The beauty of today's automated instrument tracking systems is, as one company puts it, being able to locate trays and instruments in seconds using barcode scanners and keystrokes, not search parties.

The sterile processing department provides a critical support function for surgery. Yet many hospitals and surgery centers still lean on an outdated manual routine to track surgical trays and instruments. The result: lost or misplaced inventory, too many unused instruments in trays, inconsistent preventive instrument maintenance and sketchy infection control information.

In my sterile processing department, we used to spend two to three hours of any given day just looking for instruments. Were they pulled for another case? Did an emergency come in? There was no ability to search, other than walking to the storeroom and going through the case carts to find where the equipment might be. That all changed when we invested in an automated instrument management system. It lets us track instruments and sets anywhere in the work cycle - from decontamination and assembly to sterilization, the OR and the patient.

At least four major manufacturers have systems on the market that have a specific focus on real-time instrument management (see "A Snapshot of Automated Inventory Management Systems" to compare your options). They include Impress Scan from Cardinal Health, Censitrac from Steris and Censis Technologies, T-Doc from Getinge and Tray Controller from Stryker Instruments.

Automating the OR supply chain
Depending on how much your center has spent on instruments, your tracking system may pay for itself in days. Take, for example, its ability to prevent costly errors, like when the new staffer destroys a $12,000 instrument by steaming it instead of gassing it. It happens more often than you'd like to think.

My instrument management system offers many other time- and money-saving advantages. The benefits of the automation far outweigh the few extra seconds it takes to scan the equipment. You'll know more than was ever possible to know when you track, or try to track, your instruments manually.

• No more lost instruments. Since your instruments are scanned into the system wherever they are in the processing cycle, you'll know where supplies are located at a moment's notice.
• Accurate and complete sets. A count-sheet feature lists which instruments belong in a set, item-by-item. Match your instruments with their pictures on the computer screen to double-check your accuracy. It's a useful tool for training new employees, too.
• Documentation. Your system can keep records of your sterilization process - where, when and on whom the instruments were used - showing evidence that you're keeping up with various agencies' regulations. Considering the threat of Creutzfeldt-Jakob disease and other infectious diseases, it's important to be able to trace instruments to a patient and procedure. If your facility did not have a tracking system when an infection occurred, you could be forced to replace millions of dollars' worth of instruments.
• Utilization. If you're only using 75 of 100 instruments in a set for a given procedure, you'll know. You can streamline your sets to include fewer instruments, saving time and money on sterilization. You'll also see where you can put those extra instruments to better use in other sets.
• Prevent errors. Our system alerts us when we scan instruments to be sterilized that need special handling. It also warns if you need to run a biological indicator.
• Repair and maintain. Take the guesswork out of keeping instruments in good working order. You can set your system to note a number of uses or days an instrument can be used before it's sent for repair or maintenance. If you want your scissors sharpened after 10 uses, for example, the tenth time the pair of scissors is scanned in assembly, the system will say that it needs to go out for maintenance. Then it won't let you put it in a set until after it's been scanned back from repair. This sure beats the old way of placing a sticker on an instrument and hoping someone notices it's time for a needed repair. This feature centralized our process: Now all instrument repairs come through my sterile processing department.
• Run reports. Collect your data to see trends and efficiency not available through a manual tracking system. Track the productivity of your staff - you can follow what they're doing, how much they're accomplishing by shift, individually or as a group. Take that information to plan a more efficient use of your staff and their time. Some common reports include sterilization information, productivity, lost instruments and turnaround time.
• Vendor neutral. You can buy your instruments from any vendor and they'll still be compatible with the major manufacturers' systems.
• Upgrades and support. The manufacturers offer upgrades to their systems as part of their original service contracts, so there are no additional costs when better technology comes out, they say. Technical support is offered 24/7. Even Web-based systems are secure.

Making the change
Many of the manufacturers offer varying degrees of help to implement their systems, including the marking of your instruments. To ease the transition, implementation can be done in phases. For some of the basic systems, implementation may take as little as a few weeks. For the more advanced systems, it will usually take at least three months. Some tips:

• Rally the team. It's going to have to be a collaborative effort to be an effective one. From the OR staff to the sterile processing department, everyone has to scan the instruments along the way, or you'll lose your data and tracking of where things are located.
• Plan ahead. Take a physical inventory if you've never done one before. Plan much more time than you think you'll need; I can't emphasize that enough. If you think it'll take 30 days, allow 60. If you think it'll take 90 days, allow 120.
• Be patient. I admit: it's certainly labor intensive to mark all the instruments with barcodes and enter all of their information into the system. We have 1,400 instrument sets and more than 60,000 individual instruments. We've gotten all our sets marked, but we're still plowing through the individual instruments (we have 15,000 of our individual instruments marked and entered). Be aware that you'll have to look up older instruments in catalogs; because of a lack of identification numbers, it will take longer to enter them into the system.

The wave of the future
Manufacturers say that they're already working on the next generation of instrument tracking systems. Instead of using barcodes to track instruments, the manufacturers are developing a tracking system using radio frequencies.

Radio frequency, or RF, identification will take the human element - and with that the human error - out of the system altogether. When an instrument that's been tagged enters the room, the system can track it through an antenna placed by the door or a handheld wand that's swiped above it. RF identification is currently being used in Europe and is beginning to grow in popularity now in North America.

A Snapshot of Automated Instrument Management Systems

Cardinal Health
Impress Scan
(800) 323-9088
www.cardinal.com/vmueller
List price: Not provided.
FYI: The Impress Scan Instrument Management System is part of the company's V. Mueller product line. It uses barcode technology to let techs scan sets, peel packs and individual instruments to case carts, ORs and patients. It tracks single instruments through individual barcoding, including its InfoDot labels for even the smallest instruments. The V. Mueller catalog database, which contains more than 15,000 products, is included in the system, making available all its product images, descriptions, item numbers and hospital pricing. It's also compatible with other vendors' equipment, though you must upload information about those products yourself, says Cardinal. You can access the system at any time from anywhere because it's wireless and based online. Its multi-site capability is ideal for facilities that want to transfer sets to their sister hospitals or joint-venture ASCs, says Cardinal.

Steris/Censis Technologies
Censitrac
(888) 877-3010
www.censis.net
List price: Not provided.
FYI: By integrating touchscreen and wireless scanning technology to every workstation, Censitrac lets you track your trays as they move through your facility, says Steris. You can apply a non-destructive laser-affixed 2.5mm by 2.5mm barcode to your mission-critical instruments. The instruments can be marked on site or sent to a Censis-approved marking facility. The company says it has standardized routine locations for the markings on each instrument type. Hardware installation takes less than one hour, the company says. Most of the information needed to populate your facility's database is automatically extracted from the system's global database.

Getinge
T-Doc
(800) 475-9040, ext. 5700
www.getingeusa.com
List price: Inventory management systems start at about $10,000. Add data-logging sterilizers and washers at about $3,000 per machine.
FYI: T-Doc workstations consist of a PC running Microsoft Windows operating software and equipped with barcode scanners and customized label printers. The system can be customized to integrate with your OR scheduling and inventory management systems, and can order goods from external suppliers either manually or based on predefined stock levels. It can log all of your sets in each sterilizer cycle and authenticate each sterilizer cycle for the particular equipment being registered to that machine and cycle.

Stryker Instruments
Tray Controller
(800) 253-3210
www.stryker.com
List price: Not provided.
FYI: Using touchscreen technology and wireless scanners, Tray Controller enables an accurate and efficient process for managing trays and surgical instruments. The company says it's easy to implement, increases accountability, reduces workload and costs and delivers instantaneous documentation and information. An OR scheduling interface communicates surgical tray needs to eliminate delays. Extensive utilization reporting eliminates unnecessary trays, re-deploys instruments and quickens tray turnover.