Duke University School of Medicine, Durham, NC, USA.
Duke University, Durham, NC, USA.
Hand (N Y). 2022 Nov;17(6):1250-1256. doi: 10.1177/15589447211017233. Epub 2021 Jun 8.
Instrument oversupply drives cost in the operating room (OR). We review previously reported methodologies for surgical instrument reduction and report a pilot methodology for optimizing instrument supply via ethnographic instrument tracking of thumb carpometacarpal (CMC) arthroplasties. Additionally, we report a cost analysis of instrument oversupply and potential savings of tray optimization methods.
Instrument utilization was tracked over 8 CMC arthroplasties conducted by 2 surgeons at an ambulatory surgery center of a large academic hospital. An optimized supply methodology was designed. A cost analysis was conducted using health-system-specific data and previously published research.
After tracking instrument use in 8 CMC arthroplasties, a cumulative total of 59 out of the 120 instruments in the Hand & Foot (H&F) tray were used in at least 1 case. Two instruments were used in all cases, and another 20 instruments were used in at least 50% of the cases. Using a reduced tray with 59 instruments, potential cost savings for tray reduction in 60 cases were estimated to be $2086 without peel-packing and $2356 with peel-packing. The estimated cost savings were lower than those reported in literature due to a reduced scope and exclusion of OR time cost in the analysis.
Instrument oversupply drives cost at our institution's ambulatory surgery center. Ethnography is a cost-effective method to track instrument utilization and determine optimal tray composition for small services but is not scalable to large health systems. The time and cost required to observe sufficient surgeries to enable supply reduction to motivate the need for more efficient methods to determine instrument utility.
手术室内仪器供应过剩会增加成本。我们回顾了先前报道的手术器械减少方法，并报告了一种通过对手拇指腕掌（CMC）关节成形术的民族志仪器跟踪来优化仪器供应的试点方法。此外，我们还报告了仪器供应过剩的成本分析以及托盘优化方法的潜在节省。
在一家大型学术医院的日间手术中心，由 2 名外科医生对 8 例 CMC 关节成形术进行了仪器使用情况的跟踪。设计了一种优化的供应方法。使用特定于卫生系统的数据和先前发表的研究进行了成本分析。
在对 8 例 CMC 关节成形术中的仪器使用情况进行跟踪后，在 Hand & Foot（H&F）托盘的 120 个仪器中，共有 59 个仪器在至少 1 例中使用。有 2 种仪器在所有病例中均使用，另外 20 种仪器在至少 50%的病例中使用。使用减少 59 个仪器的托盘，在不使用削皮包装的情况下，预计在 60 例中减少托盘的潜在成本节省为 2086 美元，使用削皮包装的情况下为 2356 美元。由于分析中减少了范围并排除了手术室时间成本，因此估计的节省成本低于文献中报道的成本。
在我们机构的日间手术中心，仪器供应过剩会增加成本。民族志是一种经济有效的方法，可以跟踪仪器使用情况并确定小型服务的最佳托盘组成，但无法扩展到大的卫生系统。需要观察足够的手术来实现供应减少，以激励需要更有效的方法来确定仪器的实用性，这需要时间和成本。
