Decreasing Operating Room Costs via Reduction of Surgical Instruments
Kelly J. Nast, MD, Kelly A. Swords, MD.
University of California San Diego/ Rady Children's Hospital, San Diego, CA, USA.
BACKGROUND: Rising costs in health care have demanded waste reduction and improved efficiency throughout the hospital. Surgeons have an important role in the reduction of cost in regards to amount of instruments utilized in their procedures. Previous studies demonstrate instrument maintenance and sterilization to cost approximately $0.51 to $0.77 per instrument and found that only 13-21.9% of instruments opened are ultimately used. [1,2] Our aim was to reduce the minor urology tray used primarily for orchiopexy and hernia repair so that over 50% of the instruments will be utilized leading to a cost savings of at least 20% per tray over a 6 month period. METHODS: This was a single site, single department prospective study. We used a Plan, Do, Study, Act cycle for surgical cost reduction. A multidisciplinary team was developed including urologists, surgical technicians, and representation from the central processing department. We randomly chose 10 inguinal orchiopexy with hernia, 10 scrotal orchiopexy, and 4 inguinal hernia cases to count the total number of instruments used. The exact instruments used were recorded every 3rd case to get a sampling consisting of variable patient sizes and different surgeon preferences. We calculated the % utilization and created a list of the instruments used for each case. Instruments that were never used or were employed less than 20% of the time were eliminated. The new instrument list was given to the team for review with the option to add or eliminate instruments by surgeon preference, three instruments were added. The approved reduced GU minor list was then given to the Central Processing Department to implement the new GU minor tray. Finally, we randomly chose to count the instruments used in 10 inguinal orchiopexy with hernia cases, 10 scrotal orchiopexy cases, and 10 inguinal hernia cases. In addition to calculating the % utilization which is herein reported, we also documented additional instruments needed and reason for opening in each case. RESULTS: The GU Minor instrument tray was reduced by 39%, from 57 instruments to 35. Scrotal orchiopexy used the least number of instruments on average (16.9), after reduction the utilization rate increased from 21.1% to 48.2%. Inguinal orchiopexy with concomitant hernia repair used the most instruments on average (25.1). After reduction the utilization rate increased from 41.9% to 71.7%. The average number of instruments used per inguinal hernia was 18.25, after reduction the utilization rate increased from 32% to 62.3%. Only 10% of cases required an extra instrument to be opened after reduction, the documented reason to open was due to larger patient size or a case that was more difficult than anticipated. CONCLUSIONS:
We successfully reduced the GU minor tray by 39%. Employing the cost analysis performed by Stockert and Langerman, $11.22 was saved during each procedure.  Last year we performed 311 orchiopexies translating to a potential cost savings of $3,489.42 annually for this surgery alone. A multidisciplinary approach was critical for success. This study demonstrates an excellent cost savings opportunity by decreasing reusable waste in the operating room.
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