Assessment of Instrument Utilization in Cesarean Births: Taking a Step Toward Sustainability

As an exploration of tray optimization, the authors examined the instrument utilization rates for cesarean sections, as well as factors that may be associated with the number of instruments used. Tray optimization is one avenue for improving healthcare sustainability.

From an urban academic hospital, investigators prospectively collected data on which instruments from the tray were used in cesarean sections. An instrument was considered used if it touched a surgeon's hand during the procedure. The authors also documented whether the case was a primary or repeat cesarean birth; was scheduled, urgent, or emergent; and whether the birth was a primary or twin gestation. Cohort differences were examined using chi-square and analysis of variance (ANOVA) analyses using SPSS.

A total of 28 cases were included: 12 primary and 16 repeat cesarean births, with 11 scheduled, 13 urgent, and 4 emergent cases. Of the 54 instruments on the tray, 8 were used ≤ 25.0% of the time, and an additional 8 instruments were used ≤ 50.0% of the time. Total instrument utilization rates did not differ between primary and repeat cases. The highest number of Ochsner artery forceps were used in emergent cases, while the fewest were used in urgent cases (F[2,25] = 3.474, p = 0.047]. The use of either one or both 5.1 cm Rich retractors was significantly higher for urgent than for scheduled or emergent cases (Χ² [2] = 6.31, p = 0.043).

Based on current instrument utilization rates in cesarean sections, there are opportunities for tray optimization with positive downstream environmental and financial impacts.