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Reduction and standardization of surgical instruments in pediatric inguinal hernia repair
Martin A Koyle1, Naif AlQarni2, Rakan Odeh2
1Section of Pediatric Urology, The Hospital for Sick Children, Toronto, Ontario, Canada; The Institute of Health Policy, Management, and Evaluation (IHPME), The University of Toronto, Toronto, Ontario, Canada.
Insights
Standardizing surgical instruments for pediatric inguinal hernia repair significantly reduced the number of instruments and weight. This initiative improved operating room efficiency and safety.
Area of Science:
- Surgical innovation
- Medical device standardization
- Healthcare quality improvement
Background:
- Pediatric inguinal hernia repair (PIHR) involves a high number of surgical instruments.
- Variations in instrument sets exist between surgical subspecialties, leading to inefficiencies.
Purpose of the Study:
- To standardize and reduce surgical instrumentation for PIHR by over 25% within nine months.
- To implement improvement science methodology for surgical instrument optimization.
Main Methods:
- Prospective evaluation of instruments used in 56 PIHR cases across pediatric surgery and urology.
- Development of a single standardized preference card based on instrument utilization (>50% usage).
- Analysis of 52 subsequent cases, measuring sterilization cycle time (CT) and tray weight, with pre- and post-intervention surveys.
Main Results:
- The standardized set reduced instruments from 96 (urology) and 51 (surgery) to 28, and weight from 13.5 lbs and 11.2 lbs to 7.8 lbs.
- Sterilization CT decreased from 11-8 minutes to under 5 minutes.
- Post-standardization, only 6% of cases required additional instruments; nurses and surgeons reported improved quality, safety, and efficiency.
Conclusions:
- Surgical instrument standardization across disciplines can reduce costs.
- Standardization positively impacts surgical quality, patient safety, and operational efficiencies.
- The study supports continued efforts to standardize instrumentation for other common surgical procedures.
Aim:
To standardize and reduce surgical instrumentation by >25% within a 9-month period for pediatric inguinal hernia repair (PIHR), using "improvement science" methodology.
Methods:
We prospectively evaluated instruments used for PIHR in 56 consecutive cases by individual surgeons across two separate subspecialties, pediatric surgery (S) and pediatric urology (U), to measure actual number of instruments used compared with existing practice based on preference cards. Based on this evaluation, a single preference card was developed using only instruments that had been used in >50% of all cases. A subsequent series of 52 cases was analyzed to assess whether the new tray contained the ideal instrumentation. Cycle time (CT), to sterilize and package the instruments, and weights of the trays were measured before and after the intervention. A survey of operating room (OR) nurses and U and S surgeons was conducted before and after the introduction of the standardized tray to assess the impact and perception of standardization.
Results:
Prior to creating the standardized tray, a U PIHR tray contained 96 instruments with a weight of 13.5 lbs, while the S set contained 51, weighing 11.2 lbs. The final standardized set comprised 28 instruments and weighed 7.8 lbs. Of 52 PIHRs performed after standardization, in three (6%) instances additional instruments were requested. CT was reduced from 11 to 8 min (U and S respectively) to <5 min for the single tray. Nurses and surgeons reported that quality, safety, and efficiency were improved, and that efforts should continue to standardize instrumentation for other common surgeries.
Conclusions:
Standardization of surgical equipment can be employed across disciplines with the potential to reduce costs and positively impact quality, safety, and efficiencies.
