No other departments are more aligned than the Sterile Processing department (SPD) and operating room (OR), with each playing a vital role in the successes and failures of the other. SPD professionals are responsible for applying proper principles of cleaning, testing, assembly, packaging, and sterilization, and OR staff must manage devices while in use and return them to the SPD in good working order. Unfortunately, much attention is paid to the SPD and its failure to manage resources to support the OR, while less focus is placed on the OR’s responsibilities.
A comprehensive, year-long study was conducted at a large U.S. hospital. Nearly 42,000 cases were reviewed, and 3,900 defects were recorded. Many of those defects pertained to the assembly process, which included missing, broken, malfunctioning, or incorrect instruments.1 The findings suggest that broken, missing, or inappropriately cleaned instruments are a frequent problem for surgical teams. On its surface, that assumption is correct; however, the study’s authors suggest that the problems identified point to deeper, systemic problems. Considering the SPD’s pressure to turn instrumentation around quickly, insufficient inventory, challenging instrument designs and unclear manufacturers’ instructions for use—as well as environmental factors (hot, humid, noisy, and prone to distractions)—it become clear how shortcuts and errors can occur. Note: Although the study provides a thorough review of the workload SP professionals typically perform daily, it does not paint the complete picture of the far-reaching responsibilities and the problems associated with devices delivered to the SPD from procedural areas.
The relationship between the OR and SPD should be closely aligned to elevate the quality of the work coming from each department. Point-of-use treatment and the reorganization of trays, for example, should begin in procedural areas.1 When instruments are not pretreated, cleaning becomes difficult, and when devices are improperly mixed or absent from the tray, the workload deepens further for the SPD. Many departments fail to understand all that takes place in the SPD, and for what purpose. Imagine receiving hundreds of instruments and sets daily, many of which may not have been treated at the point of use or returned to their trays in an organized manner. The SPD must effectively, efficiently, and safely manage complex, delicate medical devices and many challenging processes, often without adequate resources such as staffing, equipment, education and training, and effective leadership.
The number of instruments required for surgical procedures today continues to climb; however, it is important to consider how many devices are needed. Studies have shown only 13–21.9% of instruments opened are used for any procedure. No one is discounting a surgeon or service line coordinator’s role regarding the devices needed for a surgical procedure, but if as many as 87% of instruments go unused during a procedure, organizations have an opportunity to manage the instrument set size to save money, speed up processing, and make patient care safer.2
Leading an effective partnership
The success or failure of any department hinges on the quality of its leadership. Developing an understanding and shared commitment from all involved, with each accountable for their roles (including surgeons), is imperative. There must be a consistent platform for evaluating, prioritizing, and resolving issues. It’s vital that the departments have a unified approach to addressing problems and reviewing opportunities instead of holding only one side responsible. Leaders from each department should always be visible and accessible, ask questions, and seek to understand processes. Encouraging overcommunication between SPD and OR staff to facilitate real-time dialogue and share insights is beneficial. Finally, both departments should have shared governance and regular meetings to develop strategies to overcome problems and gauge effectiveness and consistency with quality initiatives.
Improving SP’s many processes takes time and a commitment to evaluating current processes, determining countermeasures, allocating resources, implementing changes, and sustaining improvements. Note: It is essential to change the culture and evaluate the systems controlling the newly implemented processes to ensure long-term success. This can include specific leadership tasks, real-time internal metrics specific to the process, and problem-solving techniques to address any necessary modifications. Soliciting staff feedback is crucial for evaluating the success of any new process. Once the processes are underway, it is helpful to designate SPD and OR liaisons to coordinate and oversee daily activities between the departments and facilitate efficient case flow and real-time problem solving. Liaisons can help facilitate a new culture and find additional ways to improve and sustain processes proactively.
Stronger relationships between the SPD and OR requires a focus on quality, safety, and customer service. Focusing on interdisciplinary objectives, managing data, striving to meet the metrics, and taking responsibility are key to sustaining improvements.
Alfred M, Catchpole K, Huffer E, et al. Work systems analysis of sterile processing: assembly. BMJ Qual Saf. April 1, 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7979531/
Nast K, Swords KA. Decreasing operating room costs via reduction of surgical instruments. J Pediatr Urol. April 15, 2019. https://pubmed.ncbi.nlm.nih.gov/30846251/#:~:text=Surgeons%20have%20an%20important%20role,of%20instruments%20opened%20are%20used