in Surgical Sets Final Presentation December 13 2016 Team 2 Team Clients Coordinators Jacob Homan Jania Torreblanca Matt Claysen Ivana Kosir Manager CSPD Industrial Engineer OR ID: 546096
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Missing Instrumentation in Surgical SetsFinal Presentation: December 13, 2016Team 2
Team
Clients
Coordinators
Jacob Homan
Jania
Torreblanca
Matt
Claysen
Ivana
Kosir
-Manager, CSPD
-Industrial
Engineer, OR
Timothy O’Neill
Kerstin Rider
Nicole Farquhar
Conner
VanDevelde
-Supervisor,
OR
-Industrial
Engineer, ORSlide2
Agenda IntroductionBackgroundCurrent ProcessKey Issues
Methodology
Findings & Conclusions
RecommendationsSlide3
IntroductionSurgical sets have missing, extra or incorrect instrumentsCentral Sterile Processing Department (CSPD)Operating Rooms (OR)
GOAL
Identify
root cause of missing, extra or incorrect instrumentation
OBJECTIVES
Improve CSPD assembly process
Reduce number of incorrect surgical sets
Reduce search time for missing instruments
Increase data reporting rateSlide4
Background32 operating rooms
20K+
cases per year
16K+
instruments assembled per day
$1.03M
in instrument costsSlide5
Current ProcessORCSPD
OR opens instrument set
OR runner searches for missing instrument
OR uses instruments Slide6
Current ProcessORCSPD
OR opens instrument set
OR runner searches for missing instrument
OR uses instruments
OR returns instruments into the set
CSPD sends instrument sets through decontaminationSlide7
Current ProcessORCSPD
OR opens instrument set
OR runner searches for missing instrument
OR uses instruments
OR returns instruments into the set
CSPD sends instrument sets through decontamination
CSPD assembles the instrument sets
CSPD searches for missing instruments
CSPD sends instruments set through Sterilization
OR stores instrument setsSlide8
Key IssuesSlide9
MethodologyObservations and Interviews
25 hours of observations
15 Interviews
Literature Search
2 previous IOE teams
6 Detroit News articles about Detroit Medical Center Slide10
MethodologyData Collection and Analysis12 hours of audits 75 cases analyzed
Surveys
36 responses from CSPD
65 responses from ORSlide11
MethodologyIn-service Pilot
Two truths and a lie
Marshmallow spaghetti tower
Initial findingsSlide12
Findings and ConclusionsSlide13
Lack of Understanding between Departments
Errors attributed to other department
Both departments contribute to issue
CSPD
OR
Grand Total
Incorrect Cases
8
16
24
Total Cases
34
41
75
Error Rate
24%
39%
32%
Interdepartmental Relations
Source: November Audit Data (N = 75)Slide14
Lack of Understanding between DepartmentsInterdepartmental RelationsSource: Provided Qualtrics Data (N = 403)Slide15
Lack of Understanding between Departments
Drop-off of reporting due to policy misunderstanding
OR does not want CSPD to get disciplined
CSPD is trying to meet quotas
Interdepartmental RelationsSlide16
Interdepartmental Relations MaintenanceIncrease procedural integrity, communication, and data reporting to reduce incorrect surgical setsInterdepartmental RelationsSlide17
Unstandardized Search ProcessUnstandardized Search ProcessSource: CSPD survey data (N = 30)Slide18
Unstandardized Search ProcessSearch AreaBenefit
Problem
Ask another processor
-Other processors have more experience and knowledge
-Tough to know who
to ask
-Processors are low on time
Check other instrument sets
-Instruments are mixed during surgery
-Missing instruments are likely in sets that were
used concurrently
-No way to track which sets were
used together
Unstandardized Search ProcessSlide19
Standard CSPD Search ProcessReduce search time & improve CSPD assembly processUnstandardized Search ProcessSlide20
Communication Breakdown
Communication BreakdownSlide21
Communication BreakdownAre you able to identify instruments using the manufacturer name?Communication Breakdown
Source:
CSPD survey data (N = 30)
OR survey data (N = 60)Slide22
Common Name & Allowable Substitutes CommitteeImprove CSPD assembly and OR return processesCommunication BreakdownSlide23
Valuable Information Lost on Count SheetsDecontamination Count SheetSlide24
Decontamination Count SheetsImprove CSPD assembly processDecontamination Count SheetSlide25
Expected Impact
CSPD
OR
Yearly
Lower
Upper
Lower
Upper
Current Productivity
Loss
$175K
$400K
$25K
$350K
Future Productivity Loss
$133K
$320K
$13K
$264K
Savings
$42K
$80K
$12K
$86K
Total Savings
$54K - $166K
Findings based on CSPD survey data (N = 35) , OR survey data (N = 61) and salary dataSlide26
SMEs, Common Name, Decontamination Count SheetsExpected ImpactImproving Interdepartmental Relations
Standardizing Search Process
Reduces the number of incorrect surgical sets
Improves the CSPD assembly process
Reduces the time spent searching for instrumentsSlide27
Thank You!Questions?Slide28
Expected Impact
CSPD
1
OR
Lower
Upper
Lower
2
Upper
3
Current Productivity
Loss
$175,000
$400,000
$25,000
$350,000
Future Productivity Loss
$133,000
$320,000
$13,000
$264,000
Savings
$42,000
$80,000
$12,000
$86,000
Findings
based on CSPD survey data (N = 35) , OR survey data(N = 61) and salary data
Assumed 10% reduction in search time and 1 less expected incorrect surgical set
Assumed 0% reduction in search time and 0.5 less expected incorrect surgical set
Assumed 0% reduction in search time and 1 less expected incorrect surgical setSlide29
Project ScopeIn-ScopeOut-of-Scope
Sets
missing instruments
Sets marked
incomplete
Inventory flow in OR
Clinic sets
Quick turnaround
& main CSPD
Loaner
sets
Set
transportation between floors
Surgitech
sets
Search process for missing instrument
Implantables
Cleaning, packaging, and sterilization