Missing Instrumentation in Surgical Sets Final Presentation December

Missing Instrumentation in Surgical Sets Final Presentation: December 13, 2016 Team Jacob Homan Ivana Kosir Timothy O’Neill Conner Van. Develde Team 2 Clients Jania Torreblanca Coordinators Matt Claysen -Manager, CSPD -Industrial Engineer, OR Kerstin Rider Nicole Farquhar -Supervisor, OR -Industrial Engineer, OR

Agenda • • Introduction Background Current Process Key Issues Methodology Findings & Conclusions Recommendations

Introduction • Surgical sets have missing, extra or incorrect instruments § Central 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 rate

Background 32 20 K+ operating rooms cases per year $1. 03 M in instrument costs 16 K+ instruments assembled per day

Current Process OR OR opens instrument set OR runner searches for missing instrument OR uses instruments CSPD

Current Process OR OR opens instrument set OR runner searches for missing instrument OR returns instruments into the set OR uses instruments CSPD sends instrument sets through decontamination

Current Process OR OR opens instrument set OR runner searches for missing instrument OR returns instruments into the set OR stores instrument sets OR uses instruments CSPD sends instrument sets through decontamination CSPD searches for missing instruments CSPD assembles the instrument sets CSPD sends instruments set through Sterilization

Key Issues Missing Instruments Resources Wasted Patient Safety Decreased Satisfaction

Methodology Observations and Interviews Literature Search - 25 hours of observations - 15 Interviews - 2 previous IOE teams - 6 Detroit News articles about Detroit Medical Center

Methodology Data Collection and Analysis Surveys - 12 hours of audits - 75 cases analyzed - 36 responses from CSPD - 65 responses from OR

Methodology In-service Pilot - Two truths and a lie - Marshmallow spaghetti tower - Initial findings

Findings and Conclusions

Interdepartmental Relations Lack of Understanding between Departments • Errors attributed to other department • Both departments contribute to issue Incorrect Cases Total Cases Error Rate CSPD OR Grand Total 8 34 24% 16 41 39% 24 75 32% Source: November Audit Data (N = 75)

Interdepartmental Relations Lack of Understanding between Departments Monthly responses have decreased 200 152 121 100 63 34 50 18 15 er r O ct ob be em pt Se Au gu st ly Ju ne Ju M ay 0 Source: Provided Qualtrics Data (N = 403)

Interdepartmental Relations 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 Relations Maintenance Increase procedural integrity, communication, and data reporting to reduce incorrect surgical sets Team Building Increase positive interaction between departments Restate Departmental Policies More buy-in to policies

Unstandardized Search Process Response Frequency 35 Order of Search Location 30 25 20 15 10 5 0 1 st 2 nd 3 rd 4 th Position in Search Order 5 th 6 th Back cabinet units Ask other processor Peel packs from OR cores Down cart Other instrument sets Other Source: CSPD survey data (N = 30)

Unstandardized Search Process Search Area Benefit 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 -No way to track which during surgery sets were used together -Missing instruments are likely in sets that were used concurrently

Unstandardized Search Process Standard CSPD Search Process Reduce search time & improve CSPD assembly process Subject Matter Expert External Surgical Set Marker Provide guidance on shifts without service leads Help find instrument sets used together

Communication Breakdown Manufacturer names Confuses nurses and processors No substitutes More incorrect instruments

Communication Breakdown Are you able to identify instruments using the manufacturer name? CSPD OR 15% 37% 63% 85% Source: CSPD survey data (N = 30) OR survey data (N = 60) No Yes

Communication Breakdown Common Name & Allowable Substitutes Committee Improve CSPD assembly and OR return processes Common Names Provide useful name for OR staff Allowable Substitutes Fill gap between OR and CSPD

Decontamination Count Sheet Valuable Information Lost on Count Sheets OR Decontamination CSPD • Notes added on count sheet • Non-vital information • Count sheets thrown out • Information lost • May miss small mistakes • Re-identify already known issues

Decontamination Count Sheets Improve CSPD assembly process Short Term: Tags Notes written in permanent marker Stored in bin in OR Long Term: Electronic Populate notes when set is scanned Preferably through Censitrac

Expected Impact Yearly Current Productivity Loss Future Productivity Loss Savings Total Savings CSPD Lower Upper $175 K $400 K $133 K $42 K $320 K OR Lower Upper $25 K $350 K $13 K $264 K $80 K $12 K $54 K - $166 K $86 K Findings based on CSPD survey data (N = 35) , OR survey data (N = 61) and salary data

Expected Impact Improving Interdepartmental Relations Reduces the number of incorrect surgical sets Standardizing Search Process Reduces the time spent searching for instruments SMEs, Common Name, Decontamination Count Sheets Improves the CSPD assembly process

Thank You! Questions?

Expected Impact Current Productivity Loss Future Productivity Loss CSPD 1 Lower Upper $175, 000 $400, 000 OR Lower 2 Upper 3 $25, 000 $350, 000 $133, 000 $13, 000 $320, 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 1. Assumed 10% reduction in search time and 1 less expected incorrect surgical set 2. Assumed 0% reduction in search time and 0. 5 less expected incorrect

Project Scope In-Scope Sets missing instruments Inventory flow in OR Quick turnaround & main CSPD Set transportation between floors Search process for missing instrument Cleaning, packaging, and sterilization Out-of-Scope Sets marked incomplete Clinic sets Loaner sets Surgitech sets Implantables