Steps in the Management of Surgical Instrumentation

Key assets directly related to revenue in today’s surgery departments is the management of a vast inventory of surgical instrumentation, equipment and supplies. Instrumentation, along with rigid and flexible scopes in a 350-bed hospital with a 14-suite surgical unit, can easily exceed $5 million. The number of instrument sets can hover around 400 and account for some 10,000 or more individual instruments that require special attention.

Operating budgets and capital expenses can soar to as much as $500,000 in new and replacement instruments costs annually due to poor management and high use of flash sterilization. The challenge to turn over rooms as fast as possible to achieve that magic number so desired by surgeons to expedite the next case leads to instruments going straight into the trash.

With the added cuts looming on the horizon, hospitals need to shed older-style management structures and become more business-focused on a service-related support system for managing surgical instruments and equipment. Hospital materials managers’ primary area of expertise lies with supply management, ensuring best price and contract compliance with little time or ability to address surgical instrumentation and operating room (OR) equipment. This is mostly due to the sheer volume and logistical nightmares of stocking supplies throughout hospitals.

The ability for hospital materials managers to get into the OR is also not an easy task, which is mostly due to the closed-door environment of surgery and an age-old separation between the two services. Central sterilization (CS) tends to get caught in the middle somewhere between blame and helplessness with little — if any — ability to make positive change, so some would think.

A surgical services materials management program properly structured to include CS can greatly improve surgical throughput and provide valuable data to support future growth while reducing waste. Who knows better than CS the need to manage surgical instruments; after all, CS personnel handle the bulk of them but have little ability to adjust to demand.

Now, to make matters more challenging, there is little benchmarked data to support a ratio of the number of instruments sets needed to support the daily OR schedule. Achieving the correct amount can be difficult and frustrating for all parties involved — surgeons, administrators, nurses, scrub techs and sterile processing (SP) personnel.

Surgeons expect to schedule and complete cases without delays while administrators want to ensure a profit to allow future growth. Nurses and scrub technicians just want to get through a day’s schedule error free with as few complaints as possible, with more focus on patient care than tracking down instruments.

Managing the instrument inventory generally is not related to who should be doing it rather than who wants to do it. Building a surgical services materials management program to include supplies and equipment with SP managing the instrument inventory only makes sense. As it stands, SP handles all of it, more so than any one group ever could imagine.

If given the chance, SP professionals can greatly improve the process when all the steps involved are known and followed. They can also tell you which instruments are in the highest demand due to requests to turn them over and over again.

Too often, key steps are missing because the process is fragmented between SP, surgery, and the number of users of instrumentation throughout the hospital. The emergency department, cath lab, NICU, and nursing units all have instrument management needs but do not want to hassle with it, let alone decide how much instrumentation to have.