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Hospital Play #2 – Eliminating Variability in Instruments/Disposables

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    July 4, 2018

    Variety may be the spice of life, but in the operating room, it can be a recipe for reduced profitability, inefficiency, and low quality. We frequently see leaders of Surgical Services struggling with the question of variability, particularly how much of it to allow and where to allow it. As healthcare practitioners, you know that most surgical costs are incurred in the OR, but this knowledge does not create the balance between standardization and individual freedom to practice. When we ask practitioners interested in reducing instrument and disposable variability about the lack of standardization, we typically get the following responses:

    • We don’t know how to get started, and saying no to surgeons isn’t an option.
    • We aren’t sure if standardization will improve OR efficiency and quality.
    • We aren’t sure if the returns from standardization would be worth the effort.

    What can we do?

    There are three key ways to begin enabling change and sustaining momentum across the standardization process:

    1. Picking sub-specialties and enlisting the team
    2. Gathering data and educating surgical teams
    3. Implementing tools and processes to lock in change

    Picking Sub-specialties and Enlisting the Team

    Hospitals should avoid biting off more than they can chew with a standardization project. To start, choose 1-2 sub-specialties, this allows leadership to buy-in, test their approach, and course correct for rolling out to additional sub-specialties. An ideal sub-specialty candidate has innovative leadership at the surgeon and nursing level. Next, it’s time to select a set of moderately complicated procedures performed at significant volume with a higher quotient of supplies. These characteristics will maximize your potential to create value.

    Gathering Data and Educating Surgical Teams

    Data gathering and education are paramount in convincing nurses and doctors that change is necessary. This process works best when doctors and nurses are engaged in data collection with the data coming from their procedures. These efforts shouldn’t be complicated multi-month endeavors. In fact, analysis of data from current systems, such as charge sheets, can be performed to illustrate opportunities for improvement, like cost differences in procedures across a group of doctors. Our own experience shows that teams can utilize ExplORer’s technology to collect and analyze data, eliminating the need for consultants and observers.

    Implementing Tools and Processes to Lock in Change

    We’ve found that 85% of waste in the OR occurs due to procedural knowledge gaps, particularly with instruments and disposables. Gitelis and Ujiki at Northshore University Health share that educating doctors on the cost of disposables used in laparoscopic cholecystectomies lead to a 10% savings in disposable costs -- an annual savings of $27,000. In reality, tools available in the OR are insufficient, they don’t provide a stepwise sequence of instruments to be utilized. So, it’s no surprise that efforts at standardization end up failing. In today’s high turnover environment, where 20-40% of surgical team members are replaced every year, technology required for sustainable results.

    Is standardization of instruments/disposables worth the effort?

    Not only does standardization lower costs and create operational efficiency, it does so without negative impacts. Two cases illustrate this well:

    1. Thyroidectomy: Disposable Standardization Yields $1,274/Procedure

    Our co-founder, Dr. Langerman, assessed the average disposable costs of Thyroidectomy procedures across five different surgeons at a single facility. The range of disposable costs was $298 to $1,572. Cumulatively, this variability in disposables represented a $400,000 opportunity for annual savings for that one procedure.

    2. Laparoscopic Cholecystectomy: Standardization Yields $2,497/Procedure

    The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) performed a study of the variation in equipment use across 36 surgeons. It revealed that equipment costs varied between $258 and $2,755, resulting in a potential of $2,497 in savings.

    At ExplORer, we sit at the crossroads of surgical workflows, decisions, and instrument choices, as a preoperative and realtime support solution. Teams need a centralized workflow software, like ExplORer, that builds and sustains knowledge, supports standardization, and helps your OR eliminate variability.


    About ExplORer Surgical

    ExplORer Surgical is an interactive surgical playbook that reduces disruptions and wasted disposables by improving surgical team communication. ExplORer Surgical also provides real-time performance and scheduling data to OR administrators to enhance quality of care and efficiency. Surgical teams use the software to coordinate their activities while managing their tools and supplies in a way never before possible. The result is optimal teamwork, increased efficiency, and high performance.

    End Notes:

    Gitelis M, Vigneswaran Y, Ujiki M, et al. Educating surgeons on intraoperative disposable supply costs during laparoscopic cholecystectomy: a Regional health System’s experience. Am J Surg. 2015;209:488e492.

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