Instrument tracking — a science of its own

Healthcare Purchasing News, March, 2003 by Carren Bersch

Ask those in the operating room and they will tell you that new developments are on the horizon. Two major trends have surfaced and are bound to optimize processes and performance in the OR. One is the implementation of "bleeding-edge" software programs; the other is the merging of surgery with high-technology robotics- and diagnostics-equipment. Both involve surgical instrumentation, and both are expected to produce a more coherent and integrated medical field -- but the trend that seems to be making fast inroads is the computer-based tracking system.

"In the OR, robotics is the next big thing," says Jim Leitl, vice president of sales for Cardinal's V. Mueller division. "We are working with those companies developing such instrumentation to understand the requirements of those types of systems." The merging of robotics and diagnostics into the OR, with the difficulties of sterilizing and decontaminating large pieces of equipment, present a different set of more complicated solutions.

Marilyn Wolfe, RN, MBA, CNOR, president of Wolfe Associated Inc., Medinab, IL is a supply and inventory management consultant nationally. Although Wolfe admits the software element is not new, she sees it becoming more structured and organized. "More and more hospitals are using computer systems for tracking surgical instrument trays, performing preventive maintenance on instruments, providing productivity assistance for tray assemblers, estimating time and resources needed for assembly of trays and other facets of completing the turnaround time in the OR. This is not a new concept," she says, "however, more and more hospitals are using these systems and finding value."

Wolfe contends there is progress on the supply side with more investment in hard goods. Computer software gives hospitals a better audit trail when it comes to the expensive instrumentation needed for an operating room. Wolfe believes the challenge for most hospitals is that it takes abundant resources to put a computer system in place.

"There's a saying: 'If you have time to do it over, you had time to do it fight' Installing such a system maybe driven, in part, by staffing shortages. Providing tools that aid in accuracy and efficiency could reduce errors in the OR," says Wolfe.

Rob Rogowski, vice president of sales and national contract for Jarit Instruments, Hawthorne, NY, looks back at surgical instrument tray processing years ago. "The trays were processed in a room close to the OR; therefore, the turnover was fast. Today, case carts or sterile processing means that turnaround time have become more of an issue, and getting the right instrument for the right procedure can often incur duplicate costs. Hospital budgets are thin and many have to use what they've already got in the way of instruments," Rogowski explains.

"If a basic tray has been used, and has to be turned around in a hurry, flashing or quick sterilization in the OR hurts the longevity of the instruments. Hospitals are trying to get away from this procedure and are having trouble minimizing their flash rates," Rogowski says.

Although Jarit is in the business of selling surgical instruments, Rogowski says his company has designed its own computer-tracking software, known as CIMS (Computer Inventory Management System), which works at two levels. Jarit provides a team, which aids a hospital in taking a full physical inventory of its surgical instruments, enters this data into the software program, and enables the hospital to produce count sheets. There are other functions within CIMS to monitor surgical instruments as well.

Another level of the CIMS software is the tracking component which can scan an instrument tray and deliver data which reveals how many times a day the tray is used, where the action is with the tray and where the tray is located.

"The data can assist the hospital and the OR in determining whether a tray needs to be broken up and redeployed in another configuration. Defaults in the software can also scan the number of times a tray is used and alert the staff after a given use as to whether the instruments need to be maintained. Since we're in the consulting business in large part as we sell surgical instruments, we work with any software system -- like Microsystems, Abacus or Tedoc. You can't just sell a hemostat any more," Rogowski says.

Tracking surgical instruments involves more than simply a count -- it involves the hospital's loss of hundreds, if not thousands, of dollars in an investment. Because outfitting an average 250-bed hospital's operating rooms with basic surgical instrumentation can cost as much as $500,000, not including power equipment, saws and monitors, maintaining a complete instrument inventory is essential to an institution's bottom line. Michelle Kettwig, a nurse consultant at Jarit, estimates it can cost $1.5 million to outfit atypical OR suite. "It depends upon what level of hospital we're talking about," she says. "Is it a trauma center? Is it a neurosurgery center? A standard surgical suite would run $50,000 for basic instrumentation."