Duke University School of Medicine, Durham, North Carolina.
Duke University Pratt School of Engineering, Durham, North Carolina.
J Surg Res. 2021 Aug;264:490-498. doi: 10.1016/j.jss.2021.02.049. Epub 2021 Apr 12.
Surgical instrument tray reduction attempts to minimize intraoperative inefficiency and processing costs. Previous reduction methods relied on trained observers manually recording instrument use (i.e. human ethnography), and surgeon and/or staff recall, which are imprecise and inherently limited. We aimed to determine the feasibility of radiofrequency identification (RFID)-based intraoperative instrument tracking as an effective means of instrument reduction.
Instrument trays were tagged with unique RFID tags. A RFID reader tracked instruments passing near RFID antennas during 15 breast operations performed by a single surgeon; ethnography was performed concurrently. Instruments without recorded use were eliminated, and 10 additional cases were performed utilizing the reduced tray. Logistic regression was used to estimate odds of instrument use across cases. Cohen's Kappa estimated agreement between RFID and ethnography.
Over 15 cases, 37 unique instruments were used (median 23 instruments/case). A mean 0.64 (median = 0, range = 0-3) new instruments were added per case; odds of instrument use did not change between cases (OR = 1.02, 95%CI 1.00-1.05). Over 15 cases, all instruments marked as used by ethnography were recorded by RFID tracking; 7 RFID-tracked instruments were never recorded by ethnography. Tray size was reduced 40%. None of the 25 eliminated instruments were required in 10 subsequent cases. Cohen's Kappa comparing RFID data and ethnography over all cases was 0.82 (95%CI 0.79-0.86), indicating near perfect agreement between methodologies.
Intraoperative RFID instrument tracking is a feasible, data-driven method for surgical tray reduction. Overall, RFID tracking represents a scalable, systematic, and efficient method of optimizing instrument supply across procedures.
手术器械托盘的减少旨在尽量减少手术过程中的效率低下和处理成本。以前的减少方法依赖于受过训练的观察者手动记录器械的使用情况（即人类民族志），以及外科医生和/或工作人员的回忆，这些方法既不准确，也有内在的局限性。我们旨在确定基于射频识别（RFID）的术中器械跟踪作为减少器械的有效手段的可行性。
器械托盘用独特的 RFID 标签标记。在一名外科医生进行的 15 例乳房手术中，RFID 读取器跟踪靠近 RFID 天线的器械；同时进行民族志记录。未记录使用的器械被淘汰，然后使用减少的托盘进行 10 例额外的病例。逻辑回归用于估计病例之间器械使用的可能性。Cohen's Kappa 估计 RFID 和民族志之间的一致性。
在 15 例病例中，使用了 37 种独特的器械（中位数 23 种器械/例）。平均每例增加 0.64 种（中位数=0，范围=0-3）新器械；病例之间器械使用的可能性没有变化（OR=1.02，95%CI 1.00-1.05）。在 15 例病例中，民族志标记为使用的所有器械均被 RFID 跟踪记录；7 种被 RFID 跟踪记录的器械从未被民族志记录。托盘尺寸减少了 40%。在随后的 10 例病例中，没有一例需要淘汰的 25 种器械。在所有病例中，比较 RFID 数据和民族志的 Cohen's Kappa 值为 0.82（95%CI 0.79-0.86），表明两种方法之间存在近乎完美的一致性。
术中 RFID 器械跟踪是一种可行的、数据驱动的手术托盘减少方法。总体而言，RFID 跟踪代表了一种可扩展、系统和高效的方法，可优化跨程序的器械供应。
