Like many hospitals across the United States, Tri-City Hospital experienced delays and interruptions in surgical procedures due to lost or broken instruments. Too frequently their nurses spent valuable time worrying about room set-up, instrument readiness, and their laparoscopic equipment not functioning properly.

Additionally the surgeons all had distinct instrument set and individual instrument preferences. Very little commonality or standardization existed. Each surgeon expected reliable, properly working instruments for every procedure. On a routine basis these needs were not met.

According to Amanda Moore, RN, laparoscopic and thoracic coordinator at Tri-City, instrument care did not meet her expectations. "Prior to using Onsite Services, instruments were not always cared for the way that I hoped they would be. Sometimes there were insulation issues, other times the handles or ratchets didn’t work properly, and other times the instruments were not sharp," Moore said.

"Since the nurse in the room had to take care of all the equipment, it could take 30 to 40 minutes for a room set-up before a case could get started," she said. "Even though the general surgeons don’t all operate on the same days, every day they were in I heard about a problem with a set or the video equipment."

Amanda Moore, RN, laparoscopic and thoracic coordinator and Alan Coates, director of materials managementat Tri-City Medical Center.

As a first step, OnSite Services did a complete analysis of the instrument reprocessing cycle at Tri-City Medical Center. The team studied every activity involving the surgical instruments. This began with the room break-down, extended into decontamination, pick and pack and sterilization processes. The assessment also included a review of the pre-procedure instrument inspection and testing processes and post-procedure instrument refurbishment and repair processes.

The second step of the assessment process involved interviewing staff and surgeons about their frustrations, expectations, and suggestions on opportunities for performance improvement. Commonality and trends from the interviews were prioritized and incorporated into the implementation plan.

The assessment process in its entirety provided qualitative and quantitative information needed to determine specific areas in which the current process was breaking down and identified corrective action steps to remedy the underlying causes to the problem.

A multi-faceted solution involving people, products, and process changes was required for sustainable departmental performance improvement to take place. This initial performance improvement roadmap included:

• Deployment of several full-time dedicated expert Cardinal Health instrument technicians at the hospital.

• An implementation of a quality assurance process improvement initiative throughout all stages of the surgical instrument cycle.

• A streamlining of the minimally-invasive surgical instrument sets. This included standardizing trays and reducing unique sets from 20 to 10, creating specialty sets for physicians unable to use standardized sets and providing backup instrumentation to ensure no sets were out of use, due to an instrument being repaired.

• Establishing a proactive preventive maintenance instrument repair and refurbishment program.

The implementation of these comprehensive solutions was completed within 60 days. It was a seamless process and the results were apparent early in the program.

Moore shared her perspective on the transformation. "I saw the service technicians taking care of the instruments piece by piece. Every instrument in that tray was inspected from top to bottom and every set that came through. It was just what our facility needed, just what my service needed," she said. "Doctors saw improvements in every case with every instrument they need each time. The instruments work well, the tips are sharp, the ratchets are good, there is no rust on the instruments and they’re there. If something breaks, it is replaced right away. The service technicians are there throughout the case if they’re needed and their response time is instant."

Moore said the technicians in the operating room were excellent. "They worked well with our staff, they were efficient, and worked as one team, shooting for the same goal," Moore said. "They eased the rush associated with the operating rooms by setting up the rooms and preparing for the next case. Everything went more smoothly. Our schedule is staying on track because OnSite Services takes care of the room."

Due to a well-coordinated implementation combined with strong ongoing support from hospital management, the outsourcing instrument management services program has been successful. Benefits to the program have been diverse and include:

• Faster room set-up and break-down times due to strengthened operational efficiency.

• Increased clinician peace of mind and patient focus due to quality assurance improvement and safety enhancements.

• Improved physician and nurse morale resulting from their increased satisfaction with the quality, condition, and availability of the instruments.

• Achievement of targeted cost savings due to the elimination of mistakes, re-work, unnecessary steps, reductions in repair expenses and reductions in disposable instrument utilization.

Alan Coates, director of materials management at Tri-City believes OnSite brings more than cost savings. "When I look at services provided to the hospital, one thing I do is make sure there’s a savings to that service. For this particular service, we met our initial target," Coates said. "After a while, we saw other opportunities to improve and we tripled that savings. We also saw that physician satisfaction of this program exceeds physician satisfaction overall to the hospital."

Paula White, RN, operating room manager at Tri-City likes what the program has done for staff. "This has freed up the nurses for patient care which is what they really want to do," White said. "Their focus is on patient care — not equipment — so it’s made a positive experience for the nurses too."