OR Manager August 2022 - 11

Cost Savings
them to take part in conversations and
offer opinions.
Through these changes, Thomas Jefferson
estimated it could save about
$190,000 annually, based on per instrument
processing, labor, and volume
costs. As of 2021, Thomas Jefferson
managed to remove 463 instruments
across 42 tray types, reducing on average
11.9 instruments per tray.
Looking at things closer, a previous
spine setup required four trays at an annual
cost of $157,000. The new spine
setup only uses two trays at an annual
cost of $119,000.
Thomas Jefferson is looking at other
creative ways to achieve reduction, such
as tray combination and slimmer alternative
trays. There have also been discussions
to develop a review committee
and formal process, says Kini.
The standardization challenge
At Cleveland Clinic the challenge was:
could teams standardize surgical sets
of instruments by procedure across the
enterprise? The goals were multi-fold: to
decrease variability, eliminate waste; reprocess
25-30% of non-utilized surgical
instruments per date; and store underutilized
sets, improving quality control.
Similar to Thomas Jefferson, Cleveland
Clinic used a teams approach,
bringing nurses, physicians, surgical
technicians, and SPD together to determine
what should be in their trays
and how to standardize their sets, says
Urban. These staff utilize these trays
every day, so they are the best experts
to provide feedback, she adds.
Each institute at Cleveland Clinic
evaluated their trays as a group. Urban's
team worked with them to determine
how to reduce instrumentation on
trays. The goal was to standardize trays
for specific procedures, such as chronic
ear and major/minors, as well as reducing
waste in trays. The teams approach
was all about reconciliation-to choose
and keep instruments used in the majority
of cases, and group other instruwww.ormanager.com
ments
in the " as needed " pile.
In a creative move, the clinic developed
an " instrument depot " for housing
instruments removed from trays. " This
helped us reduce expenses by not having
to purchase instruments, " explains
Urban. Cleveland Clinic also standardized
to a primary vendor to reduce the
variances of instruments in its trays.
Instrumentation
build-up places
undue strain on
OR and sterile
processing teams.
$5 million in savings
Cleveland Clinic managed to save $5.1
million under this strategy. To date, the
health system has removed more than
51,000 instruments and 672 unique
trays, reducing tray size by 30%, reported
Urban and Carol Pehotsky, DNP,
RN, CPAN, ACNS-BC, NEA-BC, associate
chief nursing officer, surgical services at
Cleveland Clinic, at ORMC 2021.
The changes elicited positive feedback
across staff. One lead surgical
technician said the project streamlined
efficiency and productivity. OR staff had
fewer instruments to open, and SPD
had fewer instruments to manage.
" It's a win for patients and caregivers, "
says an OR nurse on the team
who asked to stay anonymous. " It decreased
instruments used and risk of
retained foreign bodies. "
A case study involving gynecology
dilation and curettage (D&C) illustrates
the returns. In a change that spanned
13 regional hospitals and 14 ambulatory
surgery centers, the teams standardized
to one surgical instrument set
per enterprise. This standardized 13
variations of D&C sets from 13 unique
trays comprising 27-56 surgical instruments
at 17 different locations to a
standard set with 27 instruments. Overall,
this strategy removed 1,594 instruments,
reducing variation in care.
Standardizing instruments at each
site made things easier during the pandemic,
when physicians moved from
one location to another. " They could
transition on a dime for those services
because each site had the same trays.
We could best utilize our OR footprint, "
says Urban.
The main goal was to standardize
trays, not save money, but that is what
happened, adds Urban. " Clinical institutes
will say they want to grow a location,
grow service lines. And they will
invest millions of dollars in equipment. "
By pressing " pause " on this impulse
and having those internal conversations,
the clinic was able to move instruments
from one location to another instead of
spending money on new equipment.
Urban says the changes have made
her own job easier. " In my current role,
I'm always trying to move my surgeons
around and recruit new surgeons. So, I
have an appreciation of understanding
what barriers are in play and the importance
of building relationships back to
the OR from the clinical institutes. "
Urban says she is in constant communication
with OR directors and nursing
managers regarding new recruitment,
making sure her team knows
what instrumentation trays are being
used and what is available.
This is what prevents project derailment
or scope creep, she continues.
" If clinical teams aren't communicating
with their new physicians on instruments,
those trays just become heavier
over the years. " ORM
-Jennifer Lubell is a freelance medical
and health policy writer based in
Rockville, Maryland.
Continued on page 12
OR Manager | August 2022 11
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