OR Manager August 2022 - 10

Cost Savings
Instrumentation
Continued from page 1
" We were already
done with the project by
the time COVID started.
During the pandemic,
we were able to reap
the sustainability of it, "
says Rebecca Urban,
MEd, former project
manager
for
the duration
of the project. Urban is currently
department administrator for the GYN
subspecialty in the Women's Health Institute
at Cleveland Clinic.
Sources of waste, duplication in
trays
Both health systems had been struggling
with instrumentation duplication
and waste issues stemming in part
from poor communication among surgeons
and staff.
Instrumentation build-up can happen
over time, increasing the size of the
tray and strain on the OR and the sterile
processing department (SPD), says
Urban. Some instruments are added in
for " just in case " circumstances. New
surgeons may also have a list of instruments
they want added to the trays.
Thomas Jefferson, which includes
Rebecca
Urban, MEd
18 hospitals and 50+ outpatient and urgent
care locations, had no guidance on
tray build and maintenance. Surgeon requests
to add items to trays were being
processed without any checks and balances,
and there was no monitoring of
instrument utilization or technicians to
track underutilized instruments.
Instrument pro -
cessing is expensive,
amounting to $58 a tray,
says Erin Kini, MSN,
RN, CNOR, former case
carts/project manager
SPCC at Thomas Jefferson.
Kini currently works
at Medical-Legal Consulting,
LLC in East Norriton,
Pennsylvania.
problems related to instrumentation
tray costs and production. Digital collaboration
is not usually the normal protocol
at hospitals. " We had Microsoft
Teams in place for a while, but did not
use it that much, " says Kini.
The pandemic set in motion an optimal
setting for a virtual platform: people
working from home; decreased revenue;
underutilized nurses and surgeons;
technicians available for virtual projects;
and trays available for evaluation. As
elective case volumes dropped, a need
arose to rapidly deploy nurses to alternative
assignments with a return on
investment.
Erin Kini,
MSN, RN,
CNOR
The hospital was also grappling with
waste issues. Some unopened trays
were not being used, and there were
reports of tray assembly errors. Some
trays were overweight and difficult to
carry. Excessive instrumentation leads
to risk of bioburden and wet load, impacts
processing time and costs, and
impairs the ability to meet demand,
intraoperative setup, and count time,
Kini explained during her presentation
at ORMC 2021.
Surgeons had limited free time for
input, and it was difficult to schedule inperson
meetings.
Pandemic a catalyst for change
Shutdown of elective surgeries and
added social distancing restrictions inspired
the team at Thomas Jefferson
to create innovative solutions to reduce
costs.
An example of a standardized general
instrumentation set at Cleveland Clinic.
Used with permission.
10
OR Manager | August 2022
Prior to COVID-19, Monica Young,
MBA, RN, DNP, FACHE, CNOR, CASC,
NEA-BC, Thomas Jefferson's vice president
of perioperative services and a
member of OR Manager's editorial
board, had enlisted Kini to investigate
" We thought: there's certainly things
we can do with this time, " says Kini. An
idea arose to create a virtual communication
platform to invite feedback on
instruments. Kini saw this as a useful
tool to leverage surgeons. " I thought I
could pop open a tray, take photos, talk
to physician staff individually, find out
what they're not using in these trays,
and make a list, " she says.
Kini would upload photos and invite
surgeons through virtual meeting rooms
to meet with different teams. There was
a channel space for each service. Surgeons
could view pictures of trays online
and provide feedback in the chat
section. A messaging option facilitated
quick responses and dialogue, and
feedback was integrated into recommendations
to gain surgeon buy-in for
instrumentation reduction.
The hospital also collected data
through polls and surveys to form recommendations
on instrumentation reduction,
allowing for easy sharing of
results through the platform. All teams
were regularly informed of the reduction
project's progress and successes as
well as projected savings.
Kini and her team also appointed
surgeon " champions " to assist physicians
who were not that " tech savvy "
and hesitant to jump on the virtual
platform. The surgeon leaders walked
things through with them, encouraging
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