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The loss of surgical instruments has been a major problem for most healthcare facilities for many years. There have been a number of reasons for the high rate of loss ranging from lost or misplaced instruments to outright theft. Until the advent of readily accessible computer systems, there has not been an effective way to track both the use and inventory of surgical instrument sets. In addition to the loss issue, there has been a desire to track both the instruments themselves and the entire process associated with them. The surgical instrument cycle includes procurement, assembly, packaging, sterilization, storage, distribution, utilization in the surgical suite and other clinical settings, and the decontamination process. In addition to the internal processing cycle, it is desirable to track instruments that are in the repair cycle. Throughout this cycle there are many opportunities to lose the instruments. The ideal system must have the capability to track instrument sets through the entire cycle; reduce instrument loss and repair costs; maximize employee productivity; enhance staff training and education; optimize instrument inventory and utilization; and reduce surgical team downtime.
With the advent of the personal computer and today's tracking technologies, there are numerous ways to solve the issue of the "lost surgical instruments." Although the tracking systems were originally designed to track, locate, and control surgical instrument costs, many of the systems also have the ability to track other assets and functions such as specialty instruments, case carts, treatment equipment, and linen. There are systems capable of monitoring the instrument processing cycle including the provision of cleaning and assembly instructions as well as the sterilization and biological monitoring systems.
Many of the non-instrument applications and functions can provide valuable information for case-cart management, equipment control, and charging, and also serve as a dedicated communication and message center. Used in conjunction with a global positioning system (GPS), some systems can precisely locate instrument sets and portable equipment anywhere in your institution's complex.
Today there are instrument tracking systems available from a number of the surgical instrument manufacturers and from systems' integrators. All of the systems offer some method of tracking both the actual instrument sets or containers, as well as providing a variety of instrument, other asset, and staff management tools. Some of the tracking technologies employed include the use of barcode and radio frequency identification (RFID) systems. The RFID system provides management with the capability to pinpoint the location of a given set anywhere in or out of the institution.
Instrument tracking systems have capabilities for the entry and maintenance of all pertinent information related to instruments and their overall management. Individual instruments can be tracked by serial number where appropriate. Instrument sets can tracked through the entire cycle. Information (i.e., problems as well as solutions) can be tied to specific instrument sets to keep everyone informed regarding the instrument or set status.
This is the beginning of the actual tracking system. Instrument orders and repairs can be entered into the overall system and tracked through the procurement cycle. When the order is placed via an automated procurement system, the instruments are tracked from the vendor or manufacturer to the healthcare facility's receiving process and from the receiving department to the end user. The procurement portion of the system should provide the materials management department with the total cost of instrument acquisition and repair for the entire facility. This information can be broken down by department for cost-accounting purposes. Information obtained through this segment of the system will allow materials management to standardize products and vendors where feasible. By consolidating the institution's overall requirements, materials management or other responsible parties can set appropriate inventory levels.
This is one of the most important portions of the instrument tracking system. Most of the systems available today have the ability to track instrument sets throughout the entire processing cycle including the sterilization cycle. Most systems use barcode-scanning technology to facilitate tracking of instruments through the decontamination process; the inspection, assembly, and packaging process; and the sterilization cycle. Should there be problems in any phase of the processing cycle, appropriate corrective action can be taken and appropriate personnel notified. Problems might include items such as missing or damaged instruments. If an instrument should require repair or replacement, the sterile processing department should have the ability to initiate the necessary transaction and track its progress. The systems allow sterile processing management and others to monitor costs associated with the instrument inventory. This is extremely valuable from a cost-savings and budgeting perspective. Should corrective action be required, the sterile processing management has the necessary documentation.
The sterile processing management should have the ability to utilize the system for training and quality control purposes. Sets and individual instruments can be traced to an individual employee. This will provide sterile processing management with the ability to take corrective action and to review the productivity of the department as well as individual employees.
Most systems can also be used as procedural guides for employees assembling the sets. The systems should be capable of showing the employee a photograph of the assembled set, photographs of individual instruments, and specific instruments for proper assembly of the set. This is an invaluable tool for the sterile processing management.
In addition to tracking the movement of an instrument or instrument set through your institution, you also have the ability to interface the systems with other hospital systems, such as patient billing, patient registration, operating room scheduling, and case-cart and materials management. Specific instrument sets can be reserved or allocated to a specific physician, patient, and OR for a specific time and date. These features should incorporate a security feature to limit access to sensitive information to authorized personnel.
Should there be problems with an instrument set from the OR's perspective, the system should have the capability of entering detailed information related to the problem so that corrective action can be taken by the sterile processing management. Problems would include missing, incorrect, or damaged instruments. Corrective action should be communicated to the end user.
As previously mentioned, there are a number of other uses for tracking systems. Two alternative uses that have significant potential in the healthcare setting are the tracking and management of case carts and the tracking and management of portable diagnostic and treatment equipment.
As with instrument trays, there have been many problems associated with surgical case-cart systems. The tracking systems provide the ability to track surgical case carts and the individual components.
This application potentially has more or as much value as the instrument tracking system. Instrument tracking is actually a subset of the case-cart management system. Using the same technology on a broader scale provides an opportunity to track every aspect of the case-cart system. The status of every case cart and its location within the hospital complex is known. Inventory systems can be decremented as items are added to the case cart. Patient charges can be processed accurately and quickly. These systems give the materials management and sterile processing department the ability to track every aspect of the case-cart system.
These systems have the potential to track portable treatment and diagnostic equipment from the time it is issued to a patient until it is returned for reprocessing and return to inventory. The equipment can be tracked through the decontamination process and inventory information can be updated automatically. Department managers have the ability to adjust the inventory level for specific equipment based on actual usage records. And, as with the other applications, the equipment can be charged accurately to the patient.
In summary, the tracking systems have a great potential to reduce or eliminate conflicts between departments over both the quality of the instrumentation and the location of the instruments. Based on the personal experience that I have had, these two issues can be the cause of much consternation and frustration. The equipment tracking capabilities are an area of great potential for medium to large institutions. There is a never-ending battle to accurately track equipment and charges. The GPS technology provides us with an opportunity to manage effectively these vital resources in our healthcare facilities.
John W. Basch is the vice president of Cini-Little Schachinger, LLC, a consulting firm specializing in materials managment, Central Services, and Waste Management for Healthcare.
The new IMPRESS Scan instrument management software from Allegiance Healthcare Corporation, V. Mueller, uses sophisticated bar code technology to provide information on serialized surgical sets and instruments, including location, repair status, and sterilization method. The software also creates reports on inventory, orders, needs projections, set comparisons, productivity, and more.
For more information call V. Mueller at 800-323-9088 or visit the company's Web site atwww.cardinal.com/allegiance.
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