OR Excellence Awards: Financial Management: Less Is More

OR Excellence Ophthalmology Instrument Reprocessing and Care Financial Management Orthopedics

By: Adam Taylor | Managing Editor

Published: 9/6/2024

Share:

This suburban Pittsburgh ASC saved more money by using fewer instrument trays.

The Monroeville (Pa.) Ambulatory Surgery Center faced a significant challenge surrounding inefficient instrument use that led to increased costs and delays in surgical procedures.

Instrument trays were overstocked and contained many rarely used items that were unnecessarily sterilized and washed. Different surgeons used varying instrument sets, and the lack of standardization resulted in inconsistent tray configurations and inefficient sterilizer load utilization. The large, pre-packaged, vendor-specific trays that came into the center often included instruments that weren’t used in many procedures.

The unnecessary sterilization and washing of instruments, as well as the purchase of instruments that wound up unused, negatively impacted the ASC’s budget. The size of the sterilizers at the facility can only process a limited number of trays, and only ones of certain size, so the inefficient way in which the instrument trays were composed led to excessive sterilization loads that in turn caused longer turnaround times for instrument sets that threatened to cause case delays. The unnecessary amount of sterilization and washing contributed to increased energy consumption and generated an inordinate amount of waste.

An initiative to correct the problem, led and driven by the facility’s surgical and sterile processing technicians, reduced instrument tray sizes by 25%, increased sterilizer load efficiency by 15% and reduced instrument washing and sterilization costs by 10%, according to Administrator Jesse R. Hixson, MSN, RN, CNOR.

The comprehensive instrument consolidation project that successfully optimized instrument use and reduced costs earned the Monroeville ASC the 2024 OR Excellence Financial Management Award.

“In addition to the program itself and what it achieved, one of the best parts of this project was employee engagement and how it brought the team together as one toward a common goal of increased efficiency by repurposing instruments and eliminating waste,” says Mr. Hixson. “Surgeons benefit from shorter turnover times, nurses and techs don’t waste time setting up instrumentation that’s not used and sterile processing doesn’t have to assemble unnecessary equipment.”

Honorable Mention: Minute-Shaving Strategies
The Orthopaedic Surgery Center of Panther Creek’s Creative Turnover Solutions
ORX-Financial-Management
QUICK FLIP The OR teams at The Orthopaedic Surgery Center of Panther Creek have shaved significant minutes off their turnover times between cases.

It’s no wonder surgeons at The Orthopaedic Surgery Center of Panther Creek in Cary, N.C., voiced concerns about lengthy turnover times. Cleaning up after one case and before the next one could start was done by the OR team, which was difficult.

After all, the RN and CRNA were already tasked with taking the patient from the OR to the PACU, while the surgical technician and the scrub nurse were taking instruments to the sterile processing department.

The caseload at the small, three-OR facility didn’t justify hiring additional staff, so the current employees got creative. The former practice of turning over the same room before it would be used again was found to take an average of 17.61 minutes, or $810.76 of valuable OR time.

Two new and extremely effective methods were employed.

Fake flip turnovers, where the surgeon goes to another room for the next case and is followed by the same OR team and anesthesia provider while the first room is cleaned, cuts the turnover time to eight minutes, costing $368.32.

The 9.61 minutes shaved off equates to $442.44 in savings.

Real flip turnovers, a better option, are when surgeons go to another room with new OR teams and anesthesia providers waiting for them.

Patients for the second case arrive nearly four minutes before the patient leaves the previous OR, so there’s no downtime and equates to saving the full $810.76 of OR time.

Other changes included scheduling right or left shoulder procedures one after the other to reduce the amount of equipment that needs to be moved, having equipment needed for the next case stored closer to the OR they’ll be needed in and, when needed, moving a monitor at the end of one case when it will be needed on the other side of the room for the next case.

“We have come up with creative ways with limited staff and resources to improve our OR efficiency by lowering turnover times, which saves money and increases provider and patient satisfaction by avoiding delays when we have the space, staff and availability to do so,” says OR Manager Natalie Owens, RN, BSN.

—Adam Taylor

The project team collected data on instrument use, sterilization cycles and instrument washing costs over a six-month period prior to implementing the program. Rarely used instruments were identified, nurses and surgical techs met with surgeons to gather information about what instruments they could and could not live without and leadership met with vendor representatives about how trays could be made smaller and customized for specific procedures, particularly total joints surgeries.

The contents of the instrument trays were reduced and standardized. Rarely used items were repurposed into other trays. Staff was trained about the new tray configurations and a monitoring system that includes staff surveys was created to ensure the program stays on track and looks for ways to continue to improve. Mr. Hixson estimates the initiative has saved the facility, which is part of the Allegheny Health Network, about $45,000 so far. He says the project highlights the importance of collaboration among surgeons, nurses and surgical and sterile processing techs. In this case, the cooperation and data-driven work produced a sustainable approach to improving OR efficiency and reducing costs.

“Our next step with this program is to work closely with the total joint vendors to create size-specific trays that easily fit into the sterilizers,” notes Mr. Hixson. OSM

Honorable Mention: Goodbye to the Single Life
Saving $$$ With Multi-use Eyedrops
ORX-Financial-Management
EYES ON SAVINGS Going from single- to multi-use eye drops bolstered Rancho Cordova Eye Surgery Center’s bottom line and reduced its carbon footprint.

The switch from single-use drops saved money and reduced waste with no dip in patient outcomes.

The two-room Rancho Cordova (Calif.) Eye Surgery Center was using only three drops from each bottle of the single-use eyedrops it used to dilate patients in pre-op prior to cataract surgery. The bottle and the rest of its contents was then thrown away.

Leadership and staff knew that unnecessary waste of perioperative eyedrops increases the cost and carbon footprint of ophthalmic surgery and has contributed to periodic drug shortages. So Rancho Cordova made the switch to multi-use vials in June 2023, with great success.

Before the switch, the facility was using an average of 132 single-use vials per week. By October 2023, that number was down to 47 multi-use vials — 85 fewer than before.

“After implementing our multi-use drops policy and evaluating data over a four-month period, bottle ordering decreased by 63% and cost decreased by 53.3%,” says Hayley Murphy, BSN, RN, the facility’s assistant nurse manager. “We did not see any significant spikes in infection or complications during this period with implementing this protocol.”

When patients aren’t dilating at home, they save money not purchasing full bottles of drops at the pharmacy. Plus, they aren’t arriving at the center dilated, a condition that presents safety issues and makes reading consent forms difficult. By using multi-use drops at the facility, the national shortage of dilation drops is decreased, as is the large amount of plastic waste from the vials and the waste of substantial amounts of the medication itself.

The highly educated and talented nurses at Rancho Cordova continue to refine this and other programs at the facility and share their protocols with other local leaders who may want to use them.

“This project demonstrated the importance for nurse involvement in cost-savings decisions within healthcare to maintain the highest quality standards in the clinical setting,” says Ms. Murphy.

—Adam Taylor

Related Articles

Focus on What’s Necessary at Year’s End

Outpatient Surgery Editors 12/20/2024

The holiday season can throw some employees off track, draining their levels of engagement and enthusiasm for their jobs at the end of a long year....