Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor.
Department of Head and Neck Surgery, University of California Los Angeles.
JAMA Otolaryngol Head Neck Surg. 2022 May 1;148(5):402-407. doi: 10.1001/jamaoto.2022.0032.
In an era of increasing health care expenditure, reduction of redundant head and neck surgical instrumentation may minimize waste.
To (1) optimize head and neck surgical instrument trays at a single large academic tertiary care center and (2) identify associated direct cost savings.
DESIGN, SETTING, AND PARTICIPANTS: This prospective quality improvement initiative was conducted at an academic tertiary care medical center from July 2017 through July 2021. Participants were a multidisciplinary surgical quality team consisting of head and neck surgeons, operating room nurses, surgical technicians, and supply chain analysts.
The 4 primary surgical instrument trays (major otolaryngology [Oto], Oto plastics, direct laryngoscopy, and microdirect laryngoscopy) used in all head and neck procedures were reviewed by 10 head and neck surgical faculty with detailed case observation of instrument utilization performed by trained operating room nurses and surgical technologists. Instruments used in less than 40% of cases were excluded from surgical trays, and novel instrument trays were established based on faculty feedback and utilization. Data on instrument processing, utilization, and associated institutional direct costs were prospectively collected over a 3-year period. The primary outcome measure was change in operating room direct costs. Surgeon satisfaction with the quality improvement intervention was the secondary outcome. Direct cost savings were identified as a function of surgical volume, labor and supply costs, and instrument depreciation.
More than 1500 eligible surgical cases were reviewed during the preintervention period. Of the 149 instruments in the major Oto tray, only 118 (79%) instruments were used in more than 40% of cases. There were 58 (49%) and 32 (21%) instruments in this tray that were used in more than 40% of neck dissections and sentinel lymph node biopsies, respectively. Resulting intervention included development of a streamlined major Oto tray with 118 instruments and novel neck dissection and sentinel lymph node biopsy trays. Similar processes were applied to the remaining head and neck trays, with a total of 257 instruments removed. Over a 3-year postintervention period, streamlined surgical trays were used 9284 times with direct cost savings of $228 338 (95% CI, $227 817-$228 854). Overall surgeon satisfaction with the optimized head and neck surgical trays was 100%.
In this quality improvement study, surgeon-led elimination of redundant or rarely used instruments from surgical instrument trays was associated with reduced operating room direct costs while maintaining stakeholder satisfaction.
在医疗保健支出不断增加的时代，减少多余的头颈部外科仪器设备可能会最大限度地减少浪费。
（1）优化单一大型学术三级保健中心的头颈部外科仪器托盘，（2）确定相关的直接成本节约。
设计、地点和参与者：这项前瞻性质量改进倡议于 2017 年 7 月至 2021 年 7 月在一家学术性三级保健医疗中心进行。参与者是由头颈部外科医生、手术室护士、外科技术员和供应链分析师组成的多学科外科质量团队。
对所有头颈部手术中使用的 4 个主要外科仪器托盘（主要耳鼻喉科[Oto]、耳鼻喉科整形、直接喉镜和微直接喉镜）进行了审查，由 10 名头颈部外科教员进行了详细的案例观察，由经过培训的手术室护士和外科技术员进行了仪器使用情况的观察。在不到 40%的情况下使用的仪器被排除在手术托盘之外，并根据教员的反馈和使用情况建立了新的仪器托盘。在 3 年的时间里，前瞻性地收集了有关仪器处理、使用和相关机构直接成本的数据。主要结果衡量标准是手术室直接成本的变化。外科医生对质量改进干预的满意度是次要结果。直接成本节约是作为手术量、劳动力和供应成本以及仪器折旧的函数确定的。
在干预前期间，对 1500 多例合格手术进行了审查。在主要耳鼻喉科托盘的 149 个仪器中，只有 118 个（79%）仪器在超过 40%的病例中使用。该托盘中有 58 个（49%）和 32 个（21%）器械分别在超过 40%的颈部解剖和前哨淋巴结活检中使用。由此产生的干预措施包括开发一种简化的主要耳鼻喉科托盘，其中包含 118 个仪器，并开发一种新的颈部解剖和前哨淋巴结活检托盘。对其余的头颈部托盘也采用了类似的程序，共去除了 257 个仪器。在干预后的 3 年期间，简化后的手术托盘共使用了 9284 次，直接成本节约了 228338 美元（95%置信区间，227817-228854 美元）。外科医生对优化后的头颈部外科托盘的总体满意度为 100%。
在这项质量改进研究中，外科医生主导的从外科仪器托盘上消除多余或很少使用的仪器与降低手术室直接成本有关，同时保持了利益相关者的满意度。
