The Essentials of Instrument Tray Management

Paring down your sets can save your center time, money and resources while still keeping surgeons satisfied and patients safe.

Ever investigated just how many of the instruments and entire instrument trays that arrive in your ORs and procedure rooms throughout each day are actually necessary?

Carrying out this exercise — referred to variously as instrument tray management, reduction, rationalization or optimization — can result in significant savings of time, space, human resources and money for your facility.

I guarantee your sterile processing department (SPD) leaders and perioperative staff have some thoughts on the subject because they deal with the real-world ramifications of it every day. SPD techs likely spend time and effort reprocessing countless instruments that aren’t even used during procedures. Your nurses and surgical techs likely prepare instruments for use that are rarely if ever actually used, cluttering back tables and wasting valuable time in the process.

The problem is clear, but an effective solution requires a good deal of effort, communication, collaboration and finesse. I’ve seen very successful instrument reduction projects, and I’ve seen others go nowhere. From my experience, here’s what you need to do to better ensure you accomplish your mission.

Achieve comprehensive buy-in

Begin by talking with your SPD leaders and techs. They can give you a good idea of how much unnecessary reprocessing they do every day, and how much time and resources it consumes. Do the same with your surgical techs and nurses who set up and handle instrument sets in ORs or procedure rooms.

Next, you and your SPD leaders need to take your case to the C-suite to secure their buy-in. Find a sponsor at that level who recognizes and understands the importance of this endeavor. Your chief nursing officer or chief financial officer are great candidates. That executive sponsor should then approach your chief medical officer to stress that the surgeons will need to be involved in paring down their instrument trays or number of sets per case.

Now everybody’s talking, and you have sponsorship and transparency within the C-suite. Considering this project will likely take months or even a year, that’s crucial for success.

The next task is finding one or two of your surgeons who will champion the project. This can be difficult, because surgeons are creatures of habit who want every base covered during a procedure. Many surgeons want every instrument they could possibly need to be sterile and available to them at all times. The key is to acknowledge that their concerns about on-demand availability are legitimate, but can be accomplished in a much better way that will make both themselves and the entire center more productive. Explain that by paring down their instrument set lists, they actually will be served better and faster in the long run because their nurses, surgical techs and reprocessing techs won’t need to handle and inspect hundreds of redundant or unnecessary instruments, only a fraction of which are actually used regularly. By doing so, SPD will be able to turn their core instrumentation around more quickly, and rarely-used instruments will be sterilized and stored, available for rapid delivery at a moment’s notice.

Many surgeons have never thought of their instrument sets this way before. A great way to reinforce the need for optimization is to bring surgeons on a tour of your SPD to show them what actually goes on there, and get them to realize how paring down their sets can result in quicker service. I’ve found that once they see it, they understand.

Pilot project

SAFE AND SOUND Key to an instrument reduction program is the storage space needed to ensure infrequently used sterilized instruments don’t experience tears in their blue wrap or pouches.

The next key to success is to perform a pilot project with your surgeon champions. Don’t try to do it with every surgeon at once. You will fail because it’s too huge of an undertaking for providers and staff who are already super-busy, and so much remains unknown about the actual efficacy of your proposed initiative.

Instead, partner solely with champions who already understand and embrace the concept, who really get it. This pilot program, which should take place over the course of several months, will enable you to collect significant and valuable data that proves the power and validity of the concept. Remember that without testing, data and testimonials from the satisfied surgeons in your pilot project, you’ll struggle to get uphill with the rest of your surgeons. If the pilot project is successful, surgeons in your pilot should be encouraged to talk with their peers and say: “Here’s what I’ve done, and it’s really great. You should talk with sterile processing about it, too.”

SPD, for its part, will now be armed with ample data from your pilot program — improvements in turnaround times, same-day usage of instruments, productivity and efficiency. That data can be used to sell the concept not only to the rest of the surgeons, but also to confirm to the C-suite that a facility-wide effort is truly worthwhile.

We all know that doctors listen to doctors, nurses listen to nurses, techs listen to techs. That’s just the way it goes in health care. By achieving buy-in and champions among all of these provider types, you now have all of the elements in place to expand on the accomplishments of your pilot program.

Addressing the bloat

A key aspect of this project is building solid, lasting bridges between the providers in your ORs and procedure rooms and the leaders and techs in SPD. Often, the reason instrument sets get bloated with a lot of unused instrumentation is because providers lack confidence in their SPD.

Consider: If you’re a provider, and 10 times a year you don’t have a drill you need because it hasn’t been sterilized, your natural inclination will be to add that drill to your everyday set list. Then that provider talks to their peers about what they’ve experienced, and now all of them are bloating their set lists, creating an expanding loop of unnecessary redundancy. No surgeon wants to be caught emptyhanded in the middle of a procedure. As a result, the surgeons’ lack of confidence in SPD manifests itself in bloated instrument sets.

I’ve seen this dynamic play out time and again. Our natural tendency as humans is to remember the mistakes and the bad stuff. The phrase “once equals always” applies here mentally. But in the process of making sure all of their bases are covered, suddenly there are now three drills and whatever else on their set list because of those few times SPD couldn’t provide required instrumentation at the required level of sterility.

A preconceived notion develops among the perioperative team that if everything they could possibly need isn’t part of the standard instrument set, they will be calling for instruments all the time or won’t have what they need to help their patients in the moment. That’s where they’re coming from: They need all of these things at the ready. If they reduce the set list, will they be able to access these rarely used instruments on demand?

Your SPD must be able to confidently answer this question: “If I do this instrument reduction project with you, how can you guarantee I won’t be delaying cases or having patients spend extra time under anesthesia to get the instruments I need?” The good news is that, at this point, you’ve completed your successful trial of the concept with your pilot project — and SPD delivered.

Here’s why: Because the sets are smaller, SPD is better able to turn around your providers’ regularly used instruments. As for the instruments removed from regular rotation, they’re all sterile and sitting in storage, ready to be delivered promptly whenever they’re needed — not unavailable because they’re going through yet another unnecessary reprocessing cycle. Skeptical? Here’s the data we generated from our pilot project that proves it. Real-world proof of the concept is a great way to allay your surgeons’ fears so the whole facility can move forward.

A note here about electronic tracking systems: They’re growing, with more and more facilities using them. This tech is currently focused on tracking instrument trays, but the ability to track individual instruments to individual patients is coming. These systems collect a lot of data that your SPD leaders can present to gain support in the C-suite for your pilot project. They can say, “Here’s our baseline. We process this many thousands of individual instruments every day, it takes this amount of time, it takes this many technicians. Now imagine if we could reduce that by even 20%. Think of the savings to the facility.”

The most successful case study I’ve seen was a 40% average instrument reduction across all disciplines, which was amazing. But even if you reduce by 20%, you are saving tons of resources. Beyond time and labor, you’re also cutting costs on washers, soap, steam.

Even if you don’t use an electronic tracking system, establishing initial baseline data before you start your pilot project is extremely helpful because it will allow you to later dazzle your C-suite sponsor with evidence-based results from your pilot study: “Here’s our baseline from January, and here’s the data from the end of August. Look what we’ve done already with just two surgeons participating. What if we could get everyone to buy in?”

A final note here that is critical for success: Consider your storage spaces for reprocessed instrumentation. For this program to work, you need to ensure the sterility of infrequently used instruments sitting in storage that must be available on-demand. That means no holes in blue wrap, no broken locks, no punctured pouches that require the instruments be reprocessed again before use. Those things will derail a project like this very quickly.

With your executive sponsors, look closely at your storage of sterile instruments facility-wide — not only in sterile storage, but in procedural areas, sub-sterile rooms, wherever else they may reside — to make sure their packaging will remain intact. This is especially important at ASCs and outpatient surgery centers where space can be at a premium, and instrumentation is kept in small rooms or very tight spaces.

A project like this is a good time to reevaluate your storage space and consider whether it needs to be expanded to better accommodate and ensure consistent sterility of the increased number of instruments that will be out of regular rotation. Two or three years down the line, the payoff if your instrument reduction program succeeds is that you will actually have fewer and smaller instrument sets you’ll need to store. Maybe you can pouch things instead of putting them in rigid containers. You might even be able to get rid of some redundant sets and instruments.

Relieving the pressure

By bringing your whole center together to tackle instrument bloat, you’ll save time, labor, money and resources. In a world where margins can be tight, this project can provide significant savings that relieve pressure on your facility’s bottom line. OSM