UNC Rex Hospital, Raleigh, NC; Division of Vascular Surgery, Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC.
UNC Rex Hospital, Raleigh, NC.
J Vasc Surg. 2021 Jun;73(6):2144-2153. doi: 10.1016/j.jvs.2020.09.043. Epub 2020 Dec 24.
Surgical procedures account for 50% of hospital revenue and ∼60% of operating costs. On average, <20% of surgical instruments will be used during a case, and the expense for resterilization and assembly of instrument trays ranges from $0.51 to $3.01 per instrument. Given the complexity of the surgical service supply chain, physician preferences, and variation of procedures, a reduction of surgical cost has been extremely difficult and often ill-defined. A data-driven approach to instrument tray optimization has implications for efficiency and cost savings in sterile processing, including reductions in tray assembly time and instrument repurchase, repair, and avoidable depreciation.
During a 3-month period, vascular surgery cases were monitored using a cloud-based technology product (OpFlow, Operative Flow Technologies, Raleigh, NC) as a part of a hospital-wide project. Given the diversity of the cases evaluated, we focused on two main vascular surgery trays: vascular and aortic. An assessment was performed to evaluate the exact instruments used by the operating surgeons across a variety of cases. The vascular tray contained 131 instruments and was used for the vast majority of vascular cases, and the aortic tray contained 152 instruments. Actual instrument usage data were collected, a review and analysis performed, and the trays optimized.
During the 3-month period, 168 vascular surgery cases were evaluated across six surgeons. On average, the instrument usage per tray was 30 of 131 instruments (22.9%) for the vascular tray and 19 of 152 (12.5%) for the aortic tray. After review, 45.8% of the instruments were removed from the vascular tray and 62.5% from the aortic tray, for 1255 instruments removed from the versions of both trays. An audit was performed after the removal of instruments, which showed that none of the removed instruments had required reinstatement. The instrument reduction from these two trays alone yielded an estimated costs savings of $97,781 for repurchase and $97,444 in annual resterilization savings. Annually, the removal of the instruments is projected to save 316.2 hours of personnel time. The time required for operating room table setup decreased from a mean of 7:44 to 5:02 minutes for the vascular tray (P < .0001) and from 8:53 to 4:56 minutes for the aortic tray (P < .0001).
Given increasing cost constraints in healthcare, sterile processing remains an untapped resource for surgical expense reduction. A comprehensive data analytics solution provided the ability to make informed decisions in tray management that otherwise could not be reliably performed.
手术程序占医院收入的 50%，占运营成本的 60%左右。平均而言，<20%的手术器械将在一个病例中使用，而对器械托盘进行再消毒和组装的费用为每个器械 0.51 美元至 3.01 美元。鉴于手术服务供应链的复杂性、医生偏好和手术程序的差异，降低手术成本极其困难，而且往往难以定义。采用数据驱动的方法优化器械托盘对无菌处理的效率和成本节约具有重要意义，包括减少托盘组装时间和器械的重新购买、维修和避免折旧。
在三个月的时间里，血管外科病例使用云技术产品（OpFlow，Operative Flow Technologies，Raleigh，NC）进行监测，这是医院范围内项目的一部分。鉴于评估的病例多样性，我们专注于两种主要的血管手术托盘：血管和主动脉。对手术医生在各种病例中使用的确切器械进行了评估。收集了实际的器械使用数据，进行了审查和分析，并对托盘进行了优化。
在三个月的时间里，六位外科医生评估了 168 例血管外科病例。平均而言，血管托盘的每个托盘使用 30 个/131 个器械（22.9%），主动脉托盘使用 19 个/152 个器械（12.5%）。审查后，从血管托盘和主动脉托盘各移除了 45.8%和 62.5%的器械，从两个托盘的版本中移除了 1255 个器械。移除器械后进行了审核，结果显示没有一个被移除的器械需要重新安装。仅从这两个托盘减少器械估计可节省 97781 美元的重新购买费用和 97444 美元的年度再消毒费用。每年，移除这些器械预计可节省 316.2 小时的人员时间。血管托盘的手术室工作台设置时间从平均 7:44 分钟减少到 5:02 分钟（P <.0001），主动脉托盘从 8:53 分钟减少到 4:56 分钟（P <.0001）。
鉴于医疗保健成本不断增加，无菌处理仍然是降低手术费用的未开发资源。全面的数据分析解决方案提供了在托盘管理方面做出明智决策的能力，否则这些决策无法可靠地执行。
