Improvement Initiative to Ensure Quality Instrumentation in the OR

At Seattle Children's Hospital, in November 2016, the operating room (OR) physicians reported experiencing a high number of issues occurring during cases and believed a significant amount was related to sterile processing department (SPD) errors. These errors, hereafter called "defects," were not defined or routinely reported. There was no method of capturing these defects. There was no root cause analysis or trending of defect data. This project aimed to improve the quality of surgical instruments received in the OR.

The SPD and OR leaders collaborated to develop an OR Case Sign-Out form to capture defects during the case. The data were triaged and assigned to specific departments for root cause analysis. The SPD related data were depicted with a Pareto chart to highlight the most significant opportunities for improvement. We developed a driver diagram and identified the following interventions: orientation and competency, technician OR rotation, capacity/full-time employee analysis, surgical instruments inventory, instrument pouch work trigger, work environment, preventative maintenance, and instrument wrap reduction.

A 56% improvement in "Non-Sterile" defects was achieved. While a centerline shift in "Sterile" defects was not observed, the most significant "Sterile" defect, "breach of soft instrument wrap," dropped from 8 occurrences (at baseline) to 1. The number of OR case sign-out forms collected plateaued at 47%, which could indicate missing defect data.

SPD improved quality in the OR by reducing instrument defects. The physicians gained a mechanism for reporting barriers and tracking improvements. Ultimately, the utilization of lean tools and a quality improvement approach helped drive process changes, creating a more efficient, collaborative, and safe procedural environment for patients and staff.