Consistency of Surgical Instrument Usage in Vascular Surgery Procedures Across Multiple Facilities Demonstrates Feasibility of Predictive Analytics in the Creation of Streamlined Trays
MARTYN KNOWLES1, Trevor Goodman1, Sarah Konchan1, Robert Mendes1, Sandeep Rath2, Vinayak Deshpande2, Mark Farber3, Benjamin Wood1
1UNC Rex, 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: The contents of surgical trays vary widely across the country and there is an unsustainable trend toward excess instrumentation assigned to cases. Tray configurations have historically been dictated by anecdotal input, given that no actual instrument usage data on a procedural basis currently exist to determine predictability or optimization opportunities for efficient trays.
METHODS: Vascular surgery cases were followed using a cloud-based technology service (OpFlow, Operative Flow Technologies, Raleigh, NC) as part of a hospital-wide project at six hospitals across the US. An assessment was performed evaluating the exact instruments used by the operating surgeons for a variety of index procedure groups including aortic, cerebrovascular, peripheral obstructive, venous, AV access, and amputation. Actual instrument usage data were collected, a review and validation were performed, and the trays were optimized at each facility. Analysis was conducted to compare the data for initial tray configurations across all hospitals and then to identify empiric usage of instruments by procedure type and how that influenced the final streamlined trays.
RESULTS: Over the study period, 370 vascular surgery cases were evaluated across six nationwide hospitals in the six procedure groups. There was an average of 1.8 instrument trays opened and used across the sites for the procedure groups, whereas 6.8 total trays were pulled on average. Mean instrument usage was 22.7% for all trays assigned to cases in the procedure groups, and an average instrument reduction of 28.1% was achieved across major tray types and facilities. Aortic and peripheral obstructive cases had a significantly higher number of available instruments compared to the other groups (417.8 vs 226.5; P <.0001), but overall percent usage was equivalent (22.9% vs 22.7%; P=.47) (Table 1), supporting the assumptive model correlating instrument usage with case complexity. Upon evaluation of the instruments used, there was a significant correlation between commonly used instruments and the number of sites at which those instruments were routinely used, respective to the procedure groups (Figure 1) (P<.0001).
CONCLUSIONS: Despite vastly different initial tray case setup and contents across the different sites, empiric data analysis confirms consistent, low usage of instruments with significant overlap among those instruments actually used. These findings support the ability to reliably streamline trays on a national scale through the application of predictive analytics.
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