In the past two posts (Overstocked Trays…Part 1 and Overstocked Trays…Part 2), we have examined studies and information related to the impact underutilized instrumentation in tray sets has on cost and efficiency. Recent studies suggest that many surgical tray sets have a significant number of instruments that repeatedly go unused in surgical cases, and there are opportunities for cost savings through instrument delivery reorganization.

The issue is, documenting unused instruments at the end of a procedure is added work and time which could possibly be delaying room turn around time. Therefore, capturing data related to tray utilization should be approached as a short-term initiative rather than an on-going process change.

Below are some suggestions on how to get the ball rolling for this type of project.
  1. Engage staff. 

Getting buy-in from staff to garner their support is always helpful. Consider sharing the following points:

  • Instruments tend to be added to trays over time, but rarely are unnecessary items eliminated.
  • Reprocessing unused instrumentation over and over adds to Central Sterile Supply Department workload.
  • Overstocked trays tie up inventory, and add to department’s bottom-line. (Based on research studies, on average it costs between $0.35 and $0.51 to reprocess one instrument if you look at labor, depreciation and operating costs.)
  1. Go for the low hanging fruit. 

Ask staff to help identify which tray sets they know continuously have under utilized instrumentation. Then choose 1 or 2 of these tray sets to study.

  1. Form a task force team. 

Instead of involving the entire OR staff, select a few staff members, or ask for volunteers to help with data collection.

  1. Develop data gathering process/tools.

Possible options:

  • Approach A: At the end of the case, have the OR tech gather, segregate, and label unused instruments before sending them to the Decontamination area. Then have a designated Central Sterile Supply Department staff member identify and count the unused assets as they are received.
  • Approach B: Have the OR technician identify and count the unused assets before sending the sets to the Decontamination area. (Because scanning instruments while in PPE’s is cumbersome, having a tech who volunteers to be part of the study is something to consider with this scenario.)
  • If you have paper count sheets, use copies as checklists for data collection of unused items. If you have an instrument-level tracking system, there may be an option to scan unused instruments for data collection. In the CensiTrac system, the “Container Check” function or the “Case Tracking” function using test case numbers can be utilized to quickly scan which instruments or trays were not utilized in a case.
  1. Define the study duration. 

The goal here is to gather enough information to see if there is a potential for savings, and also to have facility-specific data to present to the surgeon to convince him or her evaluating tray composition is a worthwhile endeavor. You want just enough data to be statistically relevant. In the second research study identified below, 2 tray types were studied in a total of 20 cases.

  1. Analyze results and develop a possible solution.

Two recent studies to help guide data analysis are:

  • Stockert, Emily Walker; Langerman, Alexander. “Assessing the Magnitude and Costs of Intraoperative Inefficiencies Atributable to Surgical Instrument Trays”. American College of Surgeons, June 19, 2014. Accessed May 6, 2016. Available at:
  • Mhlaba, JulieM., Stockert, Emily W., Coronel, Martin, Langerman, Alexander J. “Surgical instrumentation: the true cost of instrument trays and a potential strategy for optimization, ”. Journal of Hospital Adminstration. 2015;Vol. 4, No.6. Accessed January 12, 2016. Available at:

Average instrument reprocessing costs are identified in the studies as well as method for determining the costs. One quick calculation to determine potential savings by eliminating over-stocked, unused assets from trays is found in the first study:

The second study underscores the option of providing under utilized instrumentation as peel pack stock in the OR. This may be part of a possible solution.

  1. Present data to appropriate surgeons / administrative staff.

Based on your findings, you may have compelling data to present to surgeons / administrative staff. Presenting the data accompanied with study information may help to achieve a consensus around the need to reorganize a few tray configurations.

We hope you found this three part series helpful and would love to hear your feedback and ideas related to this series.