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Optimizing the surgical instrument tray to immediately increase efficiency and lower costs in the operating room
Jay Toor1, Avneesh Bhangu2, Jesse Wolfstadt2
1From the Department of Orthopedic Surgery, University of Toronto, Toronto, Ont. (Toor, Wolfstadt, Rampersaud); the School of Medicine, Queen's University, Kingston, Ont. (Bhangu); Sinai Health System, Toronto, Ont. (Bassi); the Joseph L. Rotman School of Management, University of Toronto, Toronto, Ont. (Chung, Mitchell, Milner); and the Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ont. (Koyle) jay.toor@mail.utoronto.ca.
Background:
Surgical trays are often poorly configured and can be ongoing sources of frustration and excess costs. We conducted an observational study to determine if the use of a customized mathematical inventory optimization model would result in a greater reduction in the number of instruments on a surgical tray than a clinician review of the tray.
Methods:
Utilization of instruments on the major orthopedic tray at a large academic hospital was documented over 80 procedures. Processes in the medical device reprocessing department and operating room were observed to comprehensively quantify all associated costs. Results of the observations were applied to a customized mathematical model to determine the ideal tray configuration. For comparison, a clinician review was also performed.
Results:
The mathematical model alone produced an ideal tray size of 47 instruments, a reduction of 41 instruments from the original size of 88 instruments (47% reduction). This represented $34 440 in annual savings. In contrast, the clinician review alone suggested an ideal tray size of 67 instruments (23% reduction), representing $17 640 in annual savings. When clinicians were provided with the additional information from the model, they reduced the tray size to 51 instruments (42% reduction), producing $31 870 in savings. The mathematical model yielded an additional 22% instrument reduction and $14 230 in savings compared with clinician review alone.
Conclusion:
Our mathematical model is generalizable and can be applied to all specialties and hospitals to determine optimal tray configuration. As such, the financial implications are broad; at our institution, application to all surgical trays would result in $205 000 of savings annually. Surgeons and managers looking to streamline surgical trays should consider this evidence-based approach.
