As Central Sterile Supply Departments (CSSD’s), and OR’s look for cost saving opportunities, understanding the impact of reprocessing instruments and trays that repeatedly go unused in cases has become an area of focus. A recent study by Stockert and Langerman about tray management, published in June of 2014, estimates that if you take into account labor, instrument depreciation and operating costs for sterile processing, it costs between $0.35 and $0.51 per instrument to clean and re-package each exposed instrument, whether it was used in a procedure or not. The same tray management study went on to indicate that the percent use of instruments across surgical specialties and multiple tray types is low. All of this data suggests periodic evaluation of tray management and composition at facilities could eliminate waste associated with reprocessing instruments that, case after case, go unused. To give some perspective on the issue, using the above cost estimates, eliminating 40 instruments, from 1 tray type that is used in 2 procedures a day, 50 weeks a year would save between $3,500 and $5,100 per year.
# instruments eliminated/tray type X avg. instrument reprocessing cost X tray type use/wk X weeks/yr = Savings
20 X $0.35 X 10 X 50 = $3,500
20 X $0.51 X 10 X 50 = $5,100
The concern of course with eliminating some instruments from a tray or set is that in doing so, you could extend OR case times if the circulating nurse needs to leave the room to hunt for an instrument that was eliminated from the tray. One possible option to overcome this concern would be to make items eliminated from trays available as peel pack stock in the OR suite. A follow-up study was done by the same author group listed above looked at this type of instrument delivery reorganization, and the cost impact.
In the follow-up study, data was collected in a 550-bed facility. Two types of trays were analyzed: a Plastic Soft Tissue tray with 98 instruments, and a Major Laparotomy tray with 110 instruments. The cost of reprocessing one instrument in the study was determined to be between $0.34 -$0.47 in a tray, and between $0.81 -$0.84 in a peel pack. So it was roughly twice as expensive for peel packing compared to tray packing. The results indicated that if an instrument is used less than a rate of 42% -56%, peel packing becomes more cost effective.
These two studies indicate that the opportunity for savings related to effective tray composition could be very plausible for some facilities. The catch will be, how to determine which tray sets have the highest percent of under-utilized instrumentation and then pinpointing the specific instrument types that repeatedly go unused. In our next post, we will explore suggestions for determining tray and instrument utilization.
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.
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 Administration. 2015; Vol. 4, No.6. Accessed January 12, 2016. Available at: http://www.sciedu.ca/journal/index.php/jha/article/view/7134/4766.