When Gundersen Lutheran Health System in La Crosse, WI, first implemented its instrument management solution in 2003, its central service staff was impressed by the way the system improved technician training, streamlined instrument processing and assembly, improved the accuracy of trays delivered to the operating room, and allowed them to track instrument trays and locations in real time.

Today, the organization is reaping far greater benefits, thanks to its ongoing adoption of numerous other applications built into the automated management program. With the use of software, barcoding, and Internet and wireless technologies, Gundersen Lutheran is able to view instructions and digital images of trays and instruments, print count sheets and barcode labels, capture and verify tasks, associate count sheets with all trays, and record each step of the sterilization process. And that’s just the tip of the iceberg. According to Rod Brueggeman, CS manager for Gundersen Lutheran, case cart tracking will be the next step in the process.

"There are so many applications for this system. It isn’t just about instrument tracking, although that is certainly an important benefit. It is a comprehensive instrument management tool that allows us to improve our processes and efficiencies in a number of different ways," Brueggeman noted. "The options are very exciting and we are interested in exploring them."

Gundersen Lutheran isn’t alone. More and more healthcare organizations that had in the past relied on their instrument management solutions for just one or two applications are now opting to maximize its value by tapping into new territory – and looking to their vendors to provide more customizable solutions that can be easily integrated into other asset and process management programs.

"[Healthcare facilities] are realizing the value of comprehensive instrument management programs and are beginning to understand how such programs can become part of an overall strategic initiative," said Blair Myers, vice president of sales, Censis Technologies Inc., Franklin, TN. "As the vendor, it’s up to us to meet those needs with scaleable solutions that can be tailored to each organization, and to continuously look for ways to improve and build upon our [systems]."

Vendors appear to be rising to the occasion, offering sophisticated solutions that can be easily piggy-backed onto existing or future asset management applications. Sources agreed that the foundation has been laid for more meaningful, quantifiable applications that are designed to work in tandem.

"System integration is critical because no one wants another standalone system," explained Clay Cannady, head of sales, marketing and business development for Materials Management Microsystems, Mequon, WI. "Locating a tray was the first step, but now the value propositions are extending into better inventory control and into areas of risk management and infection control."

Fulfilling a critical need
Few can argue that the need for improved instrument management is great, particularly given the millions of dollars healthcare organizations spend on surgical instrumentation.

Facilities have long been challenged by poor interdepartmental communication, lost instruments or inaccurate sets, and the costly delays in surgical procedures that occur as a result. Couple that with challenges associated with maintaining adequate processing and sterilization logs, tracking instruments throughout the preventive maintenance and repair cycle, and identifying instruments in recall or outbreak situations, and the benefits of adopting an automated instrument management system become even more clear.

Despite those overwhelmingly common problems, the majority of hospitals have yet to adopt such a system – a fact that many say is rooted in budgetary constraints and end users’ reluctance to change. An April 2004 Lawson Software survey revealed that only 27% of respondents have a surgical instrument and tray tracking software product in place, despite struggles by operating room staff regarding service from the sterile processing department, high instrument repair budgets, delayed surgeries due to problems with instruments, and wasted staff time due to poor management of surgical trays.

Those findings came as no surprise to Steffan Haithcox, industry marketing director, healthcare, Lawson Software. "These are certainly concerns that [many organizations] are struggling with," he said, adding that the good news is a growing number of facilities are moving in the right direction by adopting instrument management solutions or at least considering them.

Nearly half of the 73% of survey respondents that lacked the software solution indicated that they are interested in purchasing a surgical instrument and tray tracking software product in the future. Sixty-three percent of those respondents noted they will be ready to purchase the product within a year. Findings consistently show that such a system quickly pays for itself. Lawson estimates that a 300-bed hospital can save as much as $500,000 annually from time savings, increased productivity by clinical and sterile processing staff, error prevention and reduced instrument repair and replacement costs.

Materials Management Microsystems Steris interface

Springfield, MO-based CoxHealth is one facility hoping to adopt an instrument tracking program in the near future. The health system has already found success by creatively integrating an asset tracking solution into an existing wireless sensory network solution for nurse call and staff tracking. Using infrared locating technology via a network of sensors, CoxHealth is now able to monitor the location of more than nearly 800 pieces of equipment, eliminating time spent searching floors for items in dirty, clean and holding zones, and shortening the wait for patient care needs.

"Instrument tracking will help us gather even more important information that will track our processes and productivity, and make us more efficient. Based on the benefits we’ve already seen with the asset management system, I’m sure we’ll gain even more when we can track surgical instruments," noted Barbara Nunn, director of central service, CoxHealth.

Gundersen Lutheran can attest to the rapid return on investment. Since implementing Lawson’s Surgical Instrument Management program, the organization has garnered substantial improvements, including an approximately 30% reduction in the amount of time needed to train instrument processing personnel and a 50% reduction in the occurrence of missing items in instrument sets. Brueggeman said the system has led to another key improvement that is more difficult to quantify – a better relationship between CS and OR staff.

"Since implementing this system, our relationship and communication with the OR has definitely improved," he noted, adding that the fully automated solution helped take the guesswork out of the instrument management process and eliminate finger-pointing and frustrations associated with missing or incorrect instruments. "Our benchmark has been how many calls we receive from the OR. They have dropped dramatically, which tells us that what we’re doing is working."

Logging bigger benefits
Facilities that take full advantage of their comprehensive instrument management solutions may find that other key advantages are just a barcode scan away.

Many are pleased to report that automated tracking systems can prompt more effective preventive maintenance schedules and better track instruments sent out for repairs or loaned to other facilities, thereby reducing costly replacement of lost items. According to Cannady, offering solutions that can integrate the repair or refurbishing component into the overall asset management function means users can get a clearer snapshot of utilization, which in turn, can help them determine if certain items are being repaired more or less than needed.

Still, the majority of facilities using instrument management programs haven’t been able to fully realize these benefits because they aren’t tracking all the way to the individual instrument level – a fact that is primarily driven by the assumption that unit-based tracking is both costly and labor-intensive. Even so, sources generally agreed that the pros of individual device tracking far outweigh the cons.

"When looking just at the repair component, you can see that there is an enormous opportunity to mark certain items, so [CS] can trace and document the sequence of processing, and capture all repair and refurbishing histories," Myers explained, adding that it’s difficult to track actual usage of instruments if facilities are only scanning trays because some instruments included in each tray are not always used in every procedure.

Myers also stressed that individual instrument tracking is useful because CS can set more accurate parameters for preventive maintenance scheduling. Scissors obviously require more frequent maintenance than a chisel, for example, but without individual tracking, many facilities wind up putting them on the same maintenance cycle, he explained. "By scanning each instrument, you can automatically track its use and be flagged when it’s time for it to be serviced."

Tracking to the individual instrument level can also improve infection control efforts, sources noted. If a facility is faced with a suspected or confirmed case of Creutzfeldt-Jakob Disease, for example, being able to quickly identify which items were used on which patients – and then track their current location – would certainly be beneficial.

Tracking individual scopes could also prove invaluable, particularly in suspected outbreak situations where contaminated instruments are believed to be the source of infection. In such an event, the facility could quickly pinpoint an instrument’s processing and repair history, and exact location, and then be able to identify precisely which patients were exposed to the device.

"Imagine the value of learning that 38 patients, for example, were in contact with a particular scope and contacting just those individuals, rather than notifying hundreds of patients who may have been in contact with that scope," Myers explained.

Marked improvements
While many recognize the value of individual instrument tracking, some facilities may be reluctant to adopt the approach because they question the technology available to make it happen.

Although laser-etching individual devices is one proven approach, there are reported drawbacks. Some contend the technique can be costly and time-consuming, and etchings can become "filled in" by hard water deposits. Some sterile processing professionals have also reported problems with corrosion around the etching.

As another option, individual adhesive barcodes have become available, enabling users to bypass the need for laser-etching altogether. Key Surgical Inc., Eden Prairie, MN, introduced the InfoDot lift and peel barcode label technology 18 months ago. The labels are laser-engraved with a two-dimensional barcode that can be applied directly to an instrument, and are designed to work with a facility’s current software application. Each label works like a license plate, linking a device to its own unique data file.

Because the technology’s application in healthcare is still new, some modifications to the product have been necessary. Although the current acrylate labels have been developed to last one to two years, depending on usage, some facilities have experienced premature flaking and have expressed an interest in labels that can withstand the rigors of processing for as long as five years. There have also been concerns about the labels’ ability to withstand gas plasma sterilization – another factor that Key Surgical is currently addressing, according to the company’s general manager Peter Huck.

InfoDot’s developer, Michael Meeks, said a more durable substrate is being tested and will debut later this year. The product, he noted, will be designed to better withstand gas plasma sterilization and should be able to withstand three to five years of processing, depending on usage.

Censis Technologies, which had offered the two-dimensional adhesive barcode under the name CensiDot, has circumvented the problems entirely by replacing the adhesive product with its new CensisMark technology. According to Myers, the CensisMark is an unobtrusive marking that is permanently laser-bonded to instruments. "There is no adhesive that can flake off or need to be replaced."

The big picture
Regardless of the instrument tracking approach facilities ultimately choose, industry experts agree that healthcare organizations don’t have to track each and every process or instrument in order to achieve success. In fact, starting slowly and taking the time to fully understand each application - and earn buy-in from different departments – could have a more positive impact on the application’s growth and success.

"Tracking can be an ongoing process – it doesn’t have to happen all at once," Myers said. "If a facility’s main motivation is training accuracy and better accountability in CS, they may want to track as many instruments and processes as possible. But they don’t have to mark every instrument in the inventory to reap the rewards. Any amount of data captured is better than none."

Vendors said healthcare organizations should have even more tracking capabilities in the near future, which will further boost their benefits. According to Cannady, technology that can better assist CS departments in complying with ST46, the steam sterilization and sterility assurance standard set forth by the Association for the Advancement of Medical Instrumentation, is on the horizon.

Enhanced integration with operating room and materials management programs is another prominent trend – one that Gundersen Lutheran is already tapping. The facility is serving as a beta client for Lawson’s upgraded SIM program, which integrates with Lawson’s Supply Chain Management Suite and leading OR management systems.

Numerous vendors and industry experts predict wireless and radio frequency identification-enabled solutions will also become more prominent, allowing enhanced equipment tracking and monitoring capabilities via RFID tags and handheld readers. Not only will RFID allow users to capture more specific, detailed information – such as an instrument’s identification, origin and exact usage and processes it has undergone, healthcare facilities will also benefit by the fact that RFID tags can function effectively even if they are obscured, explained Lydon Neumann, vice president of New York-based Capgemini Health.

"To track with a barcode, you need to be able to see the barcode and have [clear access to it]. That’s not the case with RFID," he said. Lydon noted that such technology could conceivably work even in implant devices where the RFID tag would not be visible.

Numerous vendors are already jumping on the wireless bandwagon. Lawson’s SIM program, for example, supports multiple transmission modes, including real-time wireless, intermittent wireless and cradle-based synching. In January 2005, Agility Healthcare Solutions announced the release of it web-based equipment management system that integrates comprehensive functionality into handheld RFID readers. Agility noted that the new solution includes functionality for patient tracking and surgical instrument management, and incorporates new tools to manage daily rental equipment not owned by the healthcare facility or Agility. The system also features an "enhanced web front-end for better usability and navigation," and an email alert system to allow healthcare facilities to respond more quickly and effectively to corporate governance, including mandates for operational visibility.

Although the instrument and asset tracking market is maturing and providing healthcare organizations with more options than ever before, Neumann warned against blindly adopting tracking technology and expecting all previous problems to be automatically erased.

"Some believe that installing a system will solve all their problems, but it doesn’t. Although I believe in the technology, I discourage people from implementing it if they don’t have the time [or resources] to make sure it’s going to be implemented correctly," he explained.

Neumann suggests hospitals first outline clear goals and objectives they aim to address with the technology, and then identify the true cost of implementation – including how much executive attention can be dedicated to the system.