INSIDE THE CURRENT ISSUE

February 2009

Central Services

RadarFind's tags indicate equipment status through a 3-position intrinsically safe sliding switch.

Given the costly instrumentation that hospitals have in their inventories – and the bleak economy that’s pushing organizations to find new ways to stretch their budgets and maximize their investments – it seems there’s never been a better time to implement instrument tracking solutions.

While today’s sophisticated solutions are more about capturing and disseminating scores of detailed data, hospitals that have yet to adopt computerized instrument tracking may find it useful to take a step back and explore how even limited use of tracking solutions can benefit their organizations, the end users and, above all, their patients.

Despite the millions of dollars of instrumentation in place in our nation’s hospitals and outpatient surgery centers, the majority of instruments in their inventory are still being tracked manually, noted Jennifer Anderson, vice president of marketing and business development for Cardinal Health’s VMueller Surgical Products and Services business. She pointed out that "roughly 20% of customers are utilizing some form of instrument tracking software, and a combination of barcoding and scanners to manage their instruments."

The benefits of computerized instrument tracking have been well-documented. At the very least, it gives facilities a clear picture of their complete inventories, which helps eliminate costly and premature replacement of devices that were previously lost or misplaced. Other basic, yet critical benefits include improved staff satisfaction and resource allocation, fewer procedure delays, improved tray accuracy, and faster surgical suite turnaround (thanks to less time spent manually searching for instruments) – all of which drives efficiencies and translates to more revenue for the hospital.

Beyond that, though, "computerized surgical instrument management systems enable programmed maintenance of instruments, facilitating instrument preventative maintenance and thereby improving infection
control processes," added Vincent Carrasco, MD, chief medical officer for RadarFind, Morrisville, NC.

Carrasco, a tenured former professor of surgery at UNC School of Medicine, has seen firsthand the challenges associated with manual instrument tracking, as well as the many benefits of adopting a better method. "With some type of automated instrument tracking system, the event of a surgeon missing a critical instrument or receiving a poorly maintained instrument during a critical part of the case can be significantly reduced."

Despite the majority of hospitals still lagging behind in their instrument tracking efforts, it does appear that more organizations are beginning to appreciate and understand the value of switching to a computerized solution.

"More recently, the C suites (CEO, COO and CIO) [have begun] to understand the need for this type of technology and its significant, positive operational and financial impact," said Alicia Torres, vice president of Ann Arbor, MI-based Rosebud Solutions, which became part of the McKesson Corp. in 2008.

Of course, being able to directly cite significant benefits to current customers certainly helps pique executives’ interest. Torres noted that one hospital, in particular, was experiencing 30-plus surgery delays per month due to incomplete and inaccurate trays. "These delays were eliminated," she said. "We increased OR turnover, surgery revenue and surgical satisfaction."

Boosting quality, efficiencies

Whether a facility is already using computerized instrument tracking and is looking to push the benefits of their solutions even further – or is one that’s looking to adopt the technology for the first time and wanting to maximize the investment from the get-go – the good news is today’s robust systems likely won’t disappoint.

Certainly, it’s an increasingly sophisticated market segment that’s been driven by the ever-evolving and –demanding needs of the sterile processing department and its many customers.

"When you look at all the requirements on people and processes necessary to achieve acceptable department performance, instrumentation management has become one piece of a much larger and complex equation," reasoned Cannady. "If you define the charter of SPD as the delivery of instrumentation in a fit condition for use at an optimal cost basis when and where needed, connectivity, integration and robust decision-support tools are essential and, typically, where systems are best distinguished from one another."

Five years ago, much of the understood challenges and frustrations surrounding instrumentation centered around issues such as "What do I need, where are they," and so on, added Cannady. These days, he said, the questions in many environments are more along the lines of "How do I mobilize limited resources to meet end-user demand, what are the proper policies, procedures and training required to ensure staff can do the work at desired quality levels, what sort of quality assurance monitoring and documentation is required to achieve compliance outcomes, and what information do I need to make informed decisions at every step in the process."

Although vendors’ solutions differ, there appears to be a common theme in product development: the push to enhance system integration to drive better data collection and output, while also automating critical processes to eliminate redundancies and error, enhance quality and process consistency, and enable staff to better allocate their time and resources, and improve their fact-based decision-making.

The greatest advancement in instrument tracking technology to date, according to Tony Vestal, regional T-DOC System Specialist for Getinge USA Inc., Rochester, NY, is the ability to integrate sterilizer and washer data into the instrument tracking system to minimize the risk of using non-sterile items on patients. "Obviously, tracking an instrument set from Point A to Point B is wonderful, however, in the sterile processing department, the main goal is to send correctly sterilized items to the OR and [have] the documentation to back it up, which is what the Joint Commission loves to see," he said. "We have seen more and more interfacing of tracking systems with other hospital systems, such as patient scheduling and materials management and billing systems, allowing them to ‘talk’ to one another," Vestal continued. "We have also seen instrument tracking become much more detailed, such as documenting loaner sets, instrument set repairs, biological indicator readings, inventory management and patient usage, to name a few features."

The T-DOC System allows for direct interfacing with most types of sterilizers and washer-disinfectors to provide real-time data logging. All processes, machines, patients, operations, physicians, etc. that an instrument will encounter will also be registered through T-DOC to allow a complete history to be documented for each instrument. Vestal predicts that as more standards are enforced for the sterile processing discipline, the greater the need will be for more detailed documentation.

Another example of advanced interfacing capabilities is the SPM/3M Attest Monitoring Interface. The co-branded technology from Materials Management Microsystems and 3M simplifies and disciplines the monitoring sequence, automates the documentation process, centralizes where this critical information resides, and makes the information available in real-time throughout the facility.

"When critical, timely information is required where decisions are being made, it is now readily available," stressed Cannady. Microsystems is so confident customers will reap significant returns on their investment that the company provides a money-back guarantee that savings in excess of the price of the system will be realized within 12 months of the system go-live date.

TGX Medical System recently upgraded the scheduling interface for its Alex Gold asset management software solution, giving users access to live, real-time information. The advanced solution, which gives facilities the option to go fully paperless with their data management across a wide range of processes, now also includes a tissue tracking module – at no extra cost. "We sell everything in one module, so customers don’t have to pay extra for added features," said TGX Medical’s director of sales Michael Mancebo, who is also a certified registered central service technician and former CS manager of 12 years. The Alex Gold system, first introduced in 2000, is currently on version 7.7 and the company will soon be rolling out the 7.8 version. TGX’s solution has come a long way since the primitive 1.0 version – essentially a count sheet manager (then called Alex Pro) — was introduced in 1999. Most would agree that unit-based tracking, whether achieved through direct parts marking or an adhesive "dot" system, has its benefits – and advanced scanner and marking technology has made getting there both more simple and cost-effective.

As Michael Meeks, president of InfoDot LLC, explained, improved scanner technology for reading small matrix symbols is a reality, as are more durable marks or dots. "Hospitals need to be able to read all labeled trays and single instruments and supply items in the department with the same scanner. An image scanner provides this capability across all applications used in the hospital today," he noted, adding that many hospitals still have older "linear scanners" only capable of reading one-dimension barcodes typically found on supply items and early software programs used to track at the tray level.

Future unique device identification marks/dots will be even more advanced. As Meeks explained, concerns about a mark not being able to be read or the potential for a dot coming off or flaking off will be better addressed through the introduction of a more durable product with better adhesion qualities.

For Rosebud Solutions, the most noteworthy advancement is the integration of its Horizon Tray & Instrument Manager to and from surgery systems. "This integration identifies the needs for upcoming cases and facilitates the issuing of trays and instruments to those cases. This creates a seamless integration of information," Torres explained, adding that this information also allows management to make more informed decisions about the workflow of the staff and the assets, resulting in a more efficient surgery department. Beyond that, she said the Horizon Tray & Instrument Manager’s proactive, user defined, alerts (provided in e-mail, pager or report format) allow for proactive – rather than reactive — management.

TGX Medical System's Alex Gold Washer load screen identifies which items are
in a particular washer, and which items have been washed together. 

Functions of the future

Moving forward, healthcare organizations can expect even more exciting developments in the instrument and process management marketplace – with enhanced integration capabilities at the forefront of the innovation.

Torres believes the future of tray and instrument tracking lies in the continued integration with the surgery system – an area she says McKesson is focusing much of its attention. "We believe the trays and instruments are an integral part of surgery. Identifying utilization trends and correlating this utilization information with specific outcomes is an important advancement."

Microsystems will continue to advance integration capabilities directly with equipment and devices for challenging and monitoring the efficiency of the decontamination and sterilization processes. Such solutions will enable users to capture data across all processing cycles — from decontamination to sterilization — in a single electronic record.

Aside from increased integration, a number of vendors predict Radio Frequency Identification — which is currently available, yet still being perfected in the instrument tracking segment — will be another option that will gain momentum.

As Cardinal Health’s Anderson explained, RFID technologies can track instruments, containers and case carts throughout the hospital, providing new alternatives for improving productivity, safety, efficiency, and compliance in instrument tracking. "RFID technologies continue to emerge and offer multiple solutions for managing hospital assets," she said, noting that a clear frequency standard, decreased tag costs and plug and play implementation will help maximize the technology’s use and adoption.

Getinge’s Vestal believes RFID technology will eventually replace the scanner and decrease instrument processing turnaround times, and Mancebo of TGX Medical said the use of RFID technology on devices, such as infusion pumps, has also helped propel the acceptance and implementation into other areas. While Mancebo acknowledged that RFID technology introduced several years ago was somewhat limited in its accuracy, he said great strides have now been made in this area.

Censis Technologies Inc, Franklin, TN, also stands firmly behind the RFID trend. According to Jim Creason, the company’s senior vice president of business development, the current limitations of RFID is more of an infrastructure and cost challenge than a system functionality obstacle. "I believe customer hurdles in this area should subside in three to five years," he said, adding that the company’s Censitrac solution is currently capable of tracking devices via RFID.

Patient Care Technology Systems LLC in Mission Viejo, CA, a real-time asset tracking solutions provider, believes RFID is a logical next step to meet hospitals’ needs for improving workflow in strategic service lines, such as perioperative services and emergency, while also improving the efficiency and economics of asset utilization facility-wide.

"Over time, this strategy will unify and integrate purpose-built solutions targeting the unique needs of different areas of the hospital around enterprise-wide visualization of flow," reasoned Stephen Armstrong, vice president of marketing for PCTS. He explained that MEMS-based RFID and chip-less RFID can enable unit-based tracking and can also be sterilized. Further, he noted, like traditional IC-based RFID, both technologies do not require line of sight to obtain a read – and the tags are passive and battery-free.

Carrasco, too, sees promise with RFID in this capacity, but he said he’d prefer other technologies that don’t require third party application of "stickers," such as barcoding or RFID tags, or even etching. "There are many approaches; however, I believe vendors are pursuing only a limited scope of technologies at present." He reasoned that a hospital that already has an intelligent Real Time Location System for monitoring the location and status of medical devices, such as infusion pumps, can also apply that to the tray tracking process. Once an instrument tray has been sterilized, he said a RadarFind 3-position status tag can be assigned to that tray and time-stamped with the sterilization date and time. The tray is again wrapped per the hospital’s standard protocol (for example, with a clear plastic protective over-wrap and with the tag in the green or "ready" mode, sealed in with the tray and then properly shelved).

"Once the tray is in the operating room, the tag is switched to the yellow or ‘in use’ mode," he said, noting that when the tray is opened, the tag is put into the red or "dirty" mode. "The tag is separated from the tray for ‘recycling’ where it is collected, disinfected and then put into use for another tray that has been completed and sterilized. The tracking software allows easy reassignment of the tag to the new tray."

"The future of instrument tracking will be a combination of RFID technologies, unit-based tracking, and tray tracking," Anderson said – all of which will serve the vital purpose of improving Central Supply productivity and driving increased efficiency, compliance, and safety.