A central service department returns a loaner orthopedic instrument set to the manufacturer only to have the company claim the set was never received – a mishap that cost the facility $60,000 in replacement expenses. A sterile processing team hunts for a tray that appears to have never made it back from the operating room, and the department still has yet to locate a hemostat that has long been sent out for repairs.

Think these are just unfortunate scenarios of some negligent, disorganized central service department? Think again. Such occurrences take place every day in facilities across the country, and for many, the age-old challenges of instrument tracking have yet to be overcome.

"Instrument accountability affects virtually every hospital," says John Basch, vice president of Cini-Little Schachinger LLC, Rockville, MD, a consulting firm specializing in materials management, central service and waste management for healthcare. "Without effective asset management [practices], instruments can easily become lost or misplaced. It’s a common – and very costly – problem."

Indeed. It’s estimated that only 10-20 percent of facilities have automated systems in place to effectively identify and track instrument inventory, despite the high cost associated with loss and inappropriate inventory levels, which can account for as much as 30 percent of a facility’s total instrument budget.

The good news is healthcare facilities have more options than ever when it comes to instrument management. Today, numerous software vendors offer cost-effective solutions that can precisely track instrument, equipment and case cart location, integrate with materials management and perioperative automation systems to monitor repairs and identify appropriate inventory levels, and even track instrument sets throughout the decontamination and sterilization cycle.

"With this technology, sterile processing departments now have the power to know their inventory and see what they actually have invested," said Peter Huck, general manager of Key Surgical Inc., Eden Prairie, MN.

"When you have a clear picture of inventory and can follow instruments and equipment throughout a facility and across different processes and cycles, you can reduce the likelihood for instrument loss and damage, and maximize efficiency and resources."

Scanning the options

At a more basic level, sterile processing departments can use instrument management systems to track the location of instrument trays throughout the facility and eliminate tedious paper-based systems through electronically managing count sheets. The value of such a task becomes clear when one considers a typical 300-bed hospital has between 500 and 750 different tray configurations and can easily carry up to $3 million in instrument inventory.

To facilitate the process and enhance efficiencies, many vendors are implementing barcode technology that allows departments to scan trays, containers and case carts at various points of receipt and use, as well as check on the status of specific instruments with just a few simple key strokes. Instrument manufacturers are also offering sophisticated tracking systems. Pilling Surgical, Horsham, PA, has designed software for a cordless handheld scanner to track instrument sets and equipment from storage to the OR and back through sterile processing. Aesculap Inc., Center Valley, PA, offers three instrument management system components that can track assets, streamline sterilization work flow and monitor and optimize instrument set utilization.

Fort Sanders Regional Medical Center in Nashville discovered the value of automated instrument tracking firsthand after implementing a system in 1999. Since then, the 400-bed facility has learned to maximize the solution’s value by tracking loaner trays from vendors, standardizing trays and identifying lost or unused equipment.

"We wanted to do more than just use the system for count sheets. We began running reports to see where items were in the system and what we actually had available. That was very helpful because we are part of a five-hospital system and have to process a lot of instruments," said Fort Sanders’ sterile processing manager Donna McLaughlin.

Last year alone, Fort Sanders’ 21 full-time CS technicians processed more than 126,000 sets and nearly 16,000 pieces of equipment. The department handles processing and equipment needs for the entire facility, including 16 operating rooms.

"As a result of a neuro standardization project, we were able to put 126 pieces of instrumentation back into the system, which totaled approximately $8,800," she continued. "And we know there are many more opportunities for improvement."

A boost from barcoding

New barcode technology is now making it possible to track down to the individual instrument level in real time – a feature that can prove particularly useful for tracking loaner items.

By providing labels that are laser-engraved with a two-dimensional bar code that can be applied directly to an instrument, Key Surgical has made detailed tracking a reality. The company’s product, called InfoDot, works like a license plate, linking a specific device to its own unique data file. Each time the instrument is scanned, a date and time stamp tracks the item at each point in the cycle. The "lift and stick" labels have been designed to last one to two years, depending on usage, and work in conjunction with a facility’s software application, providing a cost-effective way to track at the detail level.

"This requires no new hardware. All facilities have to do is go to their software vendors and ask them to modify their system to use with the label," Huck explained, adding that Key Surgical has already partnered with a number of leading software vendors that wanted to bring InfoDot tracking capabilities to their customers.

Sources agreed that ideal systems should do more than just locate instruments and provide count sheets. By effectively tracking instruments and supplies, facilities can use the system to determine inventory status, standardize equipment and make adjustments based on utilization rather than "guesstimation" – all of which can significantly reduce unnecessary instrument procurement, management and replacement.

"Many hospitals don’t even know what they have in the way of inventory. When they can’t find certain items, they just keep buying new ones, whether they really need them or not," said Dan Nelson, vice president of sales for Nashville-based Censis Technologies. "By identifying and marking instruments, facilities can put an end to [blind purchasing] and unnecessary replacement costs, which can total hundreds of thousands of dollars each year."

Such was the case for St. Vincent’s Hospital in Birmingham, AL. The 338-bed facility endured excessive deficiency rates among surgical instrument trays and case carts, and a high level of dissatisfaction from surgical staff. Beyond that, the size and value of inventory was unknown, resulting in overstocking and inefficient use of as much as 80 percent of the hospital’s surgical instruments.

Using Censis Technologies’ Censitrac instrument management system, the facility was able to mark 8,000 of its most frequently used instruments and identify many more it didn’t need. Within the first 90 days, St. Vincent’s saved more than $116,000 in tray reduction and instrument recycling, while case care deficiencies fell from 7 percent to less than 1 percent. The hospital predicts those improvements are just the tip of the iceberg, particularly given that there are as many as 90,000 more instruments that have yet to be marked.

Automation integration

Many central service professionals are finding the key to successful instrument management lies in a system’s ability to interface with automation tools in other departments and build upon the hospital’s risk management and quality improvement initiatives.

Tying in with other departments, such as the operating room and purchasing, may also make it easier to justify the system’s expense.

"The typical sterile processing department will have a difficult time navigating the capital justification process on its own. To get the level of support required, it is often necessary for these systems to interface with, and integrate into, other systems," said Clay Cannady, marketing manager for Mequon, WI-based Materials Management Microsystems.

He added that by interfacing with the surgery scheduling system, for example, the benefits of an instrument asset management system extend beyond sterile processing.

"While tracking the location of an instrument tray is helpful, it is really only the beginning. Understanding utilization rates allows for optimization of instrument inventory," Cannady continued. "Measuring quality levels for accuracy and compliance are consistent with the objectives of infection control and risk management. These are some of the more critical issues facing customers."

To that end, healthcare facilities are maximizing their infection control and risk management efforts by using asset management systems to track instruments throughout the entire processing cycle. Using barcode technology, items are scanned at each point in the process, allowing the documentation and capture of pertinent data, such as the time and date each step occurred, the technician involved, load numbers and biological test results. Equally important is the ability to trace instruments to a specific surgical case, which can prove invaluable for infection surveillance and liability purposes.

During instrument inspection, items in need of repair can also be flagged, input into the system, then effectively tracked. Beyond that, departments can use their systems to ensure their preventive maintenance schedules are being followed. If an instrument requires preventive maintenance every tenth use, for example, the system can track utilization and alert staff when it’s time to pull the item out of circulation.

Point-of-use documentation and electronic reporting can also maximize inter-departmental quality improvement efforts by pinpointing potential problems and identifying areas that may require more attention.

"By linking with the operating room’s automation system, for instance, facilities can more effectively monitor flash sterilization cycles and determine where improvements can be made to reduce inappropriate use," said Steffan Haithcox, product marketing manager for Lawson Software, St. Paul, MN.

The documentation may identify gaps in instrumentation sets, and even help justify the need for more instrumentation, he noted. In September, Lawson acquired San Francisco-based Apexion Technologies Inc., a surgical instrument and supply tracking solutions provider.

Process improvement

Thorough documentation and interdepartmental asset tracking can serve as a powerful educational tool and prod departments into redoubling quality improvement efforts at various stages of the instrument handling process.

Many systems allow departments to scan images, providing an indispensable visual aid for identifying and assembling the extremely wide array of specific instruments and trays.

"You can take that even further by [scanning] images of unique room and table set-ups, and even mayo stand set-ups, which can be invaluable for training technicians," said Bonnie Court, senior manager of sales and marketing services for V. Mueller’s IMPRESS Scan instrument management software.

Systems may also spur better collaboration and problem-solving between CS and the OR. According to Haithcox, facilities can trace problems with instrument sets back to the individual who assembled them, providing the opportunity to offer additional training where necessary.

"If an OR continues to experience the same errors or missing instruments in sets, the system can help them identify the source of the problem and solve it with follow-up education," he noted.

Improved tracking and awareness could also lead to less instrument damage and repair costs. "If a scope is steam sterilized, but was designed for gas sterilization, the system will deliver a pop-up box warning of the error," said Haithcox.

Patient and healthcare worker safety is yet another critical component. In the event of a sharps injury or suspected infection transmission via an instrument, for example, facilities can use their systems to trace that item back to a specific case.

On the horizon

Hospitals may soon have even more asset management opportunities at their fingertips as vendors move to incorporate real-time wireless scanning capabilities into their systems. Software solutions providers are already recognizing the need for modules that can track durable medical equipment throughout a hospital. St. Vincent’s is looking to tracking mobile assets like gurneys, infusion pumps, crash carts, beds and wheel chairs, to further capitalize on the value of its equipment management system.

In their quest to emphasize efficiency and overall commitment to quality, healthcare providers will demand more from instrument vendors in the way of product enhancements and ongoing system support, noted Cannady.