Diligence, multidisciplinary involvement aid adoption, ROI

Although some healthcare organizations appear to have gotten that message – and a number of vendors are citing a greater interest from hospital customers looking to tap instrument tracking solutions’ benefits – many still have yet to take the leap. The barriers to adoption are as varied as the tracking solutions themselves, but most appear to be rooted in longstanding misconceptions – and, in some cases, inadequate sterile processing department budgets and the assumption by hospital executives that instrument tracking solutions are a luxury, not a necessity.

"It’s true that instrument tracking systems can save money and be a valuable tool for any hospital. However, it is still seen as a ‘nice to have’ product rather than an integral part of the daily operations," confirmed Hana Scheichenost, T-DOC product manager, Getinge Infection Control, Getinge USA, Rochester, NY.

"One of the reasons is the initial capital investment and [the fact that] tracking systems are often the first to be cut from annual budgets," she reasoned, adding that another factor is resource allocation and staffing requirements in the SPD and IT to effectively start and manage the project. "Lastly, there are still many hospitals that don’t fully understand the impact and reach of many systems."

The V. Mueller IMPRESS instrument tracking system from CareFusion

Having a well-educated SPD staff that has a firm grip on their current productivity levels and processes, and also fully understands the full functions and benefits of a well-implemented tracking system, is the first step toward ensuring that the technology makes it into the budget – and stays there.

"Historically, tracking systems were based around instruments in the SPD, but today focus on the entire process, right up to the patient," Scheichenost noted.

"True interfacing capabilities [allow facilities] to manage patient, clinical and materials as a deliverable service to the OR, patient, surgeon and procedures under one database structure," explained Brian Newton, vice president of sales and marketing for SurgiDat Corp., Greensboro, NC.

Web-based applications, interfaces to operating room scheduling systems and radio frequency identification technologies have provided the greatest advancements in instrument tracking systems, according to Jennifer Anderson, vice president of marketing, Medical Specialties, for CareFusion Corp., San Diego, CA. "These technologies further automate manual processes within central supply and continue to offer efficiencies and improve accuracy for the central supply functions within the hospital." The V. Mueller IMPRESS instrument tracking system from CareFusion is a fully-integrated, real-time, web-based and modular instrument management solution that receives regular upgrades and functional enhancements (roughly once per quarter). The latest modules include sterilization, data entry and user interfaces, and like the solution’s other enhancements, have been developed in collaboration with customers and IT design teams.

Sophisticated software is at the heart of instrument tracking technology improvements, allowing for increased compatibility and linkage between equipment pieces and tracking systems. "Sterilizers automatically logging load data back into tracking systems at a tray level is the greatest efficiency and patient safety increase," explained Erik Hromatka, sales and marketing manager, Key Surgical, Eden Prairie, MN. "There have also been advancements in real-time technologies that may allow tray tracking solutions in the future to have real-time knowledge of the exact location of any tray in the system."

Spectrum Surgical’s Repair Tracker for scopes

Web-based hosted applications or "software as a service" (SAS) free software on a single database structure has further added to modern-day instrument tracking system benefits, offering real-time information across individual and multiple facilities, according to Newton. Further, these applications, which have redundancy built into the service and require no contracts, can reduce cost, infrastructure and maintenance, he added. SurgiDat recently launched its Serenity Audit & Recall product, a simple, expandable system that tracks goods through sterilization with validation through stock movements and traceability to the patient for historical reporting and auditing.

More advanced integration capabilities have also made it possible to electronically capture pertinent data related to biological indicator monitoring. "A more sophisticated example of [system integration] would be integration with devices, such as the 3M Attest Auto-reader, where all processes for test and control BI monitoring is disciplined and the AAMI-compliant documentation requirements – including recall procedures – are highly automated," said Clay Cannady, vice president of marketing and business development at Microsystems, Mequon, WI. The commercialization of the Auto-reader interface has been aggressively adopted by new and existing customers, Cannady said, adding that Microsystems has also just added a 3M Steri-Vac equipment interface – another Microsystems exclusive. Microsystems will follow this with additional proprietary capabilities with other types of sterilizers and digital devices sterile processing professionals increasingly rely upon, he noted.

Advanced system capabilities have also paved the way for integration with the OR scheduling system for needs list prioritization, automated expedites and "sets used" detail received back from the OR system for full traceability.

Other instrument tracking benefits abound, not the least of which relates to more effective inventory management, including the ability to capture actual instrument use and establish more appropriate, use-based repair scheduling.

"With a repair module, customers can easily calculate those hard costs associated with repairs," stressed Michael Mancebo, CRCST, director of sales for Carmel, IN-based TGX Medical Systems LLC. The company’s web-based Alex Gold solution offers full sterilization integration with virtually any sterilizer, regardless of manufacturer, including the capture of biological monitoring data, as well as OR scheduling interfacing capabilities and a case cart module that creates a live, up-to-date priority-list "based on wherever you are in the process," said Mancebo.

A technician uses Censitrac (Censis Technologies) to scan containers to a sterilizer load.

Having the capability to log flash sterilization cycles also factors into the instrument tracking value equation – and, above all, the impact on patient safety. Electronic data capture of flash sterilization loads is particularly beneficial for surgical suites that share multiple flash units.

Alex Gold tracks flash cycles for either an entire tray or individual instrument, which promotes safety and accuracy, and assists with instrument utilization. "If an instrument has been flashed six times, for example, then you will know that it will be due for maintenance six cycles earlier than the rest of the tray," said Mancebo.

Of course, the most significant benefit lies in the ability to clearly log the extent of flash sterilization in a facility and identify inappropriate flash sterilization practices that may have a negative impact on patient safety and quality care. The Bone & Joint Center at Grant Hospital, an OhioHealth hospital in Columbus, was able to reduce flash sterilization by 70 percent – down from ten times per day to approximately three times per day, on average – through the use of the IMPRESS system. While the system itself could not reduce flashing, it gave the SPD the valuable information on whether it had enough instruments and whether they were being used efficiently.

New from Spectrum Surgical Instruments Corp. (Stowe, OH) is its Repair Tracker, which provides internet-based tracking of scopes throughout the repair process. The service offers confidential customer access to the repair progress, with detailed repair history and search capabilities—by model, serial number, or purchase order number. In addition, the Repair Tracker provides automatic email updates with shipment notification and tracking information.

Microsystems’ 3M Attest Auto-reader interface automates reading and recording of BI results.

Instrument tracking has also been widely associated with increased productivity and tray accuracy, which then translates into improved outcomes.

"The true value of a tray and instrument [tracking solution] is creating a more efficient surgery department and increasing the safety of patient care and surgeon satisfaction. As you know, the operating room is the epicenter of the hospital, and surgery is the most important function of the hospital; it defines the hospital," noted Alicia Torres, Solution Line vice president for McKesson Corp. While the OR is also the most important part of the hospital from a financial perspective, she stressed that the OR cannot perform effectively without a reliable and efficient SPD. "If trays and instruments are not delivered on a timely basis, or if they are delivered incomplete with missing instruments, this compromises the OR function and has a negative impact on the entire hospital." The Horizon Tray & Instrument Manager provides immediate access to location and status details for all trays and instruments, while pop-up instructions on touch screens and wireless pocket PC scanners guide the user to follow correct procedures. Additionally, the solution’s Use History reports help management identify underutilized trays and opportunities to redeploy instruments.

Because the impact of instrument tracking solutions extend far beyond just the SPD, it’s prudent for SPD managers to align themselves with the OR and other key customers to pinpoint how a well-implemented instrument tracking solution will positively impact them, their patients and the bottom line.

"SPDs often know what they want, but they don’t go about getting it or asking for it the right way. They are competing for dollars against departments that really fight for what they want and need, such as the OR and IT. If you get the OR behind you, it’ll be a much easier sell," said Mancebo who, prior to joining TGX Medical, served as a veteran SPD manager.

Lancaster General Hospital in Lancaster, PA, has seen firsthand the impact that a well-implemented instrument tracking solution can have on accuracy and satisfaction – and the importance of having the OR actively on board with the system. Since implementing the Censitrac solution roughly five years ago, the department has experienced enhanced productivity, efficiency and accuracy, which has led to improved physician satisfaction and interdepartmental communication.

"We are seeing 99 percent tray accuracy," said Lancaster’s CS supervisor Trish Stoutzenberger. "If an instrument is broken, for example, they can quickly and easily nail down the exact set, which keeps staff from having to physically run around to try and locate it."

Censis Technologies reported that after Censitrac was implemented and used to its full potential, the percentage of incomplete instrument sets was reduced to 15 percent or less (prior to implementation, customers had reported that 50-60 percent of their instrument trays were incomplete. "This results in real savings as fewer instruments need to be purchased year in and year out," Jim Creason, senior vice president of business development for Censis Technologies, Franklin, TN, explained. Further, he added, Censitrac virtually eliminates time spent looking for lost instruments.

Yet another benefit of instrument tracking that facilities may not have considered: complying with the U.S. Food and Drug Administration’s looming Unique Device Identifier requirements, which are slated for release this year.

Using Alex Gold (TGX Medical Systems) to load items into a sterilizer.

Tracking at the instrument level will play a role in future UDI regulations for instrument tracking, sources said. "The fact that the FDA has recognized the need for discussion and comment around the concept of implementing a UDI system probably is one of the largest advancements surrounding the instrument-level tracking segment," said Creason. "Obviously, the prospect of having instruments uniquely marked for tracking purposes when purchased would reinforce the significance of instrument-level tracking when CS and OR managers assess tracking technologies for their departments."

Advancements have indeed made it possible to offer such production-level marking. SurgiDat’s Newton explained that one of the most significant advancements in the instrument tracking segment has been the ability to apply laser-bonded 2D matrix barcodes on surgical instrumentation in a production environment. "Older methods of chemical etching a 2D matrix barcode are applied by hand. Customers with significant instrument inventory may never achieve individual instrument tracking," he said. The SurgiDat software works in concert with a laser machine to apply a laser-bonded 2D matrix barcode on as many as 30 instruments in one cycle. "Customers can mark anywhere from 500 to 1,500 instruments per day to all types and sizes."

The KeyDot system is also already being used to comply with GS1 barcoding standards, according to Hromatka. Because Key Surgical is the only manufacturer of the Key Dot, he reasoned that the company has a unique opportunity to maintain a complete database of all the barcode numbers ever produced. "With this database, we can make sure that no KeyDot barcode number is ever duplicated. Certainly, in the UDI setting this is helpful, specifically, if regulations are introduced that require hospitals to barcode all their current inventory of instruments in a ‘retrofit’ of barcodes to match a specific new sequence." During the last several years, Key Surgical has improved its system for producing KeyDot custom sequences for customers, including GS1 barcodes and sequences specified by the customer.

Instrument tracking systems will help central supply functions automatically collect information for their daily operations, which provides documentation that the hospital is adhering to the new standards, added CareFusion’s Anderson.

Scheichenost, who pointed out Getinge’s T-Doc System already has the ability to read other barcode types, including GS1, recommends hospitals do their research and find those vendors, (whether in instrument tracking or those that provide consumables and other products to the industry) that support other types of codes. "Over time, vendors will need to conform to the standard, which will undoubtedly benefit the hospital."

Even those facilities that have adopted instrument tracking technologies may be shortchanging themselves on the value by only actively implementing one or several key functions.