M. J. Saari1, N. Navas1, P. F. Nichol1 1University Of Wisconsin, School Of Medicine And Public Health, Department Of Surgery, Madison, WI, USA
Introduction: Operating room (OR) efficiency is a focus of intense study. A major opportunity for efficiency and waste reduction is eliminating unnecessary instruments in pans. Elimination of unnecessary instruments has the potential to reduce the workload in sterile processing departments and costs of managing an excessively large instrument fleet. We hypothesized that on average seventy percent of instruments in surgical pans are unused during each surgical operation.
Methods: To test this hypothesis, we conducted direct measurements of instrument usage across various surgical specialties at a full-service children’s hospital with 8 operating rooms between June 2021 and August 2021. Surgical technicians counted the total number of used and unused instruments at the end of the surgical operation and referenced this to the count sheets. Data collection took place on non-holiday weekdays between 7:30 AM and 5:00 PM and included data from nine surgical specialties. Cases that continued past 5:00 PM were excluded from analysis.
Results: Observations were conducted on 328 surgical operations during the observation window. Across nine specialties, instrument usage averaged 31.6 ± 21.1%. A total of 5,564 out of 23,989 instruments were used. Instrument usage was also analyzed by surgical specialty with an emphasis on those specialties with the largest sample size (operations observed): ENT (n = 80; 33.9 ± 20.9%), general (n = 64; 29.2 ± 18.7%), ophthalmology (n = 45; 35.5 ± 22.1%), urology (n = 45; 39.3 ± 20.4%), orthopedics (n = 33; 22.2 ± 25.0%), plastics (n = 30; 26.4 ± 18.6%), and dental (n = 18; 32.2 ± 26.5%).
Conclusion: A majority of surgical instruments are unnecessarily reprocessed. In this study we sampled 328 (1.56%) surgical operations from a two-hospital campus, with a shared sterile processing department, that performs 21,000 surgical operations per year. In the sample 18,425 unused instruments were reprocessed during the observation period (56 instruments per case). Extrapolating these numbers over a year, approximately 1,176,000 unused instruments are reprocessed between the two hospitals. The average cost of sterilizing an instrument varies by institution. However, using a per instrument cost of sterilization of $0.77 calculated by the Virginia Mason system, the cost of reprocessing unused instruments across these two institutions is $905,520 annually. We suspect this estimated cost to be as low as 90% of the actual value. Cases at the children’s hospital are elective and skew heavily towards outpatient surgeries whereas most operations in the adult hospital are inpatient and favor larger pans with more instruments. Regardless, elimination of unnecessary instrumentation is a high value goal in terms of OR efficiency with clear cost savings.