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The SPD plays a critical role to the hospital, perhaps most particularly to the operating room, but can you tell by looking? Probably not. The SPD has been sort of like Rodney Dangerfield: they "get no respect." Maybe that’s changing, because the SPD is a vital component to preventing infection, and infection prevention is the name of the game since the Medicare changes took effect last October.

One area in which SPDs have been given short shrift is in information technology (IT). The ORs have their own IT programs, but SPDs have largely been overlooked in that area. That’s changing, but not before it was needed. Denise Downing, RN, MS, CNOR, perioperative nursing specialist, Center for Nursing Practice, Association of periOperative Registered Nurses (AORN), Denver, CO, commented on the lack of IT for the SPD and why there is the need for the lack to be rectified. "This is an area requiring development and integration between the OR, SPD, and anesthesia clinical information systems, as nothing currently serves the purpose. It’s only been within the last 10 years that the equipment for sterile processing has been able to track the instruments and equipment that ORs use. They are just beginning to build the programs to interface from SPD to the electronic health record. There hasn’t been the IT capability. Data that was extracted from the OR used to be about productivity. Now, especially with the American Recovery and Reinvestment Act, we’re focused on the quality of patient care that relates to the reduction of surgical-site infections and injury."

Downing believes that software or online services that troubleshoot and provide preventive maintenance or otherwise connect SPD to the OR could enable the OR and the SPD to work together more efficiently and productively. "That’s exactly what is needed," stated Downing, "an integrative system that actually monitors all elements of the equipment, the environment, the patient. With so much focus on infection and injury prevention, and so many variables involved, the more you can control those variables and that environment, the safer the environment for the patient and the caregivers."

Fortunately, industry is answering the call for IT that promotes interfacing between OR and the SPD. Healthcare Purchasing News (HPN) talked to some of the companies that are working to bring about better connectivity between the SPD and the OR.

STERIS’s ProConnect remote equipment monitoring online

STERIS’s ProConnect Response Center

Michael Hays, director of the Online Center, STERIS, Mentor, OH, told HPN how their product came about: "The ProConnect Response Center is a natural extension of traditional maintenance services. It integrates the various services and technologies that STERIS offers, from remote equipment monitoring and an online service portal to technical and field support. The ProConnect service has been available since 2007. We have more than 1,000 units connected across North America."

Hays explained how the ProConnect Response Center can help the OR and SPD stay connected in several keys ways: "ProConnect-enhanced service can help maximize the uptime of connected sterilizers and washers, which can help reduce delays in surgery and potential overtime costs in the SPD that are needed to get all instruments reprocessed. STERIS can predict when certain issues will occur, enabling the repair to be done on a scheduled basis, when it will have a minimal impact on operations. ProConnect provides additional information to help optimize your reprocessing cycle as well."

Hays talked further about what kind of information is accessible via their system. "STERIS makes nine different equipment-performance reports available to ProConnect customers through our online Customer Care Center. These reports range from service, alarms, and parts-use history, to electronic cycle tapes and an overall equipment-service summary for each connected machine, which will help SPD managers to understand the use and performance of their equipment. In addition, customers receive an e-mail from STERIS any time there is an alarm on a connected machine, so there is instant awareness of equipment performance."

Equipment-performance reports are available to both the OR and SPD on the ProConnect website, noted Hays. "These reports are available to any number of users and can be saved at the healthcare facility for future reference. In addition, the facility’s ProConnect program can be configured to send an e-mail to both the OR and SPD following an alarm. Finally, our Response Center regularly contacts both OR and SPD personnel to keep them abreast of equipment performance and next steps, should maintenance be required."

Cost is a question that always arises. The answer is simple and minimal, according to Hays: "The ProConnect Response Center is a value-added service for our customers with units on warranty or a STERIS service agreement. The only potential costs to a customer are IT-related. To enable ProConnect connectivity, two things are needed: either wired or wireless access to the customer’s ethernet network or space on a dedicated PC or server to load the ProConnect program software."

Real-time OR case data is updated and shown to SPD staff using T-DOC Asset Management System, Getinge USA

Getinge USA’s T-DOC system

Getinge USA, Rochester, NY, offers a product useful to SPD-OR connectivity that sprang from their instrument-tracking system. Over the past 15 years, their basic instrument-tracking system has blossomed into a fully integrated tracking, communication, quality assurance, and cost-saving tool for both the SPD and the OR.

Hana Scheichenost, T-DOC national manager, described their product’s capabilities: "The T-DOC system goes beyond tracking sets and instruments. It provides for precise and real-time information on instrument locations, whether they were properly sterilized, and with which cases and patients they were associated."

Scheichenost highlighted another way in which T-DOC may help to improve relations between the two departments: "Using our stock-control modules, the correct inventory is readily available. Our multimedia module allows SPD staff to view pictures, video, and documents of proper procedures. With on-screen assembly, staff is aware of critical instrument levels, which helps to ensure set accuracy. The direct data logging to sterilizers ensures sets undergo a proper sterilization cycle, and an interface to the OR system details what exactly the OR case requires. This ensures the OR has the right sets at the right time. The OR can see what they are getting beforehand; they can initiate a fast track if they have an urgent requirement; they have access to sterilization and biological indicator (BI) records; and they know which sets were used on which patients. The OR can easily view where their sets are, which instruments are missing from the sets, which case cart they are on and whether it’s complete. They can also see how long they have to wait if a set is presently being sterilized, which machine it’s in, and if the cycle ran without problems. The OR also has the assurance that the sets were sterilized, since T-DOC connects directly to the control system and will not allow non-sterile sets to move further in their processing. They can view BI results and retrieve a list of all other patients a specific set was used on, in case a recall is necessary. Without this electronic alert, OR staff must rely on manual procedures to check whether the sets are sterile before being used."

Other information accessible from reports include but are not limited to which ORs were more productive, whether flash sterilization is employed, which instruments were damaged, sharps incidents, missing instruments, recalls, user productivity, case costs with regards to instrumentation, and past sterilization and washing records.

Another advantage of the T-DOC system is its ability to integrate with other OR scheduling systems on the market. This means that the SPD knows what is needed for upcoming cases, including consumables, and that the OR is assured they will have the equipment they need when they need it. "This can also be a two-way interface where T-DOC sends data to the OR system to ensure they have up-to-date information, such as availability of sets, and the SPD is immediately notified if any cancellations occur or any emergency cases are brought in," said Scheichenost.

Now we come down to cost of the system. Scheichenost said that the cost is determined by what the facility wants. "It could be as low as $40,000 outright for the SPD, all the way up to and exceeding $300,000 for SPD, OR with integration to ORs, materials management, and finance. Many customers choose a phased approach, starting with the SPD, then incorporating the ORs, integration, and then additional departments."

That sounds like an awful lot of money to pry out of tight budgets, but Scheichenost believes it can save money in the long run. "Although the cost may seem high, the savings are there with streamlined processes, just-in-time inventory, prevention of cancelled cases, time saved in searching for sets, being able to go paperless, the use of multimedia for staff, sharps-incident prevention, management time saved in compiling reports, and immediate and accurate knowledge in case of recalls."

Skytron Asset Manager can track critical assets in real time and provide preventive maintenance alerts

Skytron’s Asset Manager

Skytron, Grand Rapids, MI, also has a product that helps the SPD and OR work together efficiently and productively. Sarah Simon, business development, assistant manager, talked about their product. "Skytron Asset Manager, powered by Awarepoint, is a fully managed real-time location solutions radio-frequency identification (RFID) system that is wireless and can be installed anywhere in your facility. Deployment for SPD, the OR, or enterprise-wide takes days or a few weeks versus months or years and is accomplished by plugging sensors into electrical outlets to form a wireless mesh network. Any network computer or hand-held device can be used to locate tagged assets. The system features multiple views and search capabilities to best meet the needs of individual departments such as SPD. Additionally, business intelligence reporting can be customized for each user to increase efficiencies within the department. Business analytics and reporting tools provide preventive-maintenance alerts, as well as insights and trends that will significantly improve business processes."

The Skytron Asset Manager can track medical instruments, but there are other ways it can be used to link the SPD to the OR, explained Simon. "The key linkage from SPD to OR and OR to SPD is immediate visibility. Any tagged asset is just a computer ‘click’ away. Real-time location system (RTLS) benefits process planning, equipment utilization, inventory control, workflows, operational efficiencies, and more. T2S sterilizable tags broadcast low-power radio messages that provide precise information about movement and location, enabling staff to quickly locate surgical instrument trays, container systems, or other critical medical equipment. T2S sterilizable tags can be programmed to alert staff if sterile protocol is compromised (ie, tagged equipment moves from one sterile area to the next before being processed by the SPD)."

"Skytron Asset Manager provides managed IT hosting through a network operations center," continued Simon. "This network architecture offers full management and support of managed web-based application servers, security services, storage, and backup. The solution offers system-level administration and support, a comprehensive Internet infrastructure, and extensive services that relieve your IT department of many critical but costly responsibilities. The network operations center provides an off-site data center, managing the network, the server, and other devices. Skytron and Awarepoint retain full control of operating systems and applications. This balance of responsibilities allows for high levels of scalability and uptime, and includes extensive managed security solutions to protect the integrity of your data and guard against service interruptions."

Simon added: "Because Skytron Asset Manager is an enterprise-wide system, it is visible by all departments. This enables the OR to see if there is a process interruption in the SPD and to change schedules accordingly. Skytron Asset Manager prevents missing equipment or loss, reduces equipment rental expense, and increases overall equipment utilization, maximizing your return on investment. Additionally, Skytron Asset Manager can make an immediate impact to improve safety, patient flow, clinical engineering, and business processes."

Again, cost is always a concern to purchasers. Simon explained how Skytron figures the cost. "Customized pricing is based upon facility square footage and number of assets to be tracked." Skytron offers three financing options: capital-purchase acquisition; service-level—agreement payment(s), which can be made on per month, per year, or per term basis; and monthly financing, with monthly payments spread out for the agreement term length. Month-to-month rental allows the customer to pay a set monthly fee based on the number of assets tagged.

AORN’s Syntegrity Standardized Perioperative Framework is a data model that overlays existing surgical nursing documentation systems to guide safer, more effective, and more efficient patient care

AORN’s SYNTEGRITY

AORN has a tool that can be used in conjunction with software or online services for the SPD. Downing described it: "AORN has developed the AORN SYNTEGRITY Standardized Perioperative Framework, a data model that overlays existing surgical nursing documentation systems, with the foundation being AORN’s perioperative nursing vocabulary, the Perioperative Nursing Data Set. The SYNTEGRITY Framework incorporates standardized data sets and values, and crosswalks content with the AORN Recommended Practices, as well as accreditation and regulatory requirements. For perioperative nurses and services, the SYNTEGRITY Framework guides safer care, promotes effective care and, with the crosswalk information and regular updates, drives more efficient care."

"AORN is in the process of developing a component of the SYNTEGRITY Framework that will address postoperative infections," added Downing. "Equipment integrity and sterilization data from SPD that can be analyzed along with the SYNTEGRITY Framework data can then be used to compare and contrast processes and outcomes."