Instrument Tray Management Made Easy

Customize trays based on procedure and surgeon preference to increase efficiency and make life easier for reprocessing staff.

In outpatient surgery, efficiency and precision are crucial not only for successful patient outcomes but also for maintaining smooth operational flow. One critical yet often overlooked aspect of this equation lies in instrument tray management.

Proper handling, sterilization and organization of surgical instruments can significantly reduce procedure times, minimize the risk of infection and ensure that ORs are prepared for back-to-back procedures as quickly as possible.

Fortunately, innovative tools are available for managing and rightsizing instrument trays that can go a long way toward more fully optimizing outpatient surgery workflows.

Care and customization

Customization of instrument trays to suit specific procedures is a concept that is on the rise. This trend is helping to facilitate greater efficiency and accuracy during surgeries, as trays are tailored to the exact needs of the procedure and the surgeon. Standardizing instrument trays for common procedures can streamline workflows and reduce setup times.

Donald B. Yoo, MD, medical director of HALO Beverly Hills (Calif.) Surgery Center, notes that most surgeons have a set routine for the surgeries they perform, which includes a very specific set of instruments upon which they rely. The key is removing the instruments they don’t regularly use, which relieves burden on sterile processing staff and keeps those tools sterile, while still ensuring infrequently used instruments are easily accessible if needed intraoperatively — just not as a standard part of the tray.

“Customizing outpatient trays for specific surgery procedures allows the operating surgeons to effectively eliminate variables and potential stressors, allowing them to focus solely on the patient and the most effective surgical techniques to care for them,” says Dr. Yoo. “Each surgery has a rhythm, and nothing disrupts the flow of surgery more than hunting for an instrument.”

The surgeon’s role

JUST RIGHT Surgical facility leaders should open a dialogue with their surgeons to find out how the center can right-size their standard instrument trays.

Dr. Yoo says that leaders at surgical facilities would be well-served by opening a dialogue with their operating surgeons about how to right-size their standard trays. By securing your surgeons’ direct input, your center can more confidently create specialty surgical trays that contain the most common and fundamental instruments, and also include more specialized instruments that specific surgeons prefer.

Kari Geyer, MBA, BSN, RN, clinical director and administrator at Precision Ambulatory Surgery Center in Fort Worth, Texas, says one key benefit of customizing instrument trays for outpatient surgery procedures is that it optimizes instrument standardization while reducing variations in surgeon preferences per case.

“This allows staff to streamline workflow processes that improve efficiency in turnover and sterile processing times while reducing time spent identifying instruments located in separate peel packs or stored in different locations,” she says. “Having customized instrument trays affects efficiency and patient outcomes by reducing patient time in the facility, increasing patient safety correlated to surgeon comfort with instruments, and reducing staff burnout.”

One best practice in selecting essential instruments for customized trays is to perform a market analysis on vendor options based on surgical specialty in order to determine which instruments are vital to have in trays, guided by a goal of reducing wasted sterile processing resources on unused instruments.

“Collaborate with your surgeons by allowing them to have a voice in preferences,” says Ms. Geyer. “Have them utilize the instruments in a real setting by asking reps to bring in samples and gain a better understanding of comfort versus cost to discuss prior to purchasing in bulk.”

Making a difference

To improve its instrument tray management and turnover times, leaders at Precision ASC performed a gap analysis of their sterile processing workflow. The exercise proved worthwhile, as they discovereda delay in instrument readiness that was leading to delays in surgical start times.

“We identified that it was best to pull instruments from trays that were not being consistently used in each case and shifted those items to peel packs, as well as only placing instruments in trays based on physician utilization during surgical cases,” says Ms. Geyer. “This reduced our tray prep time by half and increased our employee satisfaction, as they felt their workflow improved. We kept the other instruments stored in a specific location to easily access in the event they were requested.”

Precision ASC had been experiencing one of those nice problems to have: a rapid increase in patient volume. The downside, however, was sterilization delays that found OR staff waiting for instrument trays, resulting in inefficient workflows and frustration. To enhance efficiency, the center bolstered its resources not only by adding support staff for pre-op and room turnovers but also by purchasing eight additional surgical instrument trays that were then incorporated into its rotation. These additional optimized trays minimized sterilization wait times, and as a result essential instruments were readily available for each procedure.

This strategic addition, notes Ms. Geyer, allowed the ASC’s surgical teams to operate much more smoothly without delays. The new trays contributed to a reduction in pre-op times from 40 minutes to 18 to 20 minutes, while OR turnover times plunged from 20 to 25 minutes to under 10 minutes.   “The enhanced availability of instrument trays not only boosted operational efficiency but also fostered a sense of teamwork among staff,” says Ms. Geyer. “Positive patient feedback further underscored the impact of these improvements on overall service quality.”

The ASC also switched from plastic instrument trays to metal trays to increase their lifespan and better ensure patient safety.

Staying compliant

Just because a tray is standardized doesn’t mean that the manufacturer instructions for use (IFUs) for the instruments contained in them are. Facilities should ensure that all of the instruments in their standardized trays stay within regulatory and safety compliance by performing quarterly reviews of their IFUs, which all too frequently change without notice.

Ms. Geyer says these IFU reviews for instruments on standardized trays can be very time-consuming, but are best practice, as most manufacturers do not report when updates are made. (Read how the Association for Professionals in Infection Control and Epidemiology (APIC) has launched a large-scale effort to address this and numerous other persistent issues with IFUs in our August Special Edition.

“Customizing outpatient trays for specific surgery procedures allows the operating surgeons to effectively eliminate variables and potential stressors.”
Donald B. Yoo, MD

To address the lack of communication from vendors about IFU changes, Precision ASC created an instrument log in which staff maintain records of every IFU, along with the exact websites or resources to visit to look for updates.“This reduced time in locating the information, and the log allows staff to understand when the last round of safety checks was completed,” says Ms. Geyer. It’s also a good idea for instrument trays to be reviewed or updated regularly to address changing surgical practices or integrate new surgical technologies.

Overcoming challenges

A common difficulty facilities face with instrument tray management is inconsistencies in surgeon preferences. In cases where your surgeons “can't or won't” come to a consensus on what should be in the trays, consider using the preference cards for each surgeon to individualize the trays for their respective cases.

Another common challenge is understanding the IFU guidelines to ensure compliance, as some can be confusing or not clearly written.

“It is always best to reach out to the manufacturer or collaborate with your local rep for better understanding of compliance with regulations regarding a product,” says Ms. Geyer.

Another factor to keep in mind after trays are standardized is to maintain proper working order of the instruments themselves. “Proper training of operating room and sterile processing staff, and constant input from surgeons and surgical technologists regarding the identification of instruments needing sharpening or repair, are paramount to continued efficient operation,” says Dr. Yoo.

Tracking systems

An effective tracking system is very beneficial in identification of instruments used on each tray for specific procedures, as it allows staff to standardize charting in patient records and reduce unnecessary time locating pieces of information in electronic records.

“It also allows for the opportunity to manage reports more efficiently, such as the tracking of instrument tray logs,” says Ms. Geyer. “Creating an efficient workflow allows staff to spend more time on other essential tasks and creates a healthier work environment that is more organized and structured.”

Money matters

Outpatient surgical facilities have less resources available to them than found in larger hospital settings, and typically operate with lean staffing, including individual team members who are cross-trained to handle various aspects of the overall workload. By optimizing instrument trays, outpatient surgery centers can reduce time these extremely busy staff members spend locating various instruments. This, in turn, can help ASCs reduce staff turnover due to burnout, and lead to increased staff retention due to higher employee and physician satisfaction.

Tech talk

Technology plays a crucial role in instrument tray management, as it helps improve time management and provide easier access to resources for identifying and tracking measures that can be customized as well as used for inventory control and other purposes.

“Most outpatient settings have multiple staff members who need quick access to this information, and technology allows them to utilize these resources that helps identify information in a structured manner,” says Ms. Geyer. OSM