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“Optimization of surgical tray efficiency as a simple means of reducing perioperative costs”

Terence Fu, Amirpouyan Namavarian, Haytham Msallak, Eric Monteiro, Brad Hubbard, William Elmasri, Kevin Higgins, Danny Enepekides


Objectives:  Surgical trays contain frequently unused instruments, leading to unnecessary reprocessing costs. Reducing unnecessary instruments on surgical trays is one simple strategy for minimizing perioperative waste. The purpose of our study was to implement a quality improvement initiative aimed at streamlining common otolaryngology surgical trays, and to examine the impact on costs and operating room (OR) efficiency.

Methods: We conducted a review through direct observation of surgical instruments used in five common otolaryngology procedures (adenotonsillectomy, myringotomy, septoplasty, endoscopic sinus surgery, thyroidectomy) between April 2018 to October 2018 at a single community hospital. Baseline data on instrument utilization, tray setup time, length of OR, and tray reprocessing time were recorded. Instruments with a utilization rate less than 25% were removed from surgical trays after consultation with stakeholders. Frequency of instrument call-back was recorded as a balancing measure to evaluate for unintended consequences. A costing model was developed from an institutional perspective to estimate cost-savings over one- and ten-year time horizons. Costs were modelled as a function of surgical volume, labor costs, instrument depreciation, and indirect costs (i.e. utilities, maintenance). All costs are reported in 2018 Canadian dollars and a 5% discount rate was adopted.

Results: At baseline, approximately 3 of 10 instruments on average were utilized during common otolaryngology procedures. Initial conservative tray reductions decreased tray size by an average of 26%. We estimated total cost-savings of $9,813 and $75,776 over one- and ten-year time horizons, respectively. Further work is underway to examine the impact of tray optimization on balancing measures such as instrument call-back, and indicators of OR efficiency such as tray set up time. Deterministic sensitivity analyses are also underway to identify drivers of cost-savings.

Conclusions: Surgical tray optimization is a simple, effective, and potentially scalable method of reducing perioperative costs.

Learning Objectives

  1. To report the results of our quality improvement initiative aimed at streamlining common otolaryngology surgical trays.
  2. To examine the scalability of surgical tray optimization as a cost-saving measure.
  3. To review the general methodology and principles of quality improvement.

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Scheduling Details

This 7 minute presentation is scheduled to take place on June 4, 2019 at 10:28 in the Hall C.

Authors' Contact Details

Corresponding Author: Dr. Terence Fu

Senior Author: Dr. Antoine Eskander

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