Technology, teamwork help link CS, OR

Interdepartmental synergy is critical to the delivery of quality patient care and exemplary customer service. Still, communication breakdown is an all too common roadblock that prevents CS and OR professionals from reaching that goal, sources told Healthcare Purchasing News.

"The key challenge with interdepartmental connectivity is communication and the time commitment to achieve communication effectively," noted Jason Simon, assistant product manager, Skytron, Grand Rapids, MI.

The good news is software-based technologies – coupled with some old-fashioned, time-honored communication strategies – are helping CS and OR minimize confusion and error margins, and work in tandem to drive productivity and efficiency. The bottom line: Enhanced connectivity boosts overall quality, while promoting practice consistency, added one CS manager.

"New operational norms do surface and staying connected allows us to be on top of shifting objectives and new expectations – hourly, daily, weekly, or yearly," reasoned Michele DeMeo, CRCST, sterile processing manager for York, PA-based Memorial Hospital.

System connectivity allows for predictive maintenance.

If communication is the foundation for successful CS/OR relations, and myriad challenges affecting both departments on a daily basis tend to impede effective, timely information sharing, then it’s understandable why software-driven solutions that provide pertinent instrumentation-processing or procedure-related data at the simple push of a button or click of a keyboard are such a welcomed addition for CS and OR professionals.

Today, vendors are offering information technology that can quickly and precisely track instrument whereabouts, monitor tray processing progress and send real-time data scheduling information and procedure updates to help processing personnel prioritize tasks and stay abreast of subsequent instrumentation demands. And CS staffers (and their OR customers) are certainly reaping the benefits.

At Boston’s New England Baptist Hospital, for example, the implementation of the Sterile Processing Microsystems (SPM) networked software application from Materials Management Microsystems, Mequon, WI, has played an integral role in allowing its CS professionals to manage all aspects of the department, while enabling critical information sharing with the OR.

The hospital’s state-of-the-art, highly automated CS department is outfitted with Belimed processing equipment, which automatically communicates with the SPM software to provide (and record) real-time information on precisely what’s going on inside the equipment.

A tracking system in NEBH’s decontam area notifies CS staff of OR scheduling and case break times.

"We designed our department with connectivity in mind. We definitely didn’t want to be disconnected from the OR. Documentation is critical and with the tools we have in place, we now have access to all information to help us work [in tandem] and make better decisions to improve customer service," noted Mark Duro, CRCST, manager of NEBH’s Central Sterile Processing Department. The SMS Software was designed to improve asset management and CS productivity by enabling staff to build accurate and complete sets and optimize instrument inventory and utilization, remove process bottlenecks, match staffing levels to workload fluctuations, mobilize resources to meet specific end-user demands, and provide training tools to improve staff competency and efficiency. Further, the software can improve overall quality by allowing staff to access special instructions for cleaning, assembly, packaging, and sterilization, while also promoting accountability for all tasks, processes and results. SPM also can provide more than 250 standard reports, along with no-charge custom reports/queries.

Add-on modules push SPM’s benefits further. A Surgical Schedule Interface, for example, provides SPM Software one- or two-way communication with the surgery scheduling system, while SPM populates an Instrument Set dictionary to ensure consistent names and descriptions and, thereby, eliminate conflicts with the preference card system. Instrumentation requirements from the preference case system can also be passed to the SPM Software for inventory availability and for automatically populating an expedited message for set turns required the same day. The interface also allows set traceability to the patient or procedure to be documented without additional screening. Another add-on module includes the 3M Attest Monitoring Interface that allows automated, system-wide reading and recording of 3M Attest Rapid Readout Biological Indicator results. The interface provides real-time monitoring of BI incubation and immediate notification of positive results, and flags load items for quarantine. Finally, there’s an Instrument Tracking Module and a Mobile Equipment Module that ties equipment to patients for improved infection control/risk management, and allows documentation of utilization, preventive maintenance, repair, reprocessing, and distribution.

A screen clock notifies CS staff at NEBH that an OR room is complete and setting up for next case.

SPM Software isn’t the only relied-upon connectivity solution at NEBH, however. The Picis SmarTrack solution is also in place, which provides customized, secure tracking views that display relevant information about patients or resources within one facility or multiple facilities. SmarTrack also seamlessly integrates with the scheduling and documentation in Picis OR Manager, and can improve communication and reduce phone calls by providing accurate patient and resource information at the point of care.

The SmarTrack system affords a simple way for Duro and his team to know when a surgical case is closing.

As Duro explained, the system, which is populated by the OR, tracks the date, room, procedure, specialty needs and other pertinent information. When the case is concluding, the OR staff enter the system to indicate that; at this point, a countdown clock appears on the screen, which can then be viewed by CS staff, to indicate that the room will be turned over in approximately 15 minutes. "This is important for us because we know to be expecting those instruments from surgery soon," he said.

Scheduling software and asset tracking solutions have also enhanced CS and OR connectivity at Memorial Hospital, according to DeMeo.

"Our Central Sterile Supply Department has an inventory tracking system and we have access to not only the OR schedule, but their preference cards. We not only know what we have and where it is, but we can also be proactive in approach and can forecast future needs much better with these tools." The tools, she explained, have resulted in not just all priority sets being done and an ability for her team to determine which items used to be "one-of-a-kinds" or frequently used baskets, but also items that will be required for routine cases. "[These are the] same items that CSSD, in previous years, might not have known were going to be used and, hence, might have been left undone in lieu of other critically-needed baskets."

Multi-functional connectivity solutions have also become easier to use, which is good news for time-strapped CS and OR departments that require instant access to real-time information. The Skytron Asset Manager, for example, can notify CS staff or other appropriate personnel when a procedure has been completed, and it can also help locate supplies for the next case. The solution provides real-time information on the status and location of any item or device that has been tagged.

The tracking solution in NEBH’s CS department informs staff of case schedule, changes and progress made in the OR.

"Connectivity is accomplished through a Zigbee mesh sensor network, 802.15.4. It is a separate network and has been proven in over 80 acute care facilities to provide a high level of accuracy without interference," said Simon. Additional connectivity or integration with middleware is accomplished through Skytron’s open application programming interface (API).

In some cases, the breadth of information IT systems can provide reaches beyond CS and OR. "Personnel throughout the hospital may also require information from CS – from the chief financial officer seeking quarterly payroll or productivity data to the everyday data needs of OR and CS staff," reasoned Rob Avriett, BS, CSPDM, CRCST, CHL, a Certified IAHCSSM Instructor who serves as director of implementation for IMS Inc., Birmingham, AL.

To fulfill those needs, IMS designed a modular information system that makes relevant data available to any stakeholder. System features include customizable dashboards for specific users; real-time data for metrics, such as number of trays processed, tray accuracy, flash sterilization rates, error rates, and productivity rates; comprehensive quality assurance data, including not only negative events, but all information that can have an impact on process improvement; employee training and education database, including an inservice scheduler, competency recorder and certification/licensure tracker; and integration with Blackberry applications.

Solutions that provide processing equipment performance reports are also keeping CS and OR staff on the same page. The ProConnect Response Center by Mentor, OH-based STERIS Corp., for example, integrates remote equipment monitoring and an online portal, as well as field and technical support. The service can maximize uptime of connected sterilizers and washers, thereby reducing procedure delays and the need for faster-than-is-prudent instrument turnaround. Through ProConnect, STERIS can predict when service-related issues may occur, which allows facilities to secure preventive maintenance and repairs proactively, and reduce downtime. ProConnect users have access to nine equipment performance reports – including service, alarm and parts history, to name a few – through the Customer Care Center. If an alarm occurs, the ProConnect program can send an email alert to CS and OR staff. As yet another safeguard, the ProConnect Response Center contacts CS and OR staff to address equipment performance issues and ensure that maintenance issues don’t slip through the cracks.

However valuable today’s connectivity solutions are for keeping CS and OR professionals working together as harmoniously and productively as possible, sources were quick to point out that such tools will never take the place of good old-fashioned, face-to-face communication.

STERIS’ ProConnect Response Center is linked 24/7 to a hospital’s reprocessing systems.

Of course, making that direct connection isn’t always easy. "There tends to be a lot of blame-swapping because neither department really understands the other’s processes – or the way that, when their own processes fail, the other department’s processes are disrupted," explained Tracey Rapp, clinical operations manager, IMS.

Despite this historical – and sometimes epic – struggle, many facilities are making significant inroads, however. Much of their success can be linked to the delegation of interdepartmental liaisons and the push for CS and OR leaders to jointly participate in regular meetings to discuss issues, errors, quality concerns, and other factors that might impede effective customer service and erode interdepartmental teamwork.

"Mutual respect is critical," added Rapp. "The OR staff needs an opportunity to spend time in CS and vice versa. CS personnel can see how instrument delays actually affect the patient on the table, and the OR staff gets to see how their own processes can affect CS productivity."

It’s an approach that’s paid big dividends for Memorial Hospital and NEBH. At Memorial, CS joins the OR for morning reports and representatives from the CS department (which include all technicians, not just DeMeo and lead techs) also "round" the surgical department consistently throughout the day to stay abreast of challenges, expectations and any shifting demands.

"We also work on our capital and operational budgets together to assess new information and past actual results," noted DeMeo, adding that she also inservices the OR team on CS-related topics.

NEBH has dedicated liaisons who work directly in the OR to address instrumentation-related issues and Duro and his team have daily afternoon meetings to assess the next day’s schedule and create a game plan to ensure that the OR will have everything it needs. "This helps us address any issues and eliminate any problems the day before the instruments are needed," said Duro.

Some vendors are doing their part to assist CS and OR in developing effective communication and team-building strategies. IMS, for example, provides facilities with CS managers and process improvement liaisons to keep the two areas connected and boost morale. IMS’s CS manager makes daily rounds in the OR, building relationships with OR staff and surgeons. Meanwhile, an IMS process improvement liaison ensures that each case cart is checked and 100 percent complete before it is needed in the OR. The liaison responds to specific issues and problems, communicating any instrumentation errors to the IMS CS manager.

"The objective is to correct processes rather than just put out fires. When problems do arise, they’ll be resolved in a productive and cooperative way," said Sharon Hadley, BSN, RN, CNOR, CSPDM, CHL, clinical OR director for IMS.

SterilTek has also become committed to building more effective teamwork and leadership between CS and OR staff. As George Godfrey, director of project & process design management for STERIS Corp., the parent company of SterilTek Holdings Inc., pointed out, the operations and functions of CS and OR are highly dependent on one another and must be like an orchestra playing in tandem. "SterilTek can assist in developing the leadership and ensuring that all the instruments are properly tuned and that players understand their parts," Godfrey noted. The in-depth knowledge and expertise of the SterilTek team, he said, provides customers with effective solutions to challenges and process issues that often cause discord between the two departments. "We also have developed customized tools to help healthcare facilities maintain the process improvement initiatives and changes they implement, which helps ensure positive, sustainable results."

Whether CS and OR rely on a vendor to promote connectivity and teamwork, or opt to tackle interdepartmental communication in-house, the effort and dedication should pay off in spades, assured DeMeo. Connectivity, she reasoned, is more than just linking departments together with technology – and more than just engaging in idle chitchat.

"Connectivity begins with a belief that there is a true relationship between two or more elements. For OR and CS to be more unified, the connection must be more than a figurative one. Building systems with interdependencies in mind will allow cross-functional work to flourish," she said.