Managing equipment and instruments in the operating room

AORN Journal,  Feb, 2005  by Egil V. Nilsen

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In many ORs in the United States, expense reduction has the dubious distinction of nearly surpassing traditional topics, such as patient care and clinical practice, when clinical leaders and administrators gather for operational meetings. This is a sign of the times and is true at for-profit as well as not-for-profit institutions. No OR has unlimited resources, and to continue to provide first-rate care, pay salaries, upgrade facilities, and buy equipment and instruments, it is imperative that OR administrators and nurse managers minimize expenses. This article describes a systematic approach to controlling equipment and instrumentation expenses. Not only does the methodology outlined here offer a way to decrease expenses, it offers operational benefits as well. Specific examples are taken from a Northeastern tertiary care facility's surgical services department, which includes 23 OR suites plus two suites used for smaller procedures.

BACKGROUND

The example facility performs approximately 25,000 surgical procedures per year. This high volume, which was accompanied by relatively weak systems for tracking equipment and instruments, often resulted in procedures starting later than scheduled because equipment and instruments were not available. These delays generated a chain reaction that caused subsequent procedures to be delayed as well. Surgeons were frustrated, the workplace environment was suffering, and patients were negatively affected. A simple solution would have been to buy more equipment and instruments; how ever, this would have increased expenses, and opportunities for capital expenditures were extremely limited. With these constraints in mind, an improvement team consisting of clinical leaders from the OR, administrators, and an outside consultant began searching for solutions that would minimize the need for capital expenditures.

THE PROCESS

The process team members created consisted of four steps:

1. identify current inventory of equipment and instruments;

2. map how current inventory is being managed;

3. identify the best method for managing resources via staff member work groups; and

4. identify and prioritize necessary additions.

In this article, steps one through three, which concern the problem exploration phase, are discussed briefly. Step four, in which team members devised original solutions, such as developing a new methodology for assessing the relative necessity of specific pieces of equipment and instruments, is discussed in more detail.

IDENTIFYING CURRENT INVENTORY. In a small OR or an OR that has systems in place to accurately track equipment and instruments, step one is a minor task. For example, when individual instruments, trays, and equipment are tracked by a bar code system, managers can obtain information on exactly what quantity of a particular item is in circulation, rather than having to rely on static inventory data. An additional advantage of a bar code system is that an item's use can be monitored. The OR in question, however, was not small, nor did it have sophisticated systems for tracking equipment and instruments; as a result, the first step in the process required some legwork.

Gathering an accurate inventory was complicated because management of the OR inventory was split between the OR and central sterile supply. Staff members in the OR assembled, processed, and stored some trays, and staff members in the central sterile supply department assembled, processed, and stored other trays. In addition, many procedures were picked partly in central sterile supply and partly in the OR. The OR also did not have a designated materials management person; this task was split between several technicians and service line mangers (ie, nurse managers).

The initial effort to identify inventory focused on equipment and instruments that frequently caused near or actual case delays. Focus areas included surgical cameras, endoscopes, and video towers. Team members identified this equipment through interviews with select surgeons who performed large numbers of procedures in the OR and through a six-week study that asked circulating nurses to document all instances in which the unavailability of properly functioning equipment or instruments caused procedure delays. Service line managers collected data and prepared them using a Pareto diagram (Figure 1). As expected, a pattern appeared in which a few recurring issues accounted for the majority of delays.

[FIGURE 1 OMITTED]

One issue was loss of equipment and instruments. Assuming that current inventory equals all equipment and instruments initially purchased minus what is purposely discarded leads to serious flaws in the analysis. For example, although the example facility initially purchased 35 surgical cameras, an inventory taken two years after purchase found only 23 cameras. Without an established system for tracking cameras, a manual count was the only way to determine the actual number of cameras in circulation. In facilities that do not have a system for obtaining real-time equipment and instrument counts, it is important that items are counted according to their operational importance (ie, items that will cause a delay) so performance improvement team members initially do not spend time obtaining accurate inventories on items that do not cause delays or other problems.