3 Lessons to Standardize Instrument Sets

Standardizing instrument sets across all service lines has been a major undertaking at Cleveland Clinic, but well worth the effort according to perioperative nurses involved in the project.

Starting in 2019, a team of perioperative leaders (including nurses and surgeons) and led by perioperative project manager Rebecca Urban, MEd, began a comprehensive project to standardize instrument sets based on input from more than 120 caregivers in 10 specialties across 16 different physical locations.

This project began when Cleveland Clinic President and CEO, Tom Mihaljevic, MD, challenged perioperative service leaders to develop one setup of instruments per procedure, across all Northeast Ohio Cleveland Clinic locations, including regional hospitals, ambulatory surgery centers and our main campus, Urban notes. To operationalize this challenge, Urban built a project team of perioperative leaders, including Associate Chief Nursing Officer Carol Pehotsky, DNP, RN, NEA-BC, CPAN, ACNS-BC, Chairman of Enterprise Surgical Operations Mark Taylor, MD, Nurse Manager Kimberly Platt, MSN, RN, and Assistant Nurse Manager Michael Shimmel Jr., MSN, RN. In addition to the leadership team, over 100 caregivers contributed their expertise to the project.

“We knew that standardizing our surgical trays would ensure each item on every tray had a clinical purpose, improving our caregivers’ time to competency and overall work experience,” Urban says.

Standardizing Sets
The primary goal with this project was to make sure surgical instrument sets represented what was needed, not what everyone was accustomed to having. To do this, Urban and the team challenged the standard individualized mindset in favor of a team approach methodology that includes surgeons, surgical techs and sterile processing professionals who were decision makers in their area of expertise.

Instruments were added to the standard set if used in at least 50% of cases. Cost savings opportunities were captured through avoiding the purchase of new instrumentation by using instrumentation removed from sets in the standardization process. 

By applying this methodology, the project team removed 51,000 surplus instruments, and altered how they view, track and adjust inventory. For example, only if tray usage data supported additional inventory, would a tray be added.

“We now have a clearer understanding of our costs, which impacts decisions from supply chain purchasing to scheduling. This methodology can be used not only on surgical instrument sets, but in different areas of the operating room for process improvement, such as disposables,” Urban says.

Lessons Learned
Looking back, Urban and her team attribute several important approaches to achieving their goal of standardizing all instrument sets across 10 service lines.

1. Develop a “team of teams” philosophy.
   Because surgical instrument sets have an impact on teams from different functional areas in a variety of ways, including surgeons, sterile processing, nursing, surgical techs, supply chain and finance, “it was important early on to develop a ‘team of teams’ approach that brought perspectives from each area to ensure we made decisions that not only met our goals, but were also sustainable,” Urban explains. She suggests it is imperative early in the process to clearly define and understand the scope of work, including how many sets will be standardized and who will be involved in discussions to standardize.
2. Think about “surgeon specials.”
   In certain cases, outliers to the standard sets were required, and these, too, required a standardized approach. For example, surgeon specials were decided on by a shared census among surgeons.
3. Identify a timeline for standardizing instrument sets in each service line.
   This is important to map out what sets to standardize, and the specific order to tackle standardization, Urban notes. For this project, she says the length of time spent on each service line varied based on multiple factors including number of trays to review as well as scheduling. The team reviewed over 3,000 trays within one calendar year, beginning with the gynecology surgery service line.

For each service line, experts including frontline nurses and surgeons and team leaders worked with the project team to share ideas for deciding how to standardize instrument sets. “This coordination brought expertise, insight and inquiry into one room and the collective knowledge benefited the entire organization,” Urban says.

With the project complete, the methodology used for standardizing sets is now applied to product evaluation and purchasing for new instruments. “As perioperative leaders, we are expected to answer questions regarding instrument reprocessing, spend and repair costs that impact our patients and our caregivers, as well as the bottom-line—engaging in this process has created a knowledge base and a team of experts to develop and share this knowledge.”

Free Resources for Members

• AORN Journal Best Practices for Streamlining Instrument Sets

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