A reduction in labor-intensive searches for lost trays is just the beginning of what an instrument tracking program can do for CS/SPD productivity and efficiency.

In fact, "once a hospital decides to acquire a system, and uses a system, the individuals working there wonder how they got their jobs done before the system," suggested Michael Good, senior vice president, TGX Medical Systems (Carmel, IN).

Compounding the issue, said Delurgio is that "often customers are asked to ‘do more with less,’ such as pick up sterile processing services for a new surgi-center, but also trim staff."

That’s where an automated instrument management programs can be of particular help. For starters, such programs can be a tremendous boost for training efforts and quality control. From helping workers identify instruments to providing processing instructions and enabling set building, instrument management programs are driving improvements in quality of work – as well as helping to bridge the gap between CS and O.R. departments. With touch screens and alerts to guide technicians through reprocessing, instruments are more likely to be ready on time and processed correctly, which will go a long way towards reducing frustration between O.R. and CS staff.

"When the O.R. sees SPD as a reliable and responsive supplier of critical items mutual respect and cooperation are no longer pipe dreams," said Cannady.

"CS and O.R. want the same thing but rarely work together to achieve it," said Good. "An instrument tracking system makes everyone accountable. This is not to be used as a finger pointing tool, but as a tool to take away the guess work," he emphasized.

Designed for users with little or no computer experience, TGX Medical’s Alex Gold central service management software has alerts related to the proper cleaning, assembly, sterilization, storage and overall care and maintenance for a specific instrument or tray. These are forced pop-ups that will be triggered upon the item being scanned in the related department.

Tray Controller, developed by Rosebud Solutions and distributed exclusively by Stryker Corporation, includes Rosebud Alerts, automatic e-mail or pager alerts that can be generated for any management-defined event. These alerts can be triggered from scanners or workstations and sent to any number of pre-designated recipients.

"Tray Controller uses a combination of touch screen technology and wireless pocket PC scanners to reduce the probability of human error, ensure real-time documentation and reduce the time required to complete each task," said Alicia Torres, president and CEO, Rosebud Solutions (Ann Arbor, MI). "Touch screen technology increases the speed and accuracy of the packing process. Technicians simply touch the screen to document the contents of a tray. In addition, productivity reporting allows managers to identify staff members who may need further training on a specific task," she said.

"Proactive prompts, alerts and an array of reports to arm sterile processing department management with the tools they need to establish an efficient workflow," Torres continued. "Tray Controller does not change the workflow process; it simply make the process more efficient, accurate and easier to manage. We customize the format of the count sheets to match the hospital’s current or preferred format and train all users on site."

Tray Controller also allows technicians to click onto short training videos that demonstrate the various steps of the process or view pictures of specific instruments or trays.

Cardinal Health updated its IMPRESS instrument management program last year so that it is now a web-based hosted application that utilizes simple, visual prompts, tracks all sterilization loads and includes an enhanced assembly module that provides the capability to perform on-line assembly of surgical sets with additional quality checks.

"IMPRESS improves the communication lines between the O.R. and CS because the system holds people accountable for their work and, whether you are a technician assembling a set or an O.R. nurse scanning a case cart into the O.R. IMPRESS keeps track of each transaction and provides visibility to historical transactions," said Flavio Marin, senior manager, V. Mueller, Cardinal Health (Dublin, OH).

"These systems include an element of change management to proactively keep the count sheets accurate," said Duckett. "When the SPD techs scan a tray they’re assured that what comes up on their screen is the most recent and accurate version of the count sheet. When they assemble the tray, they know that it’s meeting the expectations of their biggest customer, the O.R."

"The natural result of these improvements is an improved relationship between the O.R. and the SPD. Conflict resolution is also assured because the objective data provided by the instrument management system can help resolve conflicts based on facts and without any harmful finger-pointing," he said.

Integration with surgery scheduling software can also help change the SPD from a reactionary to a proactive department, taking efficiency to new levels and allowing the SPD to actually plan ahead versus simply responding to trays as they show up at the door.

Cannady explained: "If you’re really going to manage your inventory and capacity, you’ve got to use your resources to build trays according to user demand. That’s a totally different concept. Now the sterile processing department can take orders and fill orders, they don’t just take what comes in the door. And the way that we do that is we have a bi-directional interface with the surgery scheduling system," he said of Materials Management Microsystems’ Sterile Processing Microsystem (SPM).

"Our system will take the demands from the preference card from the surgery scheduling program and conflict-check against the actual inventory levels. What it allows you to do is gear the consumption of your resources around the demand – to take all of those exceptional, expedited scenarios and have a dedicated process for dealing with them and for allowing the manager of the department to know where they stand at any given time in terms of the work that is being done relative to the demand which is dictating the priority of that work and how it gets done." SPM alerts can be targeted or global such as "set expedite requests" from the O.R. or staff-specific notifcation, said Cannady.

"The sterile processing department can proactively prioritize trays, based on the upcoming needs of the O.R.," said Rosebud’s Torres. "This is accomplished through an interface between Tray Controller and the surgery scheduling software."

Getinge’s T-DOC (Total Documentation) productivity management system tracks instrument location along with processing and maintenance status, for example, whether the instrument is sharp, or the batteries need changing. T-DOC integrates in real-time with washer-disinfectors and sterilizers archiving data for future reference.

Integrated Medical Systems (IMS) uses its instrumentReady platform of teams, processes, services, technology and infrastructure to help healthcare facilities ensure that instruments are ready when the surgical team is ready. With origins as an instrument maintenance and repair company, IMS now offers ReadyTracker - Tray and ReadyTracker - Tissue, web-based software programs that use bar-code technology to track instrument trays and/or implants and support staff training and education through electronic count sheets and digital instrument images.

The Milestone process from IMS helps maximize instrument performance through education, proactive maintenance, and trend analysis. A more comprehensive approach is available with IMS on-location surgical endoscopy solutions and central sterile process management and coaching, designed to help strengthen the bridge between CS and O.R. According to IMS, having instruments ready on time can help facilities increase the number of surgical cases that can be performed in a day – which can quickly help to pad the bottom line. The company estimates that one additional procedure per day can generate $4 - $7 million of revenue in an average sized facility (i.e., 250 beds) in one year.

TGX Medical’s Alex Gold

The patient safety advantage

Even if there were no financial or productivity benefits to be had, there’s still one extremely important reason to consider instrument-level tracking – and that’s patient safety.

The ability to link instruments directly to the patient they were used on is a critical aspect of instrument management that will be needed for JCAHO audits or in recall situations.

For example, when a facility finds a case of Creutzfeldt-Jakob disease (CJD) and they have to contact everyone who might have been exposed to those instruments, "it could mean the difference between contacting 1,000 people or contacting ten people if you can directly trace back which patients those surgical instruments were used on," said Woodcock.

"Instrument management systems are very effective when it comes to improving patient safety," confirmed Duckett. For example, "it’s alarming to see the number of loaner/vendor and short inventory trays that are flash-sterilized each day. A good information management system can help the SPD proactively manage loaners and quick-turn items by applying an interface to the hospital’s O.R. scheduling system. The STERIS IMS system has the ability to receive information from the O.R. schedule and prioritize the SPD work flow. Everyone using the system is alerted when trays are needed, based on their need throughout the day. This function reduces the dependency on flash sterilization, which in turn improves patient safety."

"A sterile processing management system has implications on not only the operational efficiency, but the sterile processing function also has a significant impact on infection control, patient liability and risk management. And that’s huge," said Cannady.

"With visibility into the history of an instrument and warning when users scan a tray to an incorrect sterilization type, Lawson Surgical Instrument Management can help prevent patient safety problems, and provide information that can be used to improve safety for future patients in the event of an infection control incident. With this level of information, as well as the ability to quickly find trays and instruments in the event of an emergency, service to the O.R. can be substantially improved," said Delurgio.

For a low-tech, low-cost, easy-to-implement aid for tying sterilized items directly to the patient they were used on, SPSmedical provides the Patient Record Card. Simply tape a card to the outside of every package and apply a lot control sticker to the card. The O.R. then separates it at the perforation and places the card on the patient’s chart. This is an economical means of complying with AAMI ST79 regarding traceability of all items used in a procedure.

Inventory aids

A key functionality of many automated instrument management programs is the ability to generate utilization reports that can ultimately lead to a reduction in unnecessary surgical instrument inventory, among other benefits.

"Utilization reports allow the hospitals to quantify exactly how many trays and instruments they actually need, and what they don’t need," said Rosebud’s Torres. "These reports can be generated quickly and can be sorted by user defined parameters. Examples of these parameters include tray type, department, owner, time frame, etc. Excess trays can be broken down and the instruments redeployed. Conversely, when more trays and instruments are needed, it can be quantified. This ultimately leads to more effective capital deployment," said Torres.

Keeping track of repairs and maintenance is yet another benefit of an automated instrument management program that can lead to cost savings.

"We work with clients to move from time-based refurbishment/repair to a schedule tied directly to the utilization rates of the specific device or instrument set," said Cannady. "This will ensure the client is spending money on the items that need it when it is needed. Not only does this optimize repair budgets but eliminates premature sharpening that can shorten the useful lifespan of instrumentation. Additionally, the ability to document repair work and expense to the specific asset increases the accountability on users for proper use and care."

"When you only track to the tray level, you interpret that everything that happens to that tray is happening to every instrument," explained Woodcock. "For example, if you’re tracking a certain tray you could have it flagged so that every 10 or 20 uses you need to pull the set for servicing sharpening, repair, etc. In any given set, you might only use 60 to 70 percent of those instruments, on any given procedure. If you can actually track individual items, you know which of those instruments really need to have servicing and which ones are just getting passed through without being used every time. You can really save money on repair and refurbishing costs."

Good relates an example of a facility that was able to cut yearly repair expenses by $80,000 using TGX Medical’s Alex Gold Central Service Management program. "One of our facilities was spending over $120,000 a year on repairs. With Alex Gold and its repair module they were able to identify that most of that money was being spent on Linvatec Reciprocating Saws.

"Using Alex Gold, they identified that the saws were being damaged on Tuesday and Thursday cases. The manager observed the surgeons that were using the drill and noticed that in order to achieve the power and speed the surgeon wanted the PSI would be cranked to over 90psi. The drill could only handle 40 psi. By simply providing this surgeon with an electric alternate, they have cut the repair budget from $120,000 a year to $40,000 a year," said Good.

To help its customers track repairs, Olympus has developed a 24/7-service portal. The repair and service tool allows customers to electronically submit service orders and track instruments in real-time through the Olympus Service Network.

"With an established account and password, customers can securely submit and approve orders, access repair history and pinpoint where a device is in the repair process. Beyond repairs, the service portal gives Olympus customers enhanced inventory and purchasing visibility," said Alec Weiss, product manager with Olympus.

"I believe that the opportunity to have greater visibility of the repair status of a product can greatly benefit our customers in scheduling procedures, as well as in balancing workloads. Furthermore, our customers will have the ability to submit and approve repairs via the service portal, and in this way minimize the repair downtime of their products," said Eddie Garces, vice president, Olympus Medical Equipment Services America.

The Olympus Repair module includes value-added customer features and services like reporting mechanisms, details regarding customer Olympus assets including model, serial number, purchase date, real-time service contract information such as consumption and balance, and any repairs performed in the past 120 days. "These additional features as well as those already contained in the service portal, will provide our customers the opportunity to more efficiently manage the tracking of repairs, repair cost, trends, etc. Knowing and understanding this information will enable customers to maximize the efficiencies and performance of their assets. Olympus customer solutions representatives can be contacted to get repair histories longer than 120 days for the life of the product," said Joel Munar, senior manager, Olympus.

Rapid ROIs

The really good news for any department needing to take the plunge and implement an automated instrument management program is that many companies are now offering guaranteed results. Some are so certain of their program’s ability to save facilities money, that they’re sticking their necks out and offering a guaranteed Return on Investment.

"It is critical that senior management be able to justify the capital dollars for an instrument management system for their SPD. To help them, we’ve created a tool that shows how this technology will pay for itself in a relatively short period of time," said Duckett. "A healthcare system’s biggest short-term gains are going to come from two areas; staff productivity and instrument repair and procurement savings," he adds.

Materials Management Microsystems provides clients with a guaranteed ROI equal to the customers’ investment in the system, typically within 12 months, explained Cannady. ROI for the SPM program is predicated on productivity, quality, the benefits of going to utilization based repair schedules, and AAMI documentation and compliance. "Those are the four primary areas where we will use our financial model to project savings," said Cannady.

TGX Medical Systems guarantees any new client that they will receive a full ROI from their Alex Gold system within 24 months. "Efficiencies are gained throughout the lifecycle process," said Good. These include reduced repair and maintenance dollars, increase in productivity, proper instrument utilization, an increase in communication, decreased down time in O.R., proper cleaning instructions that allow instrumentation to be better maintained adding to the life of the particular item.

Rosebud Solutions claims ROI results for its TrayController solution of up to 57 percent increased productivity in preparing trays at the packing station; up to a 95 percent increased productivity at the sterilization area; a reduction in SPD time responding to calls and inquiries by nearly 5 hours per day; up to a 140 percent reduction in time required for new hire orientation and training; a projected 5-8 percent reduction in annual expenditures for surgical instruments.

Marking methods

Whatever the functionality of your instrument management program, it all starts with marking the instruments or trays for tracking. This can be in the form of a barcode that’s permanent laser-etched directly on to the instrument, called Direct Parts Marking, or, another option is a tiny label containing a barcode that’s affixed to the instrument.

Key Surgical provides an alternative to laser etching with its KeyDot (previously called InfoDot). Sold in sheets of 100, KeyDot is meant to be an easy, efficient, and economical solution for facilities to quickly implement individual instrument tracking in-house. KeyDots each have a unique barcode number associated with them. Scanning the dot, with its data matrix bar code links that instrument to a datafile within the tracking software system. KeyDot is made from a durable material that can last through multiple sterilization process cycles. This year, Key Surgical has introduced a warranty that guarantees the KeyDot to last two years or 200 cycles, whichever comes first, said Woodcock.

When it comes to asset tracking there are both radio-frequency identification (RFID) and barcode specific applications. Currently, instrument-level tracking requires the use of barcode technology which is scanned by a technician at specified check points. RFID on the other hand uses strategically placed readers that automatically register items as they pass through. RFID eliminates the human factor error associated with manual scans, and can track assets as they move from room to room, but it can’t trace to the level of detail required within the SPD itself.

"RFID will greatly improve efficiency and will be able to account for instruments that move quickly in emergency situations and are not always scanned in today’s barcoded environment. However, RFID technology needs to progress from a reliability and cost perspective before customers will rely on it for their instrument tracking needs," said Lawson’s Delurgio. "Lawson has investigated RFID technology for instrument tracking, but Lawson will not directly support RFID in Lawson Surgical Instrument Management until the technology is more reliable in a sterile processing environment and less expensive to implement."

"The problem with RFID in tracking individual instruments is that most instruments are stainless steel (metal) and they’re usually contained within metal trays on a metal case cart on wheels, for example," explained Woodcock. "The idea behind RFID would be that you wouldn’t have to actually scan an instrument; as soon as that instrument went through a portal it would just pick up the RFID signal and register where that item is. When you have metal instruments inside metal trays, that really interferes with the signal. That’s one obstacle with RFID for individual surgical instrument tracking at this point."

Cannady says Materials Management Microsystems envisions a symbiotic environment where RFID and barcoding work in tandem to provide the ultimate instrument tracking method.

"RFID has, in our view of the world, sort of limited value within the department where we deal with so many SPD function-specific activities and requirements. But where it becomes pretty powerful is when you create the handshake so that items going to sterile storage, case carts, O.R. suite, etc. are tracked via the RFID system, and then we take ownership and control back from the RFID system at the point of Decontam."

"While the asset is in the SPD it rightly belongs with a system that brings all of those human touch points and machine touch points and asset management capabilities together so that you have that full-traceabilty documentation trail. But once the instrument is sterile and ready to be issued for use, if the RFID system is capable, that’s clearly the efficient answer because…all of that manual scanning goes away," said Cannady.

With its wireless real-time location system (RTLS) called SPOT, InnerWireless provides the ability to track assets as they move throughout a facility. While they’re currently able to tag and trace to the tray level, the company is investigating the use of technology to track down to the instrument level.

InnerWireless uses a software program, completely sealed ridge-free tags, and beacons that reads the tag as they move throughout the enterprise then sends those signals to the asset location engine, SPOT. SPOT will then tell the end-user where that asset is within the enterprise through a set of maps and GPS-type functions. Alerts can be provided if a product is moving into a location that it shouldn’t go into or out of.

"What we have been asked to supply, and what our customers have been talking about using SPOT for is to tag that whole tray, not at the instrument level but whole tray itself, and so when that tray leaves CS or a request comes down for that tray from the O.R., then they can track that tray as it moves throughout the hospital up to the O.R. suite and now they have kind of a closed-end process. Yes the Dr. requested the tray, it was the right tray, and it did leave CS at this time, we tracked it throughout the floor, and it arrived into the O.R. suite at "X" time. So that there is a complete history of what happened to that tray as it left CS and wound up in the O.R. suite," said Chris Click, vice president, marketing, InnerWireless.

STERIS’ Duckett suggests that the industry address the possibility of a uniform marking system applied at the time of manufacture. "A simple serial number is all that’s needed. A uniform system has many advantages. For example, by simply scanning the instrument, the tech could pull up assembly instructions, decontamination instructions, sterilization parameters, purchasing history, reprocessing history, maintenance requirements and more.

"Think about the ramifications of trying to recall instruments used for a CJD case. By having a unique serial number on each instrument, we would be able to know instantly where, when and how every instrument was used. The future is very exciting for this technology. We envision taking information management systems into the O.R. and out onto the patient floors with the objective of proactively managing the entire instrument process and providing training tools to the end users wherever possible."

No doubt, instrument management programs will continue to expand its capabilities as more facilities realize the need and the potential opportunities.

"We are constantly presenting to healthcare facilities, and attend almost every national show and have yet to come across an individual or facility that does not have a need for instrument tracking," said Good.

For those facilities that are just "getting their feet wet" with a surgical instrument management program and what to start with a simple count sheet program, Cannady advises, "That’s fine. Just make sure the runway is long enough for the next size plane that you want to fly."

"The greatest success comes from clients that use all of the system, and pull reports that help them model the department like a business. The facility will benefit greatly if it has by-in from all of the stakeholders; this includes O.R., IT, CS and upper management," said Good. "Instrument Tracking empowers individuals with information and knowledge of what is truly going on in their world. Once implemented you have the ability to know when and where you need your staff to be the most efficient and productive."