RIGHTSIZING Good things will happen when you eliminate all the unnecessary items from your instrument trays.

The key to improved OR efficiency might be hiding in an unlikely place: your overcrowded instrument trays. It's amazing how many good things have happened since we launched our build-to-order process and eliminated unnecessary items from our trays. For starters, sets are easier to assemble. We've improved throughput in the sterile processing department, so much so that we rarely have to delay start times because sets aren't back to the OR. We've also downsized many cumbersome instrument trays and decluttered our reprocessing area. And perhaps the most pleasant surprise of all: The OR and sterile processing are pulling in the same direction. All this from rightsizing our instrument trays, only filling them with the tools surgeons routinely use.

Who's using what?
How many of the instruments that your sterile processing techs clean, sterilize, repack and send to the OR get used? To find out, sit down with a willing surgeon and review his instrument preference list. Ensure the list is current and that every item on the list is sent to the OR for his cases. Next, have surgical techs go line by line down the list to note which instruments were used during cleanup after each case. Tracking real-time instrument usage for an extended period will provide an accurate idea of which tools surgeons really need. You might be surprised by the results. For example, we discovered that 60% of instruments contained in our sets were rarely used during orthopedic cases.

It's a meticulous and labor-intensive process to pick through individual instruments sent to the OR in order to separate used from non-used items, but being that deliberate is the only way to ensure you have the accurate information that's needed to make real change happen. When you're changing hearts and minds, especially in the OR, you have to drill down to the details in order to make your case.

Build a reliable process
When you share the instrument usage data with surgeons, highlight the instruments listed on his preference card that go unused. This will pave the way for you to stress that every instrument he might possibly need doesn't have to be included in the set that's delivered to the OR. But it's important to assure him that when he calls for a rarely used item, it will arrive clean and in good repair in a matter of minutes. Rightsized instrument trays work only if you build that type of reliability into the program.

After surgeons have used streamlined instrument sets for a while, ask him how many times in his last 10 cases he's had all the needed instruments in the room, ready for use. You need to keep your promise of supplying him with the instruments he needs, and keep that promise with high levels of quality.

Beware of a misconception you might have to debunk. When we proposed the build-to-order program, our surgeons thought they all needed to use the same standardized instrument sets. There were objections until we told them we were keeping single instruments in storage and compiling sets as needed per preference cards, plus pulling surgeon-specific instruments. That's when we started to get more buy-in. The more deliberate and trustworthy you make the process, the more surgeons' mindsets will change. Our surgeons are now thinking: What do I really need in the OR during my cases? They're working with us to eliminate even more unneeded items.

INSIDE THE NUMBERS
Staggering Stats of Rightsized Instrument Trays

GROUP EFFORT (left to right) Sterile processing techs Shelley Rosete, Jon Laigo and Kellie Gordley have been key players in Virginia Mason's success with build-to-order instrument sets.

When Virginia Mason in Seattle, Wash., decided to custom-build instrument trays based on the items surgeons regularly use, they realized some dramatic improvements in inventory management and case setup efficiencies. Check out these eye-popping numbers:

• 42% reduction in instrument set assembly time for neurosurgery
• 26% reduction in instrument inventory for neurosurgery
• 58,728 unnecessary instruments weighing 29,480 pounds removed from annual reprocessing
• 14 minutes slashed off instrument assembly time in sterile processing for laminectomy cases
• 22 fewer minutes spent on OR set-up before laminectomy cases
• 33% decrease in instruments sent to the OR for total knee cases

— Daniel Cook

Our reprocessing area is much neater now with slim-downed trays. We can dedicate more space in a landlocked basement to instrument care in order to keep pace with increases in case volumes.

More cases, fewer complaints
Start your built-to-order crusade with a single service line and a willing doc, and spread the program through all of your specialties with hard data and storytelling about proven results. Most of our surgeons now want their instrument sets built to order. Plus, the phone isn't ringing and meetings aren't scheduled to deal with conflicts between the ORs and sterile processing. Gone are the complaints from the surgical team that they could perform more cases if only staff in sterile processing increased its throughput. Throughput has increased, now that we've eliminated unnecessary instruments from the mix. OSM