STERILE PROCESSING for building efficiency and waste reduction into the case cart, kit-, and tray-management process.
1. Streamline surgical trays Turbett commented on how minimizing instrument volume is an important process improvement to help eliminate waste. He stated: “Communication between the OR and the SPD is paramount.
It’s critical to patient safety that the surgeon has the instruments he needs (and desires) to have available in surgery. At the same time, keeping preference cards updated to eliminate any unneeded tools streamlines the workflow and maintains the highest level of efficiency. Utilizing reprocessing products that reduce repetitive chores is key to keeping teams satisfied.”
2. Standardize on sterile supplies and their storage Ezell noted how sterile supplies and trays are often stored in both the SPD and the OR, making it imperative to consider the right equipment to service combined needs.
“Productivity and consistency are key for a seamless working
structure between an SPD and OR. Perioperative teams should ensure their storage allows for maximum trays/supplies, trans- portation that can incorporate both sterile packs and loose sup- plies, and case carts match the growth of procedure demands. Additionally, standardizing storage capabilities and emphasizing labeling creates consistency for staff to locate items and helps them be as productive as possible.”
3. Take a system-based approach Frieze said Case Medical takes a holistic, 360-degree approach with products that are durable, long lasting, and complementary with universal application. The company developed software with real-time data to manage operations and logistics. Work instructions identify the steps in sequence, so that all procedures are well defined. She stated:
“As a manufacturer of products for instrument processing and sterilization, we understand that each product is part of a system. The containers used for sterilization and instrument protection must be designed to fit into the various sterilizers and accommodate the devices within. Our instrument chemistries were developed to be fast-acting and free-rinsing to avoid residue and reduce waste, and be compatible with the devices to be cleaned, as well as the equipment. Our case carts used for transport have the appropriate signage, even a barcode for tracking, so that only the correct items are selected and transported to the intended destination.”
4. Consider your case cart design and path
Daetz said the emerging healthcare industry trend toward off-site sterilization and multi-facility distribution centers will make case cart optimization a focus area, particularly with regards to how case carts are transported between sites. “It is important to understand the cart path from stocking to OR to decontamination/cart wash to restocking. Agree on one size of cart that can work in each OR.”
5. Map SP and OR workflows To facilitate collaboration between the OR and the SPD for improved stocking and transport design of case carts, kits, and trays, Chrzanowski recommends a hospital start by digitally mapping the workspace and workflow of both departments together. He stated: “Once both teams have a clear understanding of the workspace, prioritize and streamline the assembly of kits and trays to optimize for both areas. Incorporate accurate case cart assembly, factoring in SPD staffing schedules, surgical case mix, start times, and block scheduling. Conducting a comprehensive process and flow analysis
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within the OR and the SPD can help enable the implementation of a lean, efficient workflow design, benefiting both departments.”
6. Invest in the big three: people, process and products “People are involved in pulling inventory from the shelves, loading up the case carts, then pushing the carts from the SPD to the OR,” said Loper. “Time, people, inventory, and equipment are involved in this part of the process. The sterile instruments and supplies are used in the OR, then loaded back up and rolled back down into decontamination and the SPD for processing. A process is in place and that process involves time, people, equipment, inventory, and software. So where should the hospital focus its resources: the peo- ple, the process, and the products used in every step of the way.” “Let’s envision the SPD as being an Amazon fulfillment center
and the OR being someone’s house,” Loper continued. “Amazon is incredibly proficient with order accuracy, speed with which they fill the order, delivering the order on schedule, and with close to zero damage to the contents and packaging. That’s what makes Amazon…Amazon. How?” • Step 1: Easy-to-use end-user interface with their website for order entry.
• Step 2: The software program or enterprise resource planning (ERP) system used for inventory management.
• Step 3: An automated storage and retrieval system used for storing and retrieving products.
• Step 4: The delivery system (drivers) to the end-user. “There are very successful healthcare-focused vendors for all
four steps of this proven path but it’s up to the hospital system to earmark and make the appropriate investments to improve these processes every step of the way,” Loper concluded.
Nemours Children’s Hospital navigates case carts routes for new SPD build Nemours Children’s Hospital Delaware Valley, based in Wilmington, Del., is an impactful example of how investments in people, products and processes paid off in terms of efficiency, quality, and safety when transitioning to a new sterile process- ing department.
A major move Like most SPDs, Nemours Children’s Hospital’s previous space was in the basement, while the ORs were on the hospital’s second floor. The new SPD was moved up to the third floor, one floor above the ORs. This meant they had to establish completely new case-cart routes from the SPD on the third floor down to the OR on the second floor and then back up to decontamination. They also had to establish a safe route for dirty carts coming from outside clinics into the SPD. “In our previous SPD on the ground floor, we had an elevator right up to the OR and into the clean core,” the hospital’s Interim
The Nemours SPD team
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