Steps in the Management of Surgical Instrumentation

Next, you must educate the schedulers to understand how over-booking causes shortcuts to occur, all in the name of keeping surgeons happy. Schedulers generally do not know how much instrumentation is in the system and make decisions based on pressure to get the case scheduled. They also have the ability to skip the instrument conflict without approval which should not be allowed. When the scheduler gets an instrument conflict they need to contact SP or the instrument coordinator for approval. An experienced instrument coordinator will be able to make necessary adjustments to meet demand or make the decision that it cannot be done in the name of patient safety.

Included in step three is building a conflict time for every instrument and piece of equipment in the OR. Steam and Sterrad items generally take about the same amount from decontamination to sterilization to placing them on the shelf for use; about three-and-a-half hours total for one item. This is measuring sterilizer operating times and any manual times associated to one item along with automated washers.

This time is associated to every step in the process, from receiving in decontamination, disassembly, manual washing, sonic, automated washer, cooling, drying, preventive maintenance (PM) testing, assembly, and sterilization, including putting items back on the shelf for the next case. The problem is that we do not process one item at a time. To ensure that we are maximizing through put we need to manage fully loaded washers and sterilizers.

The result is the need to measure wait times which are associated to filling the washers and sterilizers. This time varies depending on the daily schedule and complexity of the instrument sets coming through the system. Disassembly and assembly of instruments as well as pre-package PM testing is also part of this time and should never be shortened.

Time is also associated to the ratio of the number of washers, sterilizers, washer/sterilizer carts, and the instrument inventory, or the lack thereof. It’s not as difficult as it sounds. Your average 350-bed hospital completing 10,000 to 15,000 surgeries per year may have a total time of about 4.5 hours, which becomes the equipment conflict assigned to every instrument or instrument set in the OR scheduling systems inventory database, about 1,250 total items.

By adding this time to the OR scheduling systems conflict checker the schedulers now know that when they get an equipment conflict they have to get approval from SP and may have to re-schedule and not over-book.

Before implementing an equipment conflict time you will need to educate the OR staff, including surgeons, as to how long your processing time is. They will understand this when presented to them in a professional manner. Remember, surgeons and OR staffs truly have little knowledge of SP problems and challenges until we teach them. Understanding how to use conflict checking is one of the many aspects of SP that is overlooked due to our lack of involvement with the OR and the surgical instrument inventory.

Once implemented, your processes in SP will almost instantly improve. You will find the tray errors and lost instruments will almost completely stop. SP staff will be less inclined to take short cuts and surgeons' complaints will decrease.

Step 4:

SP must know as much as possible regarding the surgeon preference card and the supporting data management in the OR scheduling system. Descriptions in the OR system must drive the count sheet, shelf label and package label, and they all must be the same. If you are using an automated instrument tracking system, the description in it must be derived from the OR preference card system without exception. Assigning the instrument and equipment data-building for the preference card should also be part of the surgical materials management function.