Where can digital technologies, analytics, and AI deliver value?
The majority of healthcare executives surveyed by Deloitte “expect the accelerated adoption of digital tools will impact their strategy in 2024,” and “agree that generative AI has the potential to address many of the sector’s most vexing issues.”1
“Almost every part of healthcare has been touched by digital, AI, and innovative technologies,” noted the authors of the January 2024 report, “Transforming Healthcare: Navigating Digital Health with a Value-Driven Approach,” from the World Economic Forum and Boston Consulting Group.2
So, how have these advanced technologies touched sterile processing (SP) departments?
The workflows around instrument management, including the building and reprocessing of case carts, kits, and trays, are ripe for technology solutions that can make the SP professional’s role easier, more efficient, and more effective, enabling them to focus not on non-value-added tasks but rather clinically relevant activities at the top of their licensure.
SP professionals and technology solutions vendors offer their insights on the current and future state of advanced technologies for the SP department, including digital applications, analytics, and artificial intelligence (AI).
Preference cards
Dr. Marjorie Wall, EDBA, CSSBB, Associate Director, Sterile Processing, Cedars-Sinai, Los Angeles, is enrolled in a Harvard Medical School degree program along with 59 other healthcare professionals, 30 of them international, where they have been discussing SP topics. Her realization – SP challenges are global.
“One topic that keeps coming up in the group is preference card accuracy,” said Dr. Wall. “With the expansion of AI across healthcare applications, I am seeing the development of solutions that employ AI to monitor instrument and supply usage in the OR and build bots to automate preference card maintenance. These solutions will provide better data and flow of information so SPD [sterile processing departments] can pull what surgeons need rather than extra trays that go unused and must be reprocessed.”
Picking and packing
There are challenges not only knowing which instruments and supplies to pick and pack based on preference cards, but also where to find them based on the order and accuracy of pick sheets. This is another area where advanced technologies can help.
Carol Malone, AAB, CSPDT, CRCST, CIS, CHL, System Supervisor, and Amanda Wilcox, BA, CSPDT, CRCST, Education Coordinator, Sterile Processing Education, University Hospitals, Cleveland, spoke to the challenges of picking and packing.
“For new SP team members, and even experienced ones, the picking process can be frustrating when pick sheets are incorrect or out of order,” Wilcox explained. “The sheets should list items in the order of where they are stored in sterile storage, for example, from the front to the back of the space, to make the process easier and faster to complete. When the pick sheets list items out of order, we find ourselves running all over sterile storage trying to find what we need.”
One issue that contributes to inaccurate pick sheets is lack of integration between a healthcare organization’s electronic health record (EHR) and instrument tracking systems. According to Malone and Wilcox, when these two systems cannot seamlessly share data, the team must manually intervene to correct the gaps.
“There are a lot of pieces that must fall into place for electronic systems to work properly,” Malone noted. “With our old EHR system, none of the tray ID numbers transferred over to our instrument tracking system and that is what allows the trays to show up on our pick sheets. There is a lot of backtracking work to manually add those numbers.”
“If we could put the data in one system – for both instruments and disposables – and have it autogenerate in multiple systems, that would ease a lot of pain,” Wilcox added.
One company that is applying intelligent algorithms to solve instrument tracking/EHR system integration challenges and facilitate data integrity in perioperative workflows is Ascendco Health. The company’s Co-Founder & CEO Brian Reed commented on its surgical asset management platform, stating:
“A perioperative team may believe they have an interface between their EHR and instrument tracking systems, but when the SP team generates a pick list, there is no match between what the physician preference card is calling for and the actual inventory that needed to be picked.”
According to Reed, Ascendco Health’s platform works around its own instrument tracking system and legacy tracking systems to “fix that complicated data problem that hospitals can’t fix on their own.” They collect and clean a hospital’s surgical data, leverage sophisticated algorithms in their relational database to match and pair instrument IDs and names in the EHR and tracking systems, and correct any errors, such as missing, inaccurate, or duplicate information.
Tray assembly
“Another area where I have seen AI in SPD is with sterile processing technician assist systems or co-pilots, which are technology solutions that help guide technicians in reprocessing workflows,” said Dr. Wall.
One such solution is ScalpelAI, which leverages computer vision (CV) and machine learning (ML) to identify surgical instruments without the need for tags. Non-invasive sensors provide real time information to the platform throughout the perioperative pathway. CV and ML algorithms identify patterns in clinical actions, inventory use, and safety incidents. The platform integrates data from the sensors and clinical actions to generate actionable insights for perioperative teams.
“Our technology has been a huge value-add in SPD, particularly for early stage and semi-skilled SP techs,” said ScalpelAI founder & CEO Yeshwanth Pulijala, PhD. “It’s quite daunting when they are tasked with learning hundreds of surgical instruments, especially today with the huge burden of staffing issues and turnover. ScalpelAI helps by reducing stress levels and giving them peace of mind through on-the-job learning.”
AI assist in building trays is one ScalpelAI application where Dr. Pulijala says SP teams have gained great value, stating:
“If a technician is unsure whether a specific instrument belongs in a tray, they place the instrument in front of the cameras and the platform tells them what it is and whether it belongs in the tray they are assembling. It provides them with the tools to help them get to the source of truth quickly and make sure they are packing trays correctly. We’ve seen techs pack a tray accurately in half the time.”
IFUs
While manufacturer instructions for use (IFU) are a necessary part of sterile processing, SP professionals are vocal about their struggles to access them, understand them, and put them to use in a real-world environment (more on this topic in the February 2024 HPN article, IFU Confusion).
Hannah Schroeder, BSHA, CRCST, CIS, CHL, CER, Clinical Education Specialist, Pure Processing, speaks to the potential for AI to help address IFU challenges.
“In taking an operational spin on IFU review, how could AI give us the opportunity to change how we configure our trays and case carts and prepare them for the OR? For example, maybe the IFUs for items sharing space in a set conflict in some way. Could AI help us identify and resolve those discrepancies?”
Xcelrate UDI has developed a point of use unique device identification (UDI) barcode scanning application that leverages AI technology to not only provide SP teams immediate access (less than three seconds) to latest manufacturer IFUs and medical device data but also help them better understand them and resolve conflicting and confusing information.
“The interactive AI capabilities of IFUVitals are indeed transformative,” said Joan Melendez, President & CEO, Xcelrate UDI. “Staff can quickly obtain answers to crucial questions such as ‘Is this medical device IUSS compatible?’ ‘What are the exact sterilization temperatures?’, ‘Can lumens be processed in this peel pack?’”
Cleaning compliance and inspection
An alarming post from researcher Cori Ofstead, CEO at Ofstead & Associates, on LinkedIn called out how there were 8,573 reports of endoscope-related adverse events to the U.S. Food and Drug Administration (FDA) in Q4 2023, which “eclipsed the previous record set in Q3.”3
Because endoscopes are so challenging to clean, solutions providers have developed advanced technologies that aid with scope inspection.
“We are already starting to see artificial intelligence making its debut in the sterile processing industry by way of borescope software,” said Bobby Hutchinson, Marketing Manager, Pure Processing. “Its use aids in the identification and action against bioburden and damaged equipment making its way back to the point of care.”
Sterilization
Performing sterilization according to manufacturer IFUs and monitoring cycles for safety and compliance can be streamlined through the application of advanced technologies.
“In the context of sterilization, it’s about assisting compliance and analyzing the instruments themselves to make sure they were properly sterilized – there are a lot of areas where artificial intelligence can help the process,” said Henry Schein’s Chief Innovation Officer Bruce Lieberthal.
Lieberthal noted how Henry Schein recently entered into an agreement with a provider of a technology solution for sterilization compliance and reporting.
“Using automation, the solution can connect with virtually all sterilizers to monitor in real-time the cycle and whether it was successful. It can also link back the instruments that were sterilized to a particular run of tionhe sterilization,” Lieberthal explained. “It monitors the compliance of the team with sterilization protocols, including biological monitoring. It’s an interesting solution.”
“In my opinion, emerging technologies will be a game changer,” said Erica Smith, Surgical Solutions Manager, Henry Schein Medical. “It will help clinicians minimize the time spent on administrative tasks, which will allow for more time to focus on patient care.”
Education and training
Research has shown how standard training programs can decrease quality errors in surgical instrument reprocessing.4 But in today’s SP environment of staffing shortages, high turnover rates, and an ever-increasing volume of surgical instruments and devices, finding the time and the resources to train technicians is a tremendous challenge.
In response, SP professionals and solutions providers have been looking for ways to leverage technology for efficient and effective on-the-job education and training.
In the perioperative space, Marian Scheer, Chief Medical Officer for Incision, and her team have developed a digital training app called Assist. Through the mobile app, OR team members can digitally access protocols including surgeons' preferences, materials and draping requirements, room setup in 3D, surgical steps, and postoperative instructions.
The Incision team is now exploring a version of the Assist app for the SPD, as Aimee Space, BSN, RN, Incision Product Owner, U.S. Content, explained:
“As we have been implementing Assist in U.S. ORs, we are getting feedback from SPDs as well because both functions are so closely intertwined with their workflows. Specifically, SP teams have told us that the app could help with picking cases. These are applications we are exploring for the future.”
To support SP professional education today, Incision offers eLearning courses aligned with industry guidelines (including HSPA, AAMI, AORN) and certification programs (CNOR, CRCST).
Based on SP department supervisors' requests, Melendez says her company is currently focused on the association of AI-driven employee continuing education (CE) validation for IFU use and adapting facility-specific standard operating procedures (SOPs) for IFU limitations.
“For example, addressing unavailable specific detergents or incompatible processing instructions provided by manufacturers,” Melendez commented.
Data and analytics
The ability to analyze the vast quantities of SP data and surface insights to improve SP workflows and reprocessing quality and safety is perhaps one of the most promising and impactful for the application of advanced technologies.
“An arguable game changer in SP departments would be AI integration into instrument tracking software,” said Hutchinson. “With an ability to provide unbiased narrative of data, trends, and patterns, we can expand our horizons and opportunities as to the way we manage and facilitate the work in SPD. Opportunities could include analyzing peak processing times and changing the way we schedule work hours, measure productivity, and overall efficiency in our space.”
“To quote Peter Drucker, ‘You can’t improve what you don’t measure,’” said Joseph Avila, MBA, BHA, CRCST, Regional Director, Memorial Hermann, Houston. “The SPD could be very rich in the data it provides, but having worked in multiple hospitals, not every department has the feasibility to capture and track it. For example, some teams are still using Word documents for count sheets or handwriting their sterilization loads.”
Avila noted how many instrument tracking systems have advanced analytics capabilities to help SP teams identify patterns and trends. For Memorial Hermann, the largest trauma hospital in the U.S., Avila uses the “rich analytics” in their tracking system to build staffing schedules, evaluate tray utilization, identify missing inventory, and forecast inventory needs, among other applications. Avila presented examples of how they leverage this intelligence in “smart purchasing” decisions:
“If we look at the tray utilization data and determine a tray is heavily used, which necessitates same day turnover, which is something we try to avoid, we use these metrics to justify inventory increases.”
As Reed pointed out, the lifeblood of AI is accurate, clean, complete data. He stated:
“The SPD sits on a goldmine of information that could not only benefit them specifically but also the OR, infection prevention, quality management, and supply chain. It had been challenging to use this data because of distractions – those edge cases – that pollute the information. We’ve built an engine around filtering out those edge cases so they can get to the real story. Our information has become very actionable for those leaders that lean into it.”
Looking ahead
HPN asked those interviewed where they see future applications of advanced technology in SP departments. Here were some of their responses.
“I see some of the biggest changes happening in decontamination, which is a notoriously complex place to work,” said Dr. Pulijala. “There is a lot of support that AI can bring with manual labor to help SP teams perform their tasks.
“I would say the biggest game changer in SPD will be an AI assisted technician,” Dr. Pulijala added. “But it is important to make the distinction that this would be augmented intelligence, not artificial intelligence because there is still the need for people. You cannot replace the human element in processes that require critical thinking. But there is a lot of work you can take off their plates. I see a combination of humans and AI as the future of SPD.”
“The potential in SPD is tremendous,” said Melendez. “Future applications might involve predictive maintenance of equipment, optimizing sterilization workflows, and improving resource allocation.”
“Vendors and manufacturers will most likely spearhead the pathway of AI into sterile processing as they integrate it for product development, industry conditions, and forecasting,” said Hutchinson. “Vendors will have to lead the way for more advanced applications because it requires significant time and investment, which most hospitals don’t have available. Hospitals will want turnkey solutions as opposed to having to muddle through how to develop and apply these technologies.”
