Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL.
Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL.
J Arthroplasty. 2019 Dec;34(12):2834-2840. doi: 10.1016/j.arth.2019.07.040. Epub 2019 Aug 6.
Optimization of surgical instrument trays improves efficiency and reduces cost. The purpose of this study is to assess the economic impact of optimizing orthopedic instrument trays at a tertiary medical center.
Twenty-three independent orthopedic surgical instrument trays at a single academic hospital were reviewed from 2017 to 2018. Using Lean methodology, surgeons agreed upon the fewest number of instruments needed for each of the procedure trays. Instrument usage counts, cleaning times, room turnover times, tray weight, holes in tray wrapping, wet trays, and time invested to optimize each tray were tracked. Cost savings were calculated. Student's t-test was used to determine statistical significance, with P < .05 considered significant.
The mean instrument usage before and after Lean optimization was 23.4% and 54.2% (P < .0001). By Lean methods, 433 of 792 instruments (55%) were removed from 11 unique instrument trays (102 total trays), resulting in a reduction of 3520 instruments. Total weight reduction was 574.3 pounds (22%), ranging from 2.1-16.2 pounds per tray. The number of trays with wrapping holes decreased from 13 to 1 (P < .0001). The process of examining and removing instruments took an average of 7 minutes 35 seconds per tray. The calculated total annual savings was $270,976 (20% overall cost reduction).
In addition to substantial cost savings, tray optimization decreases tray weights and cleaning times without negatively impacting turnover times. Lean methodology improves efficiency in instrument tray usage, and reduces hospital cost while encouraging surgeon and staff participation through continuous process improvement.
Economic Quality Improvement, Level III.
优化手术器械托盘可提高效率并降低成本。本研究旨在评估优化三级医疗中心骨科器械托盘的经济影响。
从 2017 年到 2018 年，对一家学术医院的 23 个独立的骨科手术器械托盘进行了审查。使用精益方法，外科医生就每个手术托盘所需的最少器械数量达成一致。对器械使用次数、清洗时间、房间周转率、托盘重量、托盘包装上的孔、湿托盘以及优化每个托盘所花费的时间进行了跟踪。计算了节省的成本。使用学生 t 检验来确定统计学意义，P<.05 被认为具有统计学意义。
精益优化前后器械使用率分别为 23.4%和 54.2%（P<.0001）。通过精益方法，从 11 个独特的器械托盘（102 个总托盘）中移除了 433 个（55%）器械，减少了 3520 个器械。总重量减轻了 574.3 磅（22%），每个托盘的重量减轻范围为 2.1-16.2 磅。包装孔的托盘数量从 13 个减少到 1 个（P<.0001）。检查和移除器械的过程平均每个托盘需要 7 分 35 秒。计算得出的年总节省额为 270976 美元（总成本降低 20%）。
除了大幅节省成本外，托盘优化还可减轻托盘重量和缩短清洗时间，而不会对周转率产生负面影响。精益方法可提高器械托盘使用效率，降低医院成本，同时通过持续的流程改进鼓励外科医生和员工参与。
经济质量改进，III 级。
