Business Advisor: Tray Rationalization Creates Big Savings

Concerns from surgeons and nurses about the quality of our instruments forced us to determine the root cause of the issue. First, we had to find out if it was related to the tools simply aging out or if the sheer volume of instruments that needed to be reprocessed on a daily basis impeded our staff’s ability to handle and care for them properly — or both. Furthermore, given the high variety of procedures performed in our facility and the preferences of numerous physicians as to what instruments should be in the sets, reaching a consensus was difficult. 

After deciding to reduce the number of instruments in our trays and refresh the ones that remained, we wound up removing nearly 10,350 tools from 40 high-volume trays. Eliminating rarely used items instead of paying to maintain or replace them saved our facility $530,000. We project that not having to reprocess the little-used instruments that were removed from the trays will save nearly 800 hours of staff time a year, which equates to an annual savings of about $10,600. We also decreased the amount of space needed to store sterilized trays. Here are the steps we took to realize those meaningful results.

• Track instrument usage. Focus your attention on trays that contain at least 40 instruments and observe cases in which they’re brought to the OR 
to determine how many of the instruments are used. To help with this data collection, we hired a company that specializes in instrument rationalization and utilizes a cloud-based technology program that breaks down the percentage of cases in which surgeons use individual instruments. The results of the analysis identified instruments in trays that were used less than 20% of the time. When the project was over, nearly 20% of the instruments from each tray had been removed. 

This analytics approach is far superior to relying on perceptions or opinions to determine which instruments should stay or go. During this process, some surgeons identified instruments as must-keeps that the analytics showed were used only 1% or 2% of the time. After some discussion, most of those instruments were eliminated. Having access to usage data helped convince the surgeons to remove the tools.

• Trial the new sets. Review the results of the data-driven analysis with service coordinators from each surgical specialty and create newly optimized trays. Trial the new tray configurations in the OR, audit the usage of the tools and make adjustments as needed. Have service line coordinators review the final tray configurations before physician champions give the changes their stamp of approval.

This step in the process can be challenging and might involve a lot of back-and-forth before a consensus is reached. Getting numerous surgeons, each of whom has preferences for different instruments, to agree is one of the biggest challenges when it comes to standardizing trays. Physician champions who are on board with the project will help to get their colleagues to compromise and reach final agreements. The physician champions must be steadfast on the importance of reducing the contents of trays and explain why this approach is better and less expensive than buying new instruments or allocating resources to reprocess tools that are rarely used.

Deciding which trays to rationalize can be difficult in and of itself. It makes the most sense to focus your efforts on the most-often-used ones. We were correct in our assumptions that the contents of vascular, cardiac and thoracic trays could be reduced, but we looked at two ophthalmology trays as well, and ultimately opted to not remove anything.

• Make the changes. Communicate the contents of the new trays with the sterile processing department (SPD) so reprocessing techs know how to configure the updated sets before sending them back to the ORs. To make the transition as smooth as possible, we created a checklist that outlined the responsibilities for each service line coordinator, the instrument liaison from SPD, the preference card coordinator and the materials manager. These staff members assisted the SPD staff with building the new configurations of the trays.

It’s important to set specific parameters on the amount of time staff have to reconfigure the trays you want to change. We made sure all the trays that had to be converted were done so within a two-day period because trays for the same procedures in use with different configurations would have caused confusion. We pulled the trays the day before they were to be converted to expedite the process and made sure the conversions were scheduled on low-volume operating days, so the effort didn’t interfere with patient care.

The rationalization of our instrument trays produced multiple additional benefits. We repurposed almost 950 instruments that were removed from the trays to bolster our pegboard inventory and resolve gaps in quarantine carts. We also transferred some of the tools to other facilities within our healthcare system. Back table setup times decreased by nearly three minutes for vascular procedures and by almost four minutes for cardiac cases. The reduced weight of individual instrument sets benefitted surgical team members and reprocessing techs who transport trays between the ORs and SPD. Nurses appreciated not having to count and prepare instruments that aren’t often used during surgery. 

Given the increasing cost constraints in health care, we found that instrument tray reduction was an untapped resource for savings. We continue to look into instrument rationalization for other service lines and plan to consolidate additional trays that could result in even more cost containment. OSM