
| | - Edward M Gong
- Division of Urology, Ann & Robert H. Lurie Children's Hospital, 225 East Chicago Avenue, Box 24, Chicago, IL 60611, USA; Department of Urology, Northwestern University Feinberg School of Medicine, 676 Clair St, Arkes 2300, Chicago, IL 60611, USA.
| | - David I Chu
- Division of Urology, Ann & Robert H. Lurie Children's Hospital, 225 East Chicago Avenue, Box 24, Chicago, IL 60611, USA; Department of Urology, Northwestern University Feinberg School of Medicine, 676 Clair St, Arkes 2300, Chicago, IL 60611, USA.
| | - Elizabeth B Yerkes
- Division of Urology, Ann & Robert H. Lurie Children's Hospital, 225 East Chicago Avenue, Box 24, Chicago, IL 60611, USA; Department of Urology, Northwestern University Feinberg School of Medicine, 676 Clair St, Arkes 2300, Chicago, IL 60611, USA.
| | - Derek J Matoka
- Division of Urology, Ann & Robert H. Lurie Children's Hospital, 225 East Chicago Avenue, Box 24, Chicago, IL 60611, USA; Department of Urology, Northwestern University Feinberg School of Medicine, 676 Clair St, Arkes 2300, Chicago, IL 60611, USA.
| | - Catherine M Seager
- Division of Urology, Ann & Robert H. Lurie Children's Hospital, 225 East Chicago Avenue, Box 24, Chicago, IL 60611, USA; Department of Urology, Northwestern University Feinberg School of Medicine, 676 Clair St, Arkes 2300, Chicago, IL 60611, USA.
| | - Diana K Bowen
- Division of Urology, Ann & Robert H. Lurie Children's Hospital, 225 East Chicago Avenue, Box 24, Chicago, IL 60611, USA; Department of Urology, Northwestern University Feinberg School of Medicine, 676 Clair St, Arkes 2300, Chicago, IL 60611, USA.
| | - Bruce W Lindgren
- Division of Urology, Ann & Robert H. Lurie Children's Hospital, 225 East Chicago Avenue, Box 24, Chicago, IL 60611, USA; Department of Urology, Northwestern University Feinberg School of Medicine, 676 Clair St, Arkes 2300, Chicago, IL 60611, USA.
| | - Dennis B Liu
- Division of Urology, Ann & Robert H. Lurie Children's Hospital, 225 East Chicago Avenue, Box 24, Chicago, IL 60611, USA; Department of Urology, Northwestern University Feinberg School of Medicine, 676 Clair St, Arkes 2300, Chicago, IL 60611, USA.
| | - Max Maizels
- Division of Urology, Ann & Robert H. Lurie Children's Hospital, 225 East Chicago Avenue, Box 24, Chicago, IL 60611, USA; Department of Urology, Northwestern University Feinberg School of Medicine, 676 Clair St, Arkes 2300, Chicago, IL 60611, USA.
| | - Earl Y Cheng
- Division of Urology, Ann & Robert H. Lurie Children's Hospital, 225 East Chicago Avenue, Box 24, Chicago, IL 60611, USA; Department of Urology, Northwestern University Feinberg School of Medicine, 676 Clair St, Arkes 2300, Chicago, IL 60611, USA.
| | - Emilie K Johnson
- Division of Urology, Ann & Robert H. Lurie Children's Hospital, 225 East Chicago Avenue, Box 24, Chicago, IL 60611, USA; Department of Urology, Northwestern University Feinberg School of Medicine, 676 Clair St, Arkes 2300, Chicago, IL 60611, USA.
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Adamczyk AP, Kim PR, Horton I, Gofton W, Beaulé PE, Grammatopoulos G. The SLIM Study: Economic, Energy, and Waste Savings Through Lowering of Instrumentation Mass in Total Hip Arthroplasty. J Arthroplasty 2022; 37:S796-S802.e2. [PMID: 35181450 DOI: 10.1016/j.arth.2022.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/05/2022] [Accepted: 02/04/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Nearly 700,000 total hip arthroplasties (THAs) are annually performed in North America, costing the healthcare system >$15 billion and creating over 5 million tons of waste. This study aims to (1) assess satisfaction of current THA setup; (2) determine economic cost, energy cost, and waste cost of current setup and apply lean methodology to improve efficiency; and (3) design and test "Savings through Lowering of Instrumentation Mass (SLIM) setup" based on lean principles and its ability to be safely implemented into practice. METHODS A Needs Assessment Survey was performed. After review and surgeon input, the "SLIM" set was designed, significantly reducing redundancy. Eighty patients were randomized to either Standard or SLIM setup. Operating room time, blood loss, perioperative adverse events and complications, cost/case, instrument weight (kg/case), total waste (kg/case), case setup time, and number of times and number of extra trays required were compared between groups. RESULTS The SLIM setup was associated with the following savings: Cost = -$408.19/case; Energy = -7.16 kWh/case; Waste = -1.61 kg/case; Trays = -6 (758 kg/case). No differences in operating room time, blood loss, and complication rate were detected (P > .05) between groups. Setup time was significantly shorter with SLIM (P < .05) and extra instrumentation was opened in <5% of cases. CONCLUSION A more "minimalist approach" to THA can be safely implemented. The SLIM setup is efficient and has been openly accepted by our allied staff. Such setup can lead to 1,610 kg reduction in waste, 7,160 kWh, and $408,190 in savings per 1,000 THAs performed.
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Affiliation(s)
- Andrew P Adamczyk
- Division of Orthopaedics, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Paul R Kim
- Division of Orthopaedics, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Isabel Horton
- Division of Orthopaedics, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Wade Gofton
- Division of Orthopaedics, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Paul E Beaulé
- Division of Orthopaedics, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - George Grammatopoulos
- Division of Orthopaedics, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
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Yalamanchi P, Miller JE, Prout S, Matthews E, Spagnol C, Harrington S, Chang HF, Spector ME, Casper KA, Malloy KM. Association of Operating Room Costs With Head and Neck Surgical Instrumentation Optimization: A Surgeon-Led Quality Improvement Initiative. JAMA Otolaryngol Head Neck Surg 2022; 148:402-407. [PMID: 35266982 PMCID: PMC8914886 DOI: 10.1001/jamaoto.2022.0032] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance 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 Participants This 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 Measures The 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 Relevance In 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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Affiliation(s)
- Pratyusha Yalamanchi
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor
| | - Jessa E Miller
- Department of Head and Neck Surgery, University of California Los Angeles
| | - Stephanie Prout
- University Operating Rooms Administration, Michigan Medicine, Ann Arbor
| | - Eden Matthews
- University Operating Rooms Administration, Michigan Medicine, Ann Arbor
| | - Colleen Spagnol
- University Operating Rooms Administration, Michigan Medicine, Ann Arbor
| | | | - Helen F Chang
- University Operating Rooms Administration, Michigan Medicine, Ann Arbor
| | - Matthew E Spector
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor
| | - Keith A Casper
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor
| | - Kelly M Malloy
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor
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Toor J, Bhangu A, Wolfstadt J, Bassi G, Chung S, Rampersaud R, Mitchell W, Milner J, Koyle M. Optimizing the surgical instrument tray to immediately increase efficiency and lower costs in the operating room. Can J Surg 2022; 65:E275-E281. [PMID: 35414528 PMCID: PMC9007441 DOI: 10.1503/cjs.022720] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2021] [Indexed: 11/11/2022] Open
Abstract
Background: Surgical trays are often poorly configured and can be ongoing sources of frustration and excess costs. We conducted an observational study to determine if the use of a customized mathematical inventory optimization model would result in a greater reduction in the number of instruments on a surgical tray than a clinician review of the tray. Methods: Utilization of instruments on the major orthopedic tray at a large academic hospital was documented over 80 procedures. Processes in the medical device reprocessing department and operating room were observed to comprehensively quantify all associated costs. Results of the observations were applied to a customized mathematical model to determine the ideal tray configuration. For comparison, a clinician review was also performed. Results: The mathematical model alone produced an ideal tray size of 47 instruments, a reduction of 41 instruments from the original size of 88 instruments (47% reduction). This represented $34 440 in annual savings. In contrast, the clinician review alone suggested an ideal tray size of 67 instruments (23% reduction), representing $17 640 in annual savings. When clinicians were provided with the additional information from the model, they reduced the tray size to 51 instruments (42% reduction), producing $31 870 in savings. The mathematical model yielded an additional 22% instrument reduction and $14 230 in savings compared with clinician review alone. Conclusion: Our mathematical model is generalizable and can be applied to all specialties and hospitals to determine optimal tray configuration. As such, the financial implications are broad; at our institution, application to all surgical trays would result in $205 000 of savings annually. Surgeons and managers looking to streamline surgical trays should consider this evidence-based approach.
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Affiliation(s)
- Jay Toor
- From the Department of Orthopedic Surgery, University of Toronto, Toronto, Ont. (Toor, Wolfstadt, Rampersaud); the School of Medicine, Queen's University, Kingston, Ont. (Bhangu); Sinai Health System, Toronto, Ont. (Bassi); the Joseph L. Rotman School of Management, University of Toronto, Toronto, Ont. (Chung, Mitchell, Milner); and the Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ont. (Koyle)
| | - Avneesh Bhangu
- From the Department of Orthopedic Surgery, University of Toronto, Toronto, Ont. (Toor, Wolfstadt, Rampersaud); the School of Medicine, Queen's University, Kingston, Ont. (Bhangu); Sinai Health System, Toronto, Ont. (Bassi); the Joseph L. Rotman School of Management, University of Toronto, Toronto, Ont. (Chung, Mitchell, Milner); and the Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ont. (Koyle)
| | - Jesse Wolfstadt
- From the Department of Orthopedic Surgery, University of Toronto, Toronto, Ont. (Toor, Wolfstadt, Rampersaud); the School of Medicine, Queen's University, Kingston, Ont. (Bhangu); Sinai Health System, Toronto, Ont. (Bassi); the Joseph L. Rotman School of Management, University of Toronto, Toronto, Ont. (Chung, Mitchell, Milner); and the Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ont. (Koyle)
| | - Garry Bassi
- From the Department of Orthopedic Surgery, University of Toronto, Toronto, Ont. (Toor, Wolfstadt, Rampersaud); the School of Medicine, Queen's University, Kingston, Ont. (Bhangu); Sinai Health System, Toronto, Ont. (Bassi); the Joseph L. Rotman School of Management, University of Toronto, Toronto, Ont. (Chung, Mitchell, Milner); and the Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ont. (Koyle)
| | - Stanley Chung
- From the Department of Orthopedic Surgery, University of Toronto, Toronto, Ont. (Toor, Wolfstadt, Rampersaud); the School of Medicine, Queen's University, Kingston, Ont. (Bhangu); Sinai Health System, Toronto, Ont. (Bassi); the Joseph L. Rotman School of Management, University of Toronto, Toronto, Ont. (Chung, Mitchell, Milner); and the Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ont. (Koyle)
| | - Raja Rampersaud
- From the Department of Orthopedic Surgery, University of Toronto, Toronto, Ont. (Toor, Wolfstadt, Rampersaud); the School of Medicine, Queen's University, Kingston, Ont. (Bhangu); Sinai Health System, Toronto, Ont. (Bassi); the Joseph L. Rotman School of Management, University of Toronto, Toronto, Ont. (Chung, Mitchell, Milner); and the Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ont. (Koyle)
| | - William Mitchell
- From the Department of Orthopedic Surgery, University of Toronto, Toronto, Ont. (Toor, Wolfstadt, Rampersaud); the School of Medicine, Queen's University, Kingston, Ont. (Bhangu); Sinai Health System, Toronto, Ont. (Bassi); the Joseph L. Rotman School of Management, University of Toronto, Toronto, Ont. (Chung, Mitchell, Milner); and the Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ont. (Koyle)
| | - Joseph Milner
- From the Department of Orthopedic Surgery, University of Toronto, Toronto, Ont. (Toor, Wolfstadt, Rampersaud); the School of Medicine, Queen's University, Kingston, Ont. (Bhangu); Sinai Health System, Toronto, Ont. (Bassi); the Joseph L. Rotman School of Management, University of Toronto, Toronto, Ont. (Chung, Mitchell, Milner); and the Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ont. (Koyle)
| | - Martin Koyle
- From the Department of Orthopedic Surgery, University of Toronto, Toronto, Ont. (Toor, Wolfstadt, Rampersaud); the School of Medicine, Queen's University, Kingston, Ont. (Bhangu); Sinai Health System, Toronto, Ont. (Bassi); the Joseph L. Rotman School of Management, University of Toronto, Toronto, Ont. (Chung, Mitchell, Milner); and the Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ont. (Koyle)
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Evaluation of Variability in Operative Efficiency in Plastic Surgery Procedures. Ann Plast Surg 2022; 88:e13-e19. [DOI: 10.1097/sap.0000000000003096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hill I, Olivere L, Helmkamp J, Le E, Hill W, Wahlstedt J, Khoury P, Gloria J, Richard MJ, Rosenberger LH, Codd PJ. Measuring intraoperative surgical instrument use with radio-frequency identification. JAMIA Open 2022; 5:ooac003. [PMID: 35156004 PMCID: PMC8827029 DOI: 10.1093/jamiaopen/ooac003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 09/15/2021] [Accepted: 01/10/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objective
Surgical instrument oversupply drives cost, confusion, and workload in the operating room. With an estimated 78%–87% of instruments being unused, many health systems have recognized the need for supply refinement. By manually recording instrument use and tasking surgeons to review instrument trays, previous quality improvement initiatives have achieved an average 52% reduction in supply. While demonstrating the degree of instrument oversupply, previous methods for identifying required instruments are qualitative, expensive, lack scalability and sustainability, and are prone to human error. In this work, we aim to develop and evaluate an automated system for measuring surgical instrument use.
Materials and Methods
We present the first system to our knowledge that automates the collection of real-time instrument use data with radio-frequency identification (RFID). Over 15 breast surgeries, 10 carpometacarpal (CMC) arthroplasties, and 4 craniotomies, instrument use was tracked by both a trained observer manually recording instrument use and the RFID system.
Results
The average Cohen’s Kappa agreement between the system and the observer was 0.81 (near perfect agreement), and the system enabled a supply reduction of 50.8% in breast and orthopedic surgery. Over 10 monitored breast surgeries and 1 CMC arthroplasty with reduced trays, no eliminated instruments were requested, and both trays continue to be used as the supplied standard. Setup time in breast surgery decreased from 23 min to 17 min with the reduced supply.
Conclusion
The RFID system presented herein achieves a novel data stream that enables accurate instrument supply optimization.
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Affiliation(s)
- Ian Hill
- Pratt School of Engineering, Duke University, Durham, North Carolina, USA
| | - Lindsey Olivere
- School of Medicine, Duke University, Durham, North Carolina, USA
| | - Joshua Helmkamp
- School of Medicine, Duke University, Durham, North Carolina, USA
| | - Elliot Le
- School of Medicine, Duke University, Durham, North Carolina, USA
| | - Westin Hill
- Department of Neurosurgery, Duke University Hospital, Durham, North Carolina, USA
| | - John Wahlstedt
- Pratt School of Engineering, Duke University, Durham, North Carolina, USA
| | - Phillip Khoury
- School of Medicine, Duke University, Durham, North Carolina, USA
| | - Jared Gloria
- School of Medicine, Duke University, Durham, North Carolina, USA
| | - Marc J Richard
- Department of Orthopeadics, Duke University Medical Center, Durham, North Carolina, USA
| | - Laura H Rosenberger
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Patrick J Codd
- Pratt School of Engineering, Duke University, Durham, North Carolina, USA
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA
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The Importance of Explicit Change Management in Health Care: An Example from the Operating Room. Jt Comm J Qual Patient Saf 2022; 48:1-2. [PMID: 34980446 DOI: 10.1016/j.jcjq.2021.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Weigel WA, Lyons AB, Liberman JS, Blackmore CC. Using Lean tools to improve the efficiency of awake fibreoptic intubation setup. BMJ Open Qual 2021; 10:bmjoq-2021-001432. [PMID: 34862239 PMCID: PMC8647560 DOI: 10.1136/bmjoq-2021-001432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 11/09/2021] [Indexed: 11/04/2022] Open
Abstract
Background Awake fibreoptic intubation is a complex advanced airway technique used by anaesthesiologists in the management of a difficult airway. The time to setup this important procedure can be significant which may dissuade its use by some providers. In our institution, the awake intubation setup process was highly variable and error prone. Methods We deployed Lean methods to improve the efficiency and accuracy of the awake fibreoptic intubation setup process. A 2-day improvement event with a multidisciplinary team addressed the setup process, tested solutions and created standard work documents. Twenty awake fibreoptic intubation simulations were conducted before and after the intervention to quantify gains in setup efficiency and error reduction. Results Variability in the setup process, including clinical locations visited, was reduced through creating a standardised process. The average time to for an awake fibreoptic intubation setup was reduced by approximately 50%, from 23 min to 11 min (p<0.001). In addition, awake fibreoptic intubation equipment set out without error increased in the postintervention simulations from 59% to 85% (p=0.003). Conclusion Using Lean tools, we were able to make the setup of awake fibreoptic intubation not only more efficient, but also more accurate. A similar methodological approach may have value for other complex anaesthesia procedures.
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Affiliation(s)
- Wade A Weigel
- Anesthesiology, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Andrew B Lyons
- Anesthesiology, Virginia Mason Medical Center, Seattle, Washington, USA.,Anesthesiology, Gallatin Valley Anesthesia Associates, Bozeman, Montana, USA
| | - Justin S Liberman
- Anesthesiology, Virginia Mason Medical Center, Seattle, Washington, USA
| | - C Craig Blackmore
- Center for Health Care Improvement Science, Virginia Mason Medical Center, Seattle, Washington, USA
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Inventory Optimization in the Perioperative Care Department Using Kotter's Change Model. Jt Comm J Qual Patient Saf 2021; 48:5-11. [PMID: 34758922 DOI: 10.1016/j.jcjq.2021.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/19/2021] [Accepted: 09/20/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Perioperative services have been scrutinized in the context of cost containment in health care, particularly in the procurement and reprocessing of surgical instruments. Although solutions such as surgical instrument inventory optimization (IO) have been proposed, there is a paucity of literature on how to implement this change. The purpose of this project was to describe the implementation of an IO using Kotter's Change Model (KCM). METHODS This study was conducted at a tertiary academic hospital across the four highest-volume surgical services. The IO was implemented using the steps outlined by KCM: (1) create coalition, (2) create vision for change, (3) establish urgency, (4) communicate the vision, (5) empower broad-based action, (6) generate short-term wins, (7) consolidate gains, and (8) anchor change. This process was evaluated using inventory metrics, operational efficiency metrics, and clinician satisfaction. RESULTS Total inventory was reduced by 37.7%, with an average tray size reduction of 18.0%. This led to a total reprocessing time savings of 1,333 hours per annum and labor cost savings of $39,995 per annum. Depreciation cost savings were $64,320 per annum. Case cancellation rate due to instrument-related errors decreased from 3.9% to 0.2%. The proportion of staff completely satisfied with the inventory was 1.7% pre-IO and 80.0% post-IO. CONCLUSION This is the first study to describe the successful implementation of KCM to facilitate change in the perioperative setting. This success contributes to the growing body of literature supporting KCM as a valuable change management tool in health care.
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Wu S, Cerceo E. Sustainability Initiatives in the Operating Room. Jt Comm J Qual Patient Saf 2021; 47:663-672. [PMID: 34344594 DOI: 10.1016/j.jcjq.2021.06.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/25/2021] [Accepted: 06/28/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Operating rooms (ORs) contribute up to 30% of a hospital's waste, are very resource-intensive, and thus provide an opportunity for improvement. METHODS A narrative review was conducted, searching MEDLINE, EMBASE, and ProQuest databases. The study included 78 of the 108 published articles. RESULTS The researchers identified and categorized articles according to the following major themes: Committee and Leadership; Waste Reduction; Segregating OR waste; Minimizing unnecessary devices and packaging; Reducing energy consumption; Choosing anesthetic gases; Education; Reducing water consumption; Different surgical venues; Donating medical supplies. Formation of an OR committee or a hospital Green Team dedicated to environmentally sustainable initiatives can significantly improve health care's impact on the environment while saving money. Changes in supply chain with preferences for reusable devices, effective recycling, repurposing instruments, and donating items can all be effective means of diverting waste away from landfills. Reducing unnecessary packaging and instruments would eliminate excess in the waste stream. Curtailing energy and water usage results in cost and environmental savings. Surgical venue (inpatient vs. outpatient surgical center) can also contribute to waste. Transitioning away from certain inhaled anesthetics can minimize greenhouse gas impact. Education to all levels in the health care system is important to drive change and maintain change. CONCLUSION Optimizing efficiency and decreasing waste generation can have a positive impact on the environment and can be accompanied by cost reduction. Because the field of sustainability in health care is young but burgeoning, increased research is needed to support evidence-based approaches.
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Surgical Tray Optimization: a Quality Improvement Initiative that Reduces Operating Room Costs. J Med Syst 2021; 45:78. [PMID: 34231049 DOI: 10.1007/s10916-021-01753-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 06/28/2021] [Indexed: 10/20/2022]
Abstract
Surgical trays contain unused instruments which generate wasted resources from unnecessary reprocessing/replacement costs. We implemented a quality improvement initiative to optimize surgical trays for common otolaryngology procedures, and examined the impact on costs, operating room (OR) efficiency, and patient safety.We studied five common otolaryngology procedures over a 10-month period at a single community hospital. We compared pre- and post-intervention outcome measures including instrument utilization, tray set up time, tray rebuilding time, and balancing measures (operative time, instrument recall, patient safety). We estimated cost-savings from an institutional perspective over 1- and 10-year time horizons. Costs were expressed in 2017 Canadian dollars and modeled as a function of surgical volume, labor costs, instrument depreciation, and indirect costs.A total of 238 procedures by six surgeons were observed. At baseline, only 35% of instruments were utilized. We achieved an average instrument reduction of 26%, yielding 1-year cost savings of $9,010 CDN and 10-year cost savings of $69,576 CDN. Tray optimization reduced average OR tray setup time by 2.5 ± 0.4 min (p = 0.03) and average tray rebuilding time by 1.4 ± 0.2 min (p = 0.06). There was minimal impact on balancing measures such as OR time, stakeholder perception of patient safety and trainee education, and only a single case of instrument recall.Surgical tray optimization is a simple, effective, and scalable strategy for reducing costs and improving OR efficiency without compromising patient safety.
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Raveglia F, Orlandi R, Rimessi A, Minervini F, Cioffi U, De Simone M, Guttadauro A, Scarci M. Standardization of Procedures to Contain Cost and Reduce Variability of Care After the Pandemic. Front Surg 2021; 8:695341. [PMID: 34250010 PMCID: PMC8264450 DOI: 10.3389/fsurg.2021.695341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/01/2021] [Indexed: 11/30/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has changed many aspects of our private and professional routine. In particular, the lockdowns have severely affected the entire healthcare system and hospital activities, forcing it to rethink the protocols in force. We suggest that this scenario, in spite of the new challenges involving so far complex healthcare providers, may lead to the unique opportunity to rethink pathways and management of patients. Indeed, having to resume institutional activity after a long interruption that has completely canceled the previously existing schemes, healthcare providers have the unique opportunity to overcome obsolete and “we have always done in this way” model on the wave of the general desire to resume a normal life. Furthermore, the pandemic has highlighted some flaws in our health system, highlighting those critical issues that most need to be addressed. This article is a review of pre-pandemic literature addressing the use of Lean Six Sigma (LSS) and standardization processes in thoracic surgery to improve efficiency. Our goal is to identify the main issues that could be successfully improved along the entire pathway of a patient from the first referral to diagnosis, hospitalization, and surgical operation up to convalescence. Furthermore, we aim to identify the standardization processes that have been implemented to achieve significant improvements in patient outcomes while reducing costs. The methods and goals that could be used in the near future to modernize our healthcare systems are drawn up from a careful reading and interpretation in light of the pandemic of the most significant review articles in the literature.
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Affiliation(s)
- Federico Raveglia
- Thoracic Surgery, San Gerardo Hospital, Azienda Socio Sanitaria Territoriale (ASST)-Monza, Monza, Italy
| | - Riccardo Orlandi
- Thoracic Surgery, San Gerardo Hospital, Azienda Socio Sanitaria Territoriale (ASST)-Monza, Monza, Italy
| | - Arianna Rimessi
- Thoracic Surgery, San Gerardo Hospital, Azienda Socio Sanitaria Territoriale (ASST)-Monza, Monza, Italy
| | - Fabrizio Minervini
- Thoracic Surgery, Lucerne Cantonal Hospital, University of Lucerne, Lucerne, Switzerland
| | - Ugo Cioffi
- Department of Surgery, University of Milan, Milan, Italy
| | | | - Angelo Guttadauro
- Department of Surgery, Istituti Clinici Zucchi, University of Milan Bicocca, Monza, Italy
| | - Marco Scarci
- Thoracic Surgery, San Gerardo Hospital, Azienda Socio Sanitaria Territoriale (ASST)-Monza, Monza, Italy
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Rao PK, Cunningham AJ, Kenron D, Mshelbwala P, Ameh EA, Krishnaswami S. Applying LEAN Healthcare in Lean Settings: Launching Quality Improvement in Resource-Limited Regions. J Surg Res 2021; 266:398-404. [PMID: 34091087 DOI: 10.1016/j.jss.2021.04.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 04/15/2021] [Accepted: 04/16/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Lean methodology is frequently utilized in high income settings to maximize capacity and operational efficiency during process improvement (PI) initiatives. To date there has been little published on the application of these techniques in low- and-middle-income countries (LMIC) despite the potential benefits in resource limited settings. We describe a pilot project developed in 2018 to promote sustainable operating theater efficiency at two hospitals in Abuja, Nigeria. This study details the first known attempt to use Lean techniques to improve surgical care systems in LMIC. METHODS Perioperative committees were established at two Nigerian institutions to evaluate current processes, identify problems, and compile a list of priorities. A physician champion and a PI specialist in conjunction with local physician-partners held a workshop to teach practical applications of PI methodology as part of an ongoing collaboration. Pre and post-workshop surveys were administered, and theme coding was used to categorize free responses. Results were compared with a chi-square test. RESULTS In total, 42 individuals attended the PI workshop. After the workshop, 37 respondents reported the workshop as valuable both personally and for the perioperative committee (P < 0.001), and all reported that PI methodology could benefit the institution overall. CONCLUSIONS By identifying stakeholders, holding a workshop to teach tools of PI, and establishing a committee for ongoing improvement, it is possible to implement quality improvement techniques at LMIC hospitals, which may be of future benefit. Sustainability in this project will be facilitated by tele mentoring, and future efforts include expansion beyond the perioperative setting.
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Affiliation(s)
- Pavithra K Rao
- Department of Surgery, Oregon Health & Science University, Portland, OR.
| | | | - Daniel Kenron
- Department of Surgery, Oregon Health & Science University, Portland, OR
| | - Philip Mshelbwala
- Department of Surgery, University of Abuja, Gwagwalada, FCT, Nigeria
| | - Emmanuel A Ameh
- Department of Surgery, National Hospital, Abuja, FCT, Nigeria
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Lonner JH, Goh GS, Sommer K, Niggeman G, Levicoff EA, Vernace JV, Good RP. Minimizing Surgical Instrument Burden Increases Operating Room Efficiency and Reduces Perioperative Costs in Total Joint Arthroplasty. J Arthroplasty 2021; 36:1857-1863. [PMID: 33579631 DOI: 10.1016/j.arth.2021.01.041] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/05/2021] [Accepted: 01/15/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Optimizing surgical trays to improve operating room efficiency and reduce costs in instrument processing is an under-appreciated strategy for cost containment. This study aimed to assess the economic impact of instrument tray optimization in total joint arthroplasty. METHODS Thirty-five randomly selected elective primary total knee arthroplasty and total hip arthroplasty performed by 4 fellowship-trained surgeons were analyzed. Type and number of instruments used as well as timing of different steps in the sterilization process were recorded by an independent observer. Using Lean methodology, surgeons identified redundant or underutilized instruments and agreed upon the fewest number needed for each tray. Instrument utilization rates and processing time were analyzed before and after tray modifications. Annual cost savings were calculated based on a processing factor of $0.59-$11.52 per instrument. RESULTS Only 45.5% of instruments opened for total knee arthroplasty were utilized. After optimization, 28 of 87 (32.2%) instruments were removed and the remainder could be stored in one tray. Mean set-up time decreased from 20.7 to 14.2 minutes, while 40-75 minutes were saved during the sterilization process. For total hip arthroplasty, only 36.0% of instruments were utilized. Using Lean methods, 46 of 112 (41.1%) instruments were removed and tray count was reduced to 2 trays. Mean set-up time decreased from 27.9 to 18.6 minutes, while 45-150 minutes were saved during processing. Average annual savings amounted to $281,298.05. CONCLUSION Lean methodology can be used to eliminate redundant or underutilized instruments in total joint arthroplasty, improving surgical efficiency and generating substantial cost savings.
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Wood BC, Konchan S, Gay S, Rath S, Deshpande V, Knowles M. Data Analysis of Plastic Surgery Instrument Trays Yields Significant Cost Savings and Efficiency Gains. Ann Plast Surg 2021; 86:S635-S639. [PMID: 34100825 DOI: 10.1097/sap.0000000000002913] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Inpatient surgery costs have risen 30% over the past 5 years, and the operating room accounts for up to 60% of total hospital operational expense. On average, only 13.0% to 21.9% of instruments opened for a case are used, contributing to significant avoidable reprocessing, repurchase, and labor expense. METHODS A comprehensive review of 40 major instrument trays at UNC Rex Hospital was conducted using a technology service (OpFlow; Operative Flow Technologies, Raleigh, NC). Among the full scope of the project, the general plastics tray and breast reconstruction tray were evaluated for the plastic surgery service line over a 3-month period. Intraoperative data collection was performed on the exact instruments used across a standard breadth of cases. Data analytics were conducted stratifying instrument usage concordance among surgeons by tray and procedure type. After a surgeon-led review of the proposed new tray configurations, the optimized versions were implemented via a methodical change management process. RESULTS A total of 183 plastic surgery cases were evaluated across 17 primary surgeons. On average, the instrument usage per tray was 15.8% for the general plastics tray and 23.5% for the breast reconstruction tray. After stakeholder review, 32 (45.1%) of 71 instruments were removed from the general plastics tray and 40 (36.7%) of 109 were removed from the breast reconstruction tray, resulting in a total reduction of 2652 instruments. This resulted in a decrease of 81,696 instrument sterilization cycles annually. The removal of the instruments yielded an estimated cost avoidance of US $163,800 for instrument repurchase and US $69,441 in annual resterilization savings. The instrument volume reduction is projected to save 383.5 hours of sterile processing personnel time in tray assembly annually. CONCLUSIONS An analytics-driven method applying empirical data on actual case-based instrument usage has implications for better efficiency, improved quality, and cost avoidance related to instrument repurchase and sterile processing. Given increasing cost constraints and the transition to value-based care models, leveraging a technology-based solution enables meaningful change in the sterile processing department as a source for cost reduction and quality of care improvement.
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Affiliation(s)
| | | | | | - Sandeep Rath
- Department of Operations, UNC Kenan-Flagler Business School
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Radiofrequency Identification Track for Tray Optimization: An Instrument Utilization Pilot Study in Surgical Oncology. J Surg Res 2021; 264:490-498. [PMID: 33857793 DOI: 10.1016/j.jss.2021.02.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 02/16/2021] [Accepted: 02/27/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Surgical instrument tray reduction attempts to minimize intraoperative inefficiency and processing costs. Previous reduction methods relied on trained observers manually recording instrument use (i.e. human ethnography), and surgeon and/or staff recall, which are imprecise and inherently limited. We aimed to determine the feasibility of radiofrequency identification (RFID)-based intraoperative instrument tracking as an effective means of instrument reduction. METHODS Instrument trays were tagged with unique RFID tags. A RFID reader tracked instruments passing near RFID antennas during 15 breast operations performed by a single surgeon; ethnography was performed concurrently. Instruments without recorded use were eliminated, and 10 additional cases were performed utilizing the reduced tray. Logistic regression was used to estimate odds of instrument use across cases. Cohen's Kappa estimated agreement between RFID and ethnography. RESULTS Over 15 cases, 37 unique instruments were used (median 23 instruments/case). A mean 0.64 (median = 0, range = 0-3) new instruments were added per case; odds of instrument use did not change between cases (OR = 1.02, 95%CI 1.00-1.05). Over 15 cases, all instruments marked as used by ethnography were recorded by RFID tracking; 7 RFID-tracked instruments were never recorded by ethnography. Tray size was reduced 40%. None of the 25 eliminated instruments were required in 10 subsequent cases. Cohen's Kappa comparing RFID data and ethnography over all cases was 0.82 (95%CI 0.79-0.86), indicating near perfect agreement between methodologies. CONCLUSIONS Intraoperative RFID instrument tracking is a feasible, data-driven method for surgical tray reduction. Overall, RFID tracking represents a scalable, systematic, and efficient method of optimizing instrument supply across procedures.
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Dos Santos BM, Fogliatto FS, Zani CM, Peres FAP. Approaches to the rationalization of surgical instrument trays: scoping review and research agenda. BMC Health Serv Res 2021; 21:163. [PMID: 33610192 PMCID: PMC7895742 DOI: 10.1186/s12913-021-06142-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 02/02/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Surgical Tray Rationalization (STR) consists of a systematic reduction in the number 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 to identify and map available evidence on 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 future research directions, which are presented as nine research questions associated with the four generic steps proposed in the STR roadmap.
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Affiliation(s)
- Bruno Miranda Dos Santos
- Department of Industrial Engineering, Federal University of Rio Grande do Sul, Av. Osvaldo Aranha, 99, 5° andar, Porto Alegre, 90035-190, Brazil.
| | - Flavio Sanson Fogliatto
- Department of Industrial Engineering, Federal University of Rio Grande do Sul, Av. Osvaldo Aranha, 99, 5° andar, Porto Alegre, 90035-190, Brazil
| | - Carolina Melecardi Zani
- Department of Industrial Engineering, Federal University of Rio Grande do Sul, Av. Osvaldo Aranha, 99, 5° andar, Porto Alegre, 90035-190, Brazil
| | - Fernanda Araujo Pimentel Peres
- Department of Industrial Engineering, Federal University of Rio Grande do Sul, Av. Osvaldo Aranha, 99, 5° andar, Porto Alegre, 90035-190, Brazil
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Alfred MC, Cohen TN, Cohen KA, Kanji FF, Choi E, Del Gaizo J, Nemeth LS, Alekseyenko AV, Shouhed D, Savage SJ, Anger JT, Catchpole K. Using Flow Disruptions to Examine System Safety in Robotic-Assisted Surgery: Protocol for a Stepped Wedge Crossover Design. JMIR Res Protoc 2021; 10:e25284. [PMID: 33560239 PMCID: PMC7902184 DOI: 10.2196/25284] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/20/2020] [Accepted: 12/23/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The integration of high technology into health care systems is intended to provide new treatment options and improve the quality, safety, and efficiency of care. Robotic-assisted surgery is an example of high technology integration in health care, which has become ubiquitous in many surgical disciplines. OBJECTIVE This study aims to understand and measure current robotic-assisted surgery processes in a systematic, quantitative, and replicable manner to identify latent systemic threats and opportunities for improvement based on our observations and to implement and evaluate interventions. This 5-year study will follow a human factors engineering approach to improve the safety and efficiency of robotic-assisted surgery across 4 US hospitals. METHODS The study uses a stepped wedge crossover design with 3 interventions, introduced in different sequences at each of the hospitals over four 8-month phases. Robotic-assisted surgery procedures will be observed in the following specialties: urogynecology, gynecology, urology, bariatrics, general, and colorectal. We will use the data collected from observations, surveys, and interviews to inform interventions focused on teamwork, task design, and workplace design. We intend to evaluate attitudes toward each intervention, safety culture, subjective workload for each case, effectiveness of each intervention (including through direct observation of a sample of surgeries in each observational phase), operating room duration, length of stay, and patient safety incident reports. Analytic methods will include statistical data analysis, point process analysis, and thematic content analysis. RESULTS The study was funded in September 2018 and approved by the institutional review board of each institution in May and June of 2019 (CSMC and MDRH: Pro00056245; VCMC: STUDY 270; MUSC: Pro00088741). After refining the 3 interventions in phase 1, data collection for phase 2 (baseline data) began in November 2019 and was scheduled to continue through June 2020. However, data collection was suspended in March 2020 due to the COVID-19 pandemic. We collected a total of 65 observations across the 4 sites before the pandemic. Data collection for phase 2 was resumed in October 2020 at 2 of the 4 sites. CONCLUSIONS This will be the largest direct observational study of surgery ever conducted with data collected on 680 robotic surgery procedures at 4 different institutions. The proposed interventions will be evaluated using individual-level (workload and attitude), process-level (perioperative duration and flow disruption), and organizational-level (safety culture and complications) measures. An implementation science framework is also used to investigate the causes of success or failure of each intervention at each site and understand the potential spread of the interventions. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/25284.
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Affiliation(s)
- Myrtede C Alfred
- Medical University of South Carolina, Department of Anesthesia and Perioperative Medicine, Charleston, SC, United States
| | - Tara N Cohen
- Cedars-Sinai Medical Center, Department of Surgery, Los Angeles, CA, United States
| | - Kate A Cohen
- Cedars-Sinai Medical Center, Department of Surgery, Los Angeles, CA, United States
| | - Falisha F Kanji
- Cedars-Sinai Medical Center, Department of Surgery, Los Angeles, CA, United States
| | - Eunice Choi
- Cedars-Sinai Medical Center, Department of Surgery, Los Angeles, CA, United States
| | - John Del Gaizo
- Medical University of South Carolina, Biomedical Informatics Center, Charleston, SC, United States
| | - Lynne S Nemeth
- Medical University of South Carolina, College of Nursing, Charleston, SC, United States
| | - Alexander V Alekseyenko
- Medical University of South Carolina, Biomedical Informatics Center, Charleston, SC, United States
| | - Daniel Shouhed
- Cedars-Sinai Medical Center, Department of Surgery, Los Angeles, CA, United States
| | - Stephen J Savage
- Department of Urology, Medical University of South Carolina, Carleston, SC, United States
| | - Jennifer T Anger
- Cedars-Sinai Medical Center, Department of Surgery, Los Angeles, CA, United States
| | - Ken Catchpole
- Medical University of South Carolina, Department of Anesthesia and Perioperative Medicine, Charleston, SC, United States
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Gidumal S, Gray M, Oh S, Hirsch M, Rousso J, Rosenberg J. Utilization fraction of rhinoplasty instrument sets: Model for efficient use of surgical instruments. Am J Otolaryngol 2021; 42:102764. [PMID: 33096338 DOI: 10.1016/j.amjoto.2020.102764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/23/2020] [Accepted: 10/12/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Recognize the avoidable costs incurred due to overpacking of rhinoplasty instrument trays. Reduce rhinoplasty instrument trays by including only instruments used frequently. Establish methods to reduce trays prepared for other otolaryngologic procedures. METHODS This is a prospective study. The study evaluates the specific use of instruments opened for rhinoplasty procedures at the New York Eye & Ear Infirmary of Mount Sinai. Instruments were counted in 10 rhinoplasty cases. Usage rate was calculated for each instrument. Additionally, all instruments used in at least 20% of cases were noted. This "20%" threshold was used to create new rhinoplasty tray inventories more reflective of actual instrument usage. Some instruments above the 20% threshold were included in multiples (i.e. two Adson Brown forceps vs. one curved iris scissor). RESULTS 189 instruments were opened, and 32 instruments were used on average in each rhinoplasty. 55 instruments were used in at least 20% of cases. The 55 "high usage" instruments were used to create new, reduced rhinoplasty tray inventory lists. Based on our analysis, a new rhinoplasty tray inventory was created comprised of 68 instruments, a 64% reduction from 189. CONCLUSION Instruments are sterilized and packed in gross excess for rhinoplasty procedures. Previously published figures estimate re-sterilization costs of $0.51 to $0.77 per instrument. Reduction in instruments opened from 189 to 68 is expected to lead to cost savings ranging from $62 to $93 per case, yielding a savings between $6200 and $9300 per 100 cases performed. LEVEL OF EVIDENCE II-3.
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Affiliation(s)
- Sunder Gidumal
- Division of Facial Plastic and Reconstructive Surgery, Mount Sinai Department of Otolaryngology - Head and Neck Surgery, United States of America.
| | - Mingyang Gray
- Division of Facial Plastic and Reconstructive Surgery, Mount Sinai Department of Otolaryngology - Head and Neck Surgery, United States of America
| | - Samuel Oh
- Icahn School of Medicine at Mount Sinai, United States of America
| | - Matthew Hirsch
- Division of Facial Plastic and Reconstructive Surgery, Mount Sinai Department of Otolaryngology - Head and Neck Surgery, United States of America
| | - Joseph Rousso
- Division of Facial Plastic and Reconstructive Surgery, Mount Sinai Department of Otolaryngology - Head and Neck Surgery, United States of America
| | - Joshua Rosenberg
- Division of Facial Plastic and Reconstructive Surgery, Mount Sinai Department of Otolaryngology - Head and Neck Surgery, United States of America
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Knowles M, Gay SS, Konchan SK, Mendes R, Rath S, Deshpande V, Farber MA, Wood BC. Data analysis of vascular surgery instrument trays yielded large cost and efficiency savings. J Vasc Surg 2020; 73:2144-2153. [PMID: 33359847 DOI: 10.1016/j.jvs.2020.09.043] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 09/22/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Surgical procedures account for 50% of hospital revenue and ∼60% of operating costs. On average, <20% of surgical instruments will be used during a case, and the expense for resterilization and assembly of instrument trays ranges from $0.51 to $3.01 per instrument. Given the complexity of the surgical service supply chain, physician preferences, and variation of procedures, a reduction of surgical cost has been extremely difficult and often ill-defined. A data-driven approach to instrument tray optimization has implications for efficiency and cost savings in sterile processing, including reductions in tray assembly time and instrument repurchase, repair, and avoidable depreciation. METHODS During a 3-month period, vascular surgery cases were monitored using a cloud-based technology product (OpFlow, Operative Flow Technologies, Raleigh, NC) as a part of a hospital-wide project. Given the diversity of the cases evaluated, we focused on two main vascular surgery trays: vascular and aortic. An assessment was performed to evaluate the exact instruments used by the operating surgeons across a variety of cases. The vascular tray contained 131 instruments and was used for the vast majority of vascular cases, and the aortic tray contained 152 instruments. Actual instrument usage data were collected, a review and analysis performed, and the trays optimized. RESULTS During the 3-month period, 168 vascular surgery cases were evaluated across six surgeons. On average, the instrument usage per tray was 30 of 131 instruments (22.9%) for the vascular tray and 19 of 152 (12.5%) for the aortic tray. After review, 45.8% of the instruments were removed from the vascular tray and 62.5% from the aortic tray, for 1255 instruments removed from the versions of both trays. An audit was performed after the removal of instruments, which showed that none of the removed instruments had required reinstatement. The instrument reduction from these two trays alone yielded an estimated costs savings of $97,781 for repurchase and $97,444 in annual resterilization savings. Annually, the removal of the instruments is projected to save 316.2 hours of personnel time. The time required for operating room table setup decreased from a mean of 7:44 to 5:02 minutes for the vascular tray (P < .0001) and from 8:53 to 4:56 minutes for the aortic tray (P < .0001). CONCLUSIONS Given increasing cost constraints in healthcare, sterile processing remains an untapped resource for surgical expense reduction. A comprehensive data analytics solution provided the ability to make informed decisions in tray management that otherwise could not be reliably performed.
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Affiliation(s)
- Martyn Knowles
- UNC Rex Hospital, Raleigh, NC; Division of Vascular Surgery, Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | | | | | - Robert Mendes
- UNC Rex Hospital, Raleigh, NC; Division of Vascular Surgery, Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Sandeep Rath
- Department of Operations, Kenan-Flagler Business School, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Vinayak Deshpande
- Department of Operations, Kenan-Flagler Business School, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Mark A Farber
- Division of Vascular Surgery, Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Ikuma L, Nahmens I, Ahmad A, Gudipudi Y, Dasa V. Resource evaluation framework for total knee arthroplasty. Int J Health Care Qual Assur 2020; 33:189-198. [PMID: 32233354 DOI: 10.1108/ijhcqa-04-2019-0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE This article describes a framework for evaluating efficiency of OR procedures incorporating time measurement, personnel activity, and resource utilization using traditional industrial engineering tools of time study and work sampling. METHODS The framework measures time using time studies of OR procedures and work sampling of personnel activities, ultimately classified as value-added or non-value-added. Statistical methods ensure that the collected samples meet adequate levels of confidence and accuracy. Resource utilization is captured through documentation of instrument trays used, defects in instruments, and trash weight and classification at the conclusion of surgeries. FINDINGS A case study comprising 12 observations of total knee arthroplasty surgeries illustrates the use of the framework. The framework allows researchers to compare time, personnel, and resource utilization simultaneously within the OR setting. PRACTICAL IMPLICATIONS The framework provides a holistic evaluation of methods, instrumentation and resources, and staffing levels and allows researchers to identify areas for efficiency improvement. ORIGINALITY/VALUE The methods presented in this article are rooted in traditional industrial engineering work measurement methods but are applied to a healthcare setting in order to efficiently identify areas for improvement including time, personnel, and processes in operating rooms.
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Affiliation(s)
- Laura Ikuma
- Department of Mechanical and Industrial Engineering, Louisiana State University and A&M College, Baton Rouge, Louisiana, USA
| | - Isabelina Nahmens
- Department of Mechanical and Industrial Engineering, Louisiana State University and A&M College, Baton Rouge, Louisiana, USA
| | - Amani Ahmad
- Department of Mechanical and Industrial Engineering, Louisiana State University and A&M College, Baton Rouge, Louisiana, USA
| | - Yasaswi Gudipudi
- Department of Mechanical and Industrial Engineering, Louisiana State University and A&M College, Baton Rouge, Louisiana, USA
| | - Vinod Dasa
- Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
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Alfred M, Catchpole K, Huffer E, Fredendall L, Taaffe KM. Work systems analysis of sterile processing: assembly. BMJ Qual Saf 2020; 30:271-282. [PMID: 33077512 DOI: 10.1136/bmjqs-2019-010740] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 08/31/2020] [Accepted: 09/17/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Sterile processing departments (SPDs) play a crucial role in surgical safety and efficiency. SPDs clean instruments to remove contaminants (decontamination), inspect and reorganise instruments into their correct trays (assembly), then sterilise and store instruments for future use (sterilisation and storage). However, broken, missing or inappropriately cleaned instruments are a frequent problem for surgical teams. These issues should be identified and corrected during the assembly phase. OBJECTIVE A work systems analysis, framed within the Systems Engineering Initiative for Patient Safety (SEIPS) model, was used to develop a comprehensive understanding of the assembly stage of reprocessing, identify the range of work challenges and uncover the inter-relationship among system components influencing reliable instrument reprocessing. METHODS The study was conducted at a 700-bed academic hospital in the Southeastern United States with two reprocessing facilities from October 2017 to October 2018. Fifty-six hours of direct observations, 36 interviews were used to iteratively develop the work systems analysis. This included the process map and task analysis developed to describe the assembly system, the abstraction hierarchy developed to identify the possible performance shaping factors (based on SEIPS) and a variance matrix developed to illustrate the relationship among the tasks, performance shaping factors, failures and outcomes. Operating room (OR) reported tray defect data from July 2016 to December 2017 were analysed to identify the percentage and types of defects across reprocessing phases the most common assembly defects. RESULTS The majority of the 3900 tray defects occurred during the assembly phase; impacting 5% of surgical cases (n=41 799). Missing instruments, which could result in OR delays and increased surgical duration, were the most commonly reported assembly defect (17.6%, n=700). High variability was observed in the reassembling of trays with failures including adding incorrect instruments, omitting instruments and failing to remove damaged instrument. These failures were precipitated by technological shortcomings, production pressures, tray composition, unstandardised instrument nomenclature and inadequate SPD staff training. CONCLUSIONS Supporting patient safety, minimising tray defects and OR delays and improving overall reliability of instrument reprocessing require a well-designed instrument tracking system, standardised nomenclature, effective coordination of reprocessing tasks between SPD and the OR and well-trained sterile processing technicians.
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Affiliation(s)
- Myrtede Alfred
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ken Catchpole
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Emily Huffer
- Department of Industrial Engineering, Clemson University, Clemson, South Carolina, USA
| | - Larry Fredendall
- Department of Management, Clemson University, Clemson, South Carolina, USA
| | - Kevin M Taaffe
- Department of Industrial Engineering, Clemson University, Clemson, South Carolina, USA
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Abstract
The practice of plastic surgery has become more complex. As plastic surgeons face the postgraduate realities of contracts, negotiations, and health system employment, they are frequently unprepared to effectively manage these challenges. Furthermore, many plastic surgery training programs do not emphasize real-world business and policy concerns in residency training. Plastic and Reconstructive Surgery endeavors to provide robust conceptual education and guidance in business and policy to help both private practice and academic plastic surgeons participate in, lead, and shape the future of health care.
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Zepeda-Lugo C, Tlapa D, Baez-Lopez Y, Limon-Romero J, Ontiveros S, Perez-Sanchez A, Tortorella G. Assessing the Impact of Lean Healthcare on Inpatient Care: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155609. [PMID: 32759705 PMCID: PMC7432925 DOI: 10.3390/ijerph17155609] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/23/2020] [Accepted: 07/29/2020] [Indexed: 12/16/2022]
Abstract
Healthcare services are facing challenges in increasing their efficiency, quality of care, and coping with surges in demand. To this end, some hospitals have implemented lean healthcare. The aim of this systematic review is to evaluate the effects of lean healthcare (LH) interventions on inpatient care and determine whether patient flow and efficiency outcomes improve. The review was performed according to PRISMA. We used six databases to search for studies published from 2002 to 2019. Out of 5732 studies, 39 measuring one or more defined outcomes were included. Hospital length of stay (LOS) was measured in 23 studies, 16 of which reported a reduction, turnover time (TOT) decreased in six out of eight studies, while the turnaround time (TAT) and on-time starts (OTS) improved in all five and seven studies, respectively. Moreover, eight out of nine studies reported an earlier discharge time, and the boarding time decreased in all four cases. Meanwhile, the readmission rate did not increase in all nine studies. Lastly, staff and patient satisfaction improved in all eight studies. Our findings show that by focusing on reducing non-value-added activities, LH contributed to improving patient flow and efficiency within inpatient care.
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Affiliation(s)
- Carlos Zepeda-Lugo
- Facultad de Ingeniería, Arquitectura y Diseño, Universidad Autónoma de Baja California, Ensenada 22860, Mexico; (C.Z.-L.); (J.L.-R.)
| | - Diego Tlapa
- Facultad de Ingeniería, Arquitectura y Diseño, Universidad Autónoma de Baja California, Ensenada 22860, Mexico; (C.Z.-L.); (J.L.-R.)
- Correspondence: (D.T.); (Y.B.-L.); Tel.: +52-6461750744 (D.T.)
| | - Yolanda Baez-Lopez
- Facultad de Ingeniería, Arquitectura y Diseño, Universidad Autónoma de Baja California, Ensenada 22860, Mexico; (C.Z.-L.); (J.L.-R.)
- Correspondence: (D.T.); (Y.B.-L.); Tel.: +52-6461750744 (D.T.)
| | - Jorge Limon-Romero
- Facultad de Ingeniería, Arquitectura y Diseño, Universidad Autónoma de Baja California, Ensenada 22860, Mexico; (C.Z.-L.); (J.L.-R.)
| | - Sinue Ontiveros
- Facultad de Ciencias de la Ingeniería, Administrativas y Sociales, Universidad Autónoma de Baja California, Tecate 21460, Mexico;
| | - Armando Perez-Sanchez
- Facultad de Ciencias de la Ingeniería y Tecnología, Universidad Autónoma de Baja California, Tijuana 22260, Mexico;
| | - Guilherme Tortorella
- Department of Systems and Production Engineering, Universidade Federal de Santa Catarina, Florianópolis 88040, Brazil;
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Reducing instruments in a vitrectomy surgical tray: cost savings and results from a major academic hospital. Int J Retina Vitreous 2020; 6:12. [PMID: 32566250 PMCID: PMC7301997 DOI: 10.1186/s40942-020-00215-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 03/21/2020] [Indexed: 11/17/2022] Open
Abstract
Background Unused or rarely used instruments in standard surgical trays can unnecessarily increase costs. Prior studies have demonstrated the practicality and cost savings of reduced instrument tray sizes in various subspecialties. This study describes results and estimated cost savings from a reduced instrument tray used for vitrectomy surgery at a large, tertiary academic medical center. Methods Common usage patterns of vitrectomy instruments by one retina surgeon were reviewed and a reduced instrument vitrectomy tray was created and implemented in successive vitrectomy surgeries. Need for opening the previously utilized larger tray was recorded. Estimated cost savings of the new trays were calculated based upon per instrument sterilization, processing, and instrument replacement costs. Results New vitrectomy trays including just 7 instruments (89% reduction compared to original trays) were created and implemented in 189 successive cases. The original tray was never opened. Estimated cost savings from saved sterilization and processing resources is approximately $9588 per year. Assuming 5- and 10-year lifespan per instrument, annual cost avoidance is projected at $7886 and $15,772, respectively. Other indirect benefits relevant to healthcare quality were also noted. Conclusion A reduced instrument tray can be successfully implemented for vitrectomy surgery and can result in significant indirect benefits as well as direct cost savings from reduced sterilization costs. Our study highlights the substantial impact made by evaluating the usage pattern and making appropriate instrument tray changes for just one retina surgeon. Applying these same methods to other surgeons and specialties can have significant implications on healthcare costs and quality.
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