Like most hospitals faced with soaring healthcare costs, Wesley Medical Center in Wichita, KS, and Abbott Northwestern Hospital in Minneapolis periodically evaluate internal processes to find potential efficiencies and cost savings that may have been overlooked. Surgical instrument management, a monumental task that requires significant expenditures of both time and money, was one area of concern for both facilities.

OR and instrument room managers at Wesley heard grumbling from operating room personnel about instruments not being on hand when they were needed, even though the hospital was spending a great deal to maintain adequate instrumentation. Worse, there was no way to know where those instruments were, at any given moment, and managers didn’t have the tools to adequately, economically and efficiently ensure instruments were being properly maintained and processed.

Then they implemented V. Mueller’s Impress surgical instrument management software from Cardinal Health, McGaw Park, IL.

In the first year that the Impress system was fully implemented at Wesley, the system – along with a renewed commitment to monitoring costs – decreased expenditures for new instruments by 66 percent. At Abbott Northwestern, the system helped slash sterile processing department expenses in the first year, eliminated a mountain of paperwork, increased efficiency and improved quality control.

With handheld scanners at computer stations in various departments to read bar codes affixed to instrument sets, the Impress system allows hospitals to keep track of instruments, whether they are in sterile processing, an operating room, a repair shop or another hospital. When staff members need to identify instruments, they can look up more than 6,000 pictures that come preloaded for V. Mueller instruments. They also can easily add images from other vendors as required. In addition, by adding digital pictures of complicated sets or back table setups, hospitals can use the Impress system as a training tool that shows staff exactly how each assembly should be completed.

OR and instrument room managers at Wesley and Abbott Northwestern say the system has already proven its worth, and they anticipate additional efficiencies as the system is expanded in their facilities. In short, it has allowed the hospitals to gain and keep control of their surgical instrument expenditures and the instruments themselves.

Closing the black hole

"The black hole can be huge without an instrument management system," said Karen Salmey, RN, instrument room supervisor at Abbott Northwestern. "One person, or even one department can’t manage instrument tracking alone. Instruments go out to too many people."

The hole was huge at Wesley. "We were spending too much time looking for needed instruments," said Sandy Laymon, RN "Nobody knew where they were or why they weren’t available. Once, after hours of looking for an instrument, we finally located it in a repair shop in Kansas City."

Understanding that administrators might not see instrument tracking as a priority, Julie Atcherson, surgical RN at Wesley found additional value to offer. "When we first considered purchasing an instrument management system, we needed administrative support for additional funds," said Atcherson. "So we decided to include instrument tracking as a goal, and to close a loophole in the process of locating a failed sterilization load. We noted that a tracking system would allow us to track each instrument set back to the patient on which it was used. There are only a handful of hospitals that can do that, and the ability to have this information got the attention of our chief nursing officer and full administrative support."

Choosing the best instrument management system was much easier. "We knew exactly what we wanted," Atcherson said. "And when we met with the V. Mueller Products and Services team to discuss the Impress system we realized we could have it. Cardinal Health was the only company who offered what we wanted, rather than what they had available."

At Abbott Northwestern, a task force helped identify needs and got the necessary computers off of the wish list and into service. Salmey was already using the system on a limited basis and saw no reason to change.

According to Salmey, Atcherson and Laymon, the features that make the Impress system unique are:

• Extensive V. Mueller Products and Services staff support, on and off-site, during design, implementation and beyond.

• On-site management of the database, as opposed to sending changes to a vendor and waiting for them to be made.

• In-house database management avoids some companies’ charges of up to $100,000 for that service.

• Data can be imported into Microsoft Excel, where it can be manipulated as required.

• A point-and-click system that is easy to understand and navigate, where managers can quickly add pictures, unique descriptions, catalog numbers and storage locations.

Salmey said the support from Cardinal Health was particularly valuable during system implementation, when unforeseen complications could arise. "At first we forgot to include information services staff in our planning meetings," she said. "Our V. Mueller rep was an important member of our implementation team."

A critical step in implementation is the comprehensive inventory that Cardinal conducts before building the database. "When we looked at doing an inventory ourselves, we soon realized it was an overwhelming task," said Laymon. "We truly didn’t have a handle on it."

"There were bins and bins of instruments packed away, some not even out of their packages," said Atcherson. "We know of one facility that found thousands of dollars in instruments that they didn’t even know existed. The instrument management system forced us to do an inventory."

What surfaced at one hospital was so revealing that surgical instrumentation is now considered an asset on the hospital’s books.

Seeing the benefits

Inventory and implementation of the system typically takes six to 12 months. After that, the benefits are numerous. "There are a lot of opportunities to streamline processes," said Laymon. "The Impress system gives you the documentation to justify doing it."

The system provides more than 60 reports. Hospital personnel can track productivity, usage, inventory transfers, losses and repairs. They also can compare instrument sets to determine whether consolidation is possible, use a budget module to gauge expenses and create or edit sets as required. Among the reports that Laymon, Atcherson and Salmey use most often are:

Inventory transfer: By showing when each set moves from department to department or to another facility, the Impress system’s inventory transfer report demonstrates where slowdowns occur. For example, the system indicates how long instruments stay in operating rooms or a holding area before they begin the decontamination process. Any area that bottlenecks the process prolongs the time before instruments are completely processed and ready for use.

• Productivity: The Impress system tracks how long it takes each person to assemble instruments and repack sets, identifying areas where additional training may be needed and demonstrating where staffing shifts or additions may improve operations.

• Usage: Tracking how many times instruments are used allows managers to determine whether there is enough instrumentation to meet demand.

• Refurbishment: Managers can schedule refurbishments based on usage, meaning lesser-used instruments do not get unnecessary service.

• Set comparisons: Using the system, managers can determine where slight changes can be made to allow more doctors to use the same sets. They also can identify consolidation opportunities for basic trays and special adds, keeping special additions to a minimum and freeing more basic instrumentation for more physicians.

• Sterilization: Complete sterilization records allow staff to track which load instruments were sterilized in, where they are stored and, if necessary, which patients they were used on. The reports also are valuable for tracking and reducing flash sterilizations.

What’s next

Laymon sees potential for using the system to track hospital equipment. "Our equipment is dispensed from a central supply area," she said. "We could differentiate the supplies from the instruments, enter all equipment into the system and have a system ready to track hospital equipment that could include patient tracking and even billing information, if needed."

Although the Impress system is not yet integrated with other computer systems at either hospital, Atcherson, Laymon and Salmey agreed that it would be worthwhile to tie it to scheduling and charging.

The information in this article was compiled and written by individuals at Wesley Medical Center, Abbott Northwestern Hospital and Cardinal Health.