Data analysis of vascular surgery instrument trays yield large cost and efficiency savings

Published: December 24, 2020

Martyn Knowles, MD, MBA; Samuel S. Gay, BS

Sarah K. Konchan, BS; Robert Mendes, MD

Sandeep Rath, PhD ; Vinayak Deshpande, PhD

Mark A. Farber, MD ; Benjamin C. Wood, MD, MBA

ABSTRACT:

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, and the expense for re-sterilization and assembly of instrument trays ranges from $0.51-3.01 per instrument. Given the complexity of the surgical service supply chain, physician preferences, and variation of procedures, reduction of surgical cost is extremely difficult and often ill-defined. A data driven approach to instrument tray optimization has implications for efficiency and cost savings in sterile processing, including reduction in tray assembly time and instrument repurchase, repair, and avoidable 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, a primary focus was placed on two main vascular surgery trays: vascular and aortic. An assessment was performed evaluating the exact instruments used by the operating surgeons across a variety of cases. The vascular tray contained 131 instruments and was used for the vast majority of vascular cases, and the aortic tray contained 152 instruments. Actual instrument usage data were collected, a review and analysis were performed, and the tray was optimized.

Results

Over the 3-month period, 168 vascular surgery cases were evaluated across six 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. After review, 45.8% of instruments were removed from the vascular tray and 62.5% from the aortic tray. A total of 1255 instruments were removed from the versions of both trays. An audit was performed after the removal of instruments, none of the removed instruments were required to be added back. The instrument reduction from those two trays alone yielded an estimated cost savings of $97,781 for repurchase and $97,444 in yearly re-sterilization savings. Annually, the removal of the instruments is projected to save 316.2 hours of personnel time. The operating room table set-up decreased from a mean of 7:44 to 5:02 minutes (P<.0001) for the vascular tray, and form 8:53 to 4:56 minutes (P<.0001) for the aortic tray.

Conclusion

Given increasing cost constraints in healthcare, sterile processing remains an untapped resource for surgical expense reduction. A comprehensive data analytics solution provides the ability to make informed decisions in tray management that otherwise cannot be reliably performed.

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