Every day in OR’s across the country, at the conclusion of a case or procedure, there are typically numerous instruments and/or trays, that although part of the standard tray set, repeatedly go unused.  It happens so frequently that it is considered the norm rather than an exception for sets to have excess instrumentation.  The quick response as to why this occurs is related to the held belief that over stocking trays is necessary to avoid idle surgeon time during a procedure that occurs when the circulating nurse is required to leave the OR suite and gather needed instruments missing from a tray.  In other words, being over-stocked on instrumentation avoids OR delays.  But is this the case?  Or do trays contain excessive instrumentation due to an inability to predict what will be needed effectively?

Recent 2015 studies by Stockert and Langerman investigated this very issue.  They looked at four surgery specialties, including otolaryngology, plastic surgery, bariatric surgery, and neurosurgery.  After observing 49 procedures, involving 237 trays, they found out the following about tray management:

  • 24 trays or 10% had 0 instruments used
  • 16 trays or 7% had only 1 instrument used

The study also noted some interesting observations about tray management:

  • The more instruments per tray, the lower the instrument utilization.
  • While the circulating nurse spent up to 15.5% of operative time outside the operating room to retrieve needed items, the majority of these items were for disposable items
  • Not stored inside the operating room. Only 0.5% to 2.5% of the circulating nurses time outside the OR was to gather instrument retrieval.
  • 49% of trays with 40 or more instruments had missing, incorrect, or broken instruments, while only 13% of trays with fewer than 40 instruments had instrumentation issues.


All of this data, combined with the need for hospitals and surgery centers to continually find ways to reduce operating costs, suggests that evaluating tray utilization may be warranted.  In Part II of this series, we will look at the recent analysis of the costs associated with instrument reprocessing concerning labor, instrument depreciation, and sterile processing operating costs, as well as how to estimate potential savings associated with downsizing trays where possible.


Stockert, Emily Walker; Langerman, Alexander.  “Assessing the Magnitude and Costs of Intraoperative Inefficiencies Attributable to Surgical Instrument Trays”.  American College of Surgeons, June 19, 2014.  Accessed May 6, 2016.  Available at:  http://dx.doi.org/10.1016/j.jamcollsurg.2014.06.019.