Data analysis of vascular surgery instrument trays yield large cost and efficiency savings
MARTYN KNOWLES1, Samuel S Gay1, Sarah K Konchan1, Robert Mendes1, Sandeep Rath2, Vinayak Deshpande2, Mark A Farber3, Benjamin C Wood1
1UNC Rex Hospital, Raleigh, NC;2University of North Carolina Business School, Department of Operations, Chapel Hill, NC;3University of North Carolina, Division of Vascular Surgery, Chapel Hill, NC
INTRODUCTION: Surgical procedures account for 50% of hospital revenue and approximately 60% of operating costs. On average, less than 20% of surgical instruments are used during a case with each instrument generally priced $0.77-3.01 for resterilization and assembly. Given the complexity of the surgical service supply chain, physician preferences, and variation of procedures, reduction of cost is extremely difficult and often nebulous. A data-analytic approach to instrument trays has implications in efficiency within the operating room and cost savings in sterile processing including tray assembly time and instrument repurchase, repair, and depreciation.
METHODS: Over a 3-month period, vascular surgery cases were followed using a cloud-based technology product (OpFlow, Operative Flow Technologies, Raleigh, NC) as part of a hospital-wide project. Given the diversity of cases evaluated, we focused on two main surgical trays: vascular and aortic. An assessment was performed evaluating the exact instruments used by the operating surgeons across a variety of cases. Last year, the vascular tray was utilized 1236 times and the aortic tray was used 178 times. The vascular tray contains 131 instruments and was used for the vast majority of vascular cases, and the aortic tray contains 158 instruments. After the evaluation, a review and analysis was performed, and after agreement, the tray was optimized.
RESULTS: Over the 3-month period, 168 vascular surgery cases were evaluated across 6 surgeons. On average, the instrument usage per tray was 30/131(22.9%) for the vascular tray and 19/152(12.5%) for the aortic tray. The concordance of surgeon instrument use is shown in figure 1. After review, 40.1% of instruments were removed from the vascular and 62.5% from the aortic tray. Although the aortic tray was meant as a stand-alone tray, the vascular tray was opened 100% of the time during aortic cases, and thus the aortic tray was optimized to be an add-on tray. An audit was performed after the removal of instruments and 2 instruments were added back to the vascular tray 2/131(1.5%) and none were added back to the aortic tray. A total of 780 instruments were removed from the 13 instances of the vascular tray, and 475 from the 5 instances of the aortic tray for a total of 1275 instruments. The removal of the instruments yielded an estimated cost savings of $62,750 for repurchase and $97,444 in re-sterilization savings. Yearly, the removal of the instruments is projected to save 316.2 hours of personnel time in tray assembly at a cost of $5,691.88. The table set-up decreased from a mean of 7 minutes 44 sec to 5 minutes 2 seconds (P<.0001) for the vascular tray, and 8 minutes 53 seconds to 4 minutes 56 seconds (P<.0001) for the aortic tray.
CONCLUSIONS: Given increasing cost constraints in healthcare, sterile processing remains an untapped resource for cost improvement. Data analysis provides the ability to make sweeping decisions in tray management that otherwise cannot be performed reliably. 
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