Hidden costs due to poor Instrument Management

One common mistake in the equipment planning process is the practice of “copying and pasting” surgical set structures, set contents and sterile packaging system from already existing healthcare facilities. Unfortunately, very often these set lists from existing hospitals do not match with the new facility’s future OR demands and thereby are not useful. In addition to that, many sets of already existing hospitals are inefficient in terms of structures and contents. ^[1]

For instance, many instruments within a set are never used during surgery. A study shows that the instrument utilization rate often is as low as 13% due to overloading of sets. ^[2] After surgery, all devices should be reprocessed, even if they were not used. This causes significant unnecessary costs for health institutions, considering that the total reprocessing costs per instrument exceed US$ 0,51. ^[3] 

In many purchase decisions different offers are compared. When selecting the supplier one decisive factor is the lower price for the offered equipment. ^[4] Unfortunately, the so called Total Cost of Ownership (TCO), considering the direct but also the indirect costs during the equipment lifetime are not considered in the equipment planning process. An analysis shows that the price for low-end medical devices only makes up approximately between 20-25% of the TCO. ^[5]

The following example is showing that poor set planning and neglecting of care and maintenance could result in high unnecessary costs:
The price of a single missing or malfunctioning surgical instrument during a surgery can be really expensive. When a new tray has to be ordered during surgery, it takes approximately seven minutes until it arrives in the OR. ^[3] One minute of OR time costs up to US$ 37, ^[4] which means that one missing or malfunctioning instrument can cost up to US$ 259 only due to the delay it is causing.

The quantity and configuration of surgical sets has also a huge impact in the planning and dimensioning of central sterile supply department (CSSD). For example, by calculating the required floor space of CSSD, it is absolutely necessary to consider: the number of future surgeries, the quantity and features of medical devices and also the sterile packaging system, that needs to be transported, cleaned, disinfected, sterilized and stored. The German Sterile Association advises against calculating the required spaces based on the number of hospital beds, as there is no direct correlation between hospital beds and space needs of the hospital. ^[6]

Professional planning of surgical instruments in new construction hospital projects prevents from oversizing surgical inventory, overloading surgical sets and thereby avoids associated extra costs (e.g. unnecessary reprocessing costs).

Experts in set planning support you in defining the right set quantities, set structures and sterile packaging solution to meet your healthcare’s future OR demands. In this process the number of future operating rooms and the projected surgeries in the different disciplines of the future health care institution is taken into account.

This professional approach is also vital for defining the architectural design of the future hospital’s CSSD, as it enables, for example, conclusions regarding the needed number of washer and disinfector machines and sterilizers.

Considering the Total Cost of Ownership in the planning and acquisition process of surgical equipment and sterile goods supply could increase the performance of your future health care facility. ^[8] Ensuring the optimal functionality and availability of surgical equipment allows operations to go ahead as planned, avoiding delays, stress and costs. A professional high-quality repair management and a technical service that is reliable and always available when needed can help you to achieve a long lifetime and proper functioning of your instruments and thus preserves the value of your surgical sets. Moreover, for guaranteeing that sets are complete with functioning instruments during surgery, a well-defined backup stock where high-runner and critical items are available as a backup, is recommended. This will enable surgeries to go ahead as planned while broken or lost instruments get repaired or replaced.

Digital solutions, as support of CSSD and OR processes, allow for simple data administration and documentation of the sterile goods supply. These solutions may reduce errors, stress and pressure among the CSSD and OR staff and facilitate adherence to procedures, guidelines and patient safety. ^[9]

In many markets, soft wraps are commonly used to pack sterilized surgical instruments but are very prone to pinholes or tears. Damaged packaging cannot guarantee sterility of the instruments and is a high risk for the patient’s health. By contrast, containerization does not only enable safer storage, but also easier handling as containers can be stacked and different lid colors allow for sorting by disciplines. Containers prevent contamination of sets and maintain sterility for at least 360 days. ^[10] One case study found that – compared to soft wrap packaging – on average US$ 190,000 can be saved per year by containerization. ^[11]