Finding ways to cut unnecessary spending is crucial for healthcare organizations and surgeons, especially when it comes with the added benefit of enhancing operations.
Robert Huler, MD, is a spine surgeon at OrthoIndy, a large physician-owned single and multispecialty hospital based in Indianapolis. The organization has four urgent care clinics, two ambulatory care centers and two hospitals with 17 total operating suites.
This year, Dr. Huler worked with staff at OrthoIndy’s main hospital to reduce the number of instruments included in each operating room, saving the organization thousands of dollars while cutting down turnaround time for surgeons.
Here is how Dr. Huler led the change and his next goals.
Note: Dr. Huler’s response was lightly edited for clarity and length.
Question: What are the best opportunities for you to grow your practice/organization in the next 12 months?
The problem: At our main campus, Indiana Orthopaedic Hospital, we have 10 OR suites turning over 50 general anesthetic procedures each day. This is more than 300 sterile packaged trays and hundreds more of sterile vendor trays. Spine procedures may need more than 20 trays for each case. This had overwhelmed the staff, resulting in case delay, lengthy room turnover and incomplete or missing critical sterile instruments. For each opened tray in OR, even if the instruments are never touched, a lengthy process is needed to turn around the tray to be used again. This includes physical decontamination, visual inspection, repair or repurchase of damaged instruments, restocking the pan per specs, final sterilization, packaging and delivering correctly to the correct OR on time. This needs a lot of space. People and facilities are the two biggest costs of any hospital or ASC. Our sterile processing department had become a bottleneck for our surgical suites. We had become victims of our own success.
The solution: Since January of this year, I have focused on parsing the needs of our sterile processing department and empowering our CST and SPD to help me understand what is needed to facilitate their successes. I engaged during the morning biweekly CST huddles. We broke out the CSTs into interested teams of spine, joint, shoulder, trauma, hand and foot and ankle. We went through the basic spine pans, specialty fusion pans, surgeon “specials”, vascular sets and vendor pans. We broke down every stringer and identified all duplicate instruments from different trays. We got buy-in from our surgeons. The vendors streamlined from 10 to 7 pans. Some pans exceeded the 25-pound weight limit, but their surgeons pushed back. That needed another surgeon (me) to explain the guidelines. I thought this would be overwhelming for my time. Our amazing CSTs, however, already knew what was needed and now they were empowered to inform me. My work became to listen and interface with our SPD director. We eliminated duplicated instruments on stringers. We eliminated instruments that surgeons did not even know were in the pans. Overall, we achieved the goal of eliminating 25% of the instruments in each tray.
The outcome: Cost saving in hard dollars to date included eliminating a vendor software as a service tracking program at $4,000 a month over two prior years that had not been effective in reducing instrument counts. We returned unopened $35,000 worth of vascular instruments to create new vascular sets once learning the purchased instruments would rarely or never be used in our specialty hospital. Turnover time for two surgeon vascular access cases has dropped from 50 minutes to 35 minutes. We thought we would need to purchase new sterilizable pans at $600 each. Rather, we now have an excess. Many CSTs became “super efficiency experts”. They conference with others by the OR desk asking what is really needed in these hip pans and then working with their surgeons. The efficiency process is now self-sustaining. This was my opportunity to make a difficult process more efficient.
Epilogue: My next project is to help select and deploy a new surgical tracking system as our current program is no longer supported. This will be easier now with fewer instruments to track. After initial hesitation from our SPD manager and OR director I now feel like a part of their team and I am making a difference.
