It is a well-known fact that hospital infections cause suffering to patients and lead to additional treatment costs [1]. If these infections can be minimised, resources could be used in a more efficient way. The battle against bacteria includes a number of preventive measures. The risk of spreading airborne particles, for example, will be reduced by minimizing the number of packages containing sterile items required for an operation, and also by having as few staff in the operating room as possible for preparation work. This is one important part of the asepsis procedure.
In order to offer patients safe, good quality treatment in reasonable time it is
necessary to make the most of available resources. Preventing hospital-acquired infections is one part of this. Another vital issue is working processes, such as set-up times for operations. Studies show that custom procedure trays, containing all the single-use medical devices needed for a specific intervention, offer significant potential for improving efficiency.
A study conducted at three German hospitals in 2002 showed there is great potential to save costs by the use of custom procedure trays [2]. The savings were estimated as follows:
• Cost of in-house supply processes: reduced by 31.8 %.
• Cost of procurement: reduced by 76.3 %.
• Cost of daily pre-selection of surgical products: reduced by 31.1 %.
• Cost of product-picking for individual surgical procedures: reduced by 57.0 %.
• Operating room set-up time: reduced by 36.6 %.
Another study, conducted at a Day Surgery Unit in the UK in 2005, revealed that the total estimated average time saved for three different procedures in one year could be over 65 hours, or more than eight working days [3]. In addition, the conclusions of an advisory board in France in 2004 confirm that custom procedure trays can improve both safety and efficiency in the operating theatre [4]. The risk of infection can be controlled better if one tray is opened by only two peoples and staff can feel confident that everything is included for a certain operation. In addition, traceability can be improved [4].
Three hospitals were included in the German study. One of them was the Protestant-Lutheran Hospital in Flensburg, with ten departments, one hospice and 480 beds. The hospital’s 62-bed gynaecology department, which carries out 1,582 surgical procedures annually under anaesthesia, has switched from multiple-use cotton textiles to custom procedure trays, including single-use medical devices. The study, conducted over several weeks, showed that the most substantial savings potential was linked to procurement. In addition, it concluded that in-house supply and product picking costs for individual surgical procedures can be halved [2].
The Georgius-Agricola Hospital in Zeitz switched from multiple-use synthetics to custom procedure trays, which contain single-use medical devices. The hospital has 283 beds and nine departments. The study included the 42-bed general and visceral surgery department, which performs 948 major interventions annually. The results indicated that human resource costs for in-house supply processes can potentially be almost halved [2].
The Steinfurt Hospital switched from single-packed disposable medical devices to single-use custom procedure trays. The study involved the trauma and emergency surgery department, which has 40 beds and performs 830 operations annually. The switch revealed a potential of reducing human resource costs for surgical product procurement (by 86,6 %), as well as product picking for surgical procedures (by 84,4 %). In addition, as a result of a 60 % reduction in operating theatre set-up time, the hospital was able to greatly increase its daily throughput of operations [2].
Considerable improvements in cost-efficiency, hygiene and patient safety have also been experienced at the Starnberg hospital, outside Munich in Germany:
“Starnberg hospital delivers health care in Bavaria near Munich with 11,000 surgical procedures expected this year. In 2005, we started to switch from multiple-use cotton textiles to single-use products and procedure trays to achieve the greatest possible standardisation of single-use medical devices. In my experience, the expected substantial saving in set-up time, especially in complex procedures requiring more than 30 single-use medical devices, has been accomplished. Other advantages have also come to light, such as simplified and more valid documentation, as well as simplified procurement with a significant reduction in the number of articles. This is especially true in out-patient operations performed by our consultants. The reduction of set-up times and the reliable, standardised procurement of the medical devices required, has created new efficiencies which benefit both the hospital and the consultant performing the operations. Altogether, operating procedures for our patients became safer, were better prepared and were carried out with a higher level of hygiene as a result of using procedure trays increasingly over the last two years. Nevertheless we are still trying to improve our custom procedure trays and we want to extend the current usage. Today, single-use custom procedure trays are used in about 80 % of more than 500 standardised operating procedures in eleven disciplines. Identifying total costs has also become much easier with custom procedure trays and they help to meet the challenge of economising in a ‘high-costarea’ such as the operating theatre.”
(Dr. med. Ulrich Wenning Head of Operating Room Functions at Starnberg hospital)
The English study, conducted in 2005 at the Day Surgery Unit at Kingston Hospital in Surrey, revealed considerable potential in saving a great deal of time both before, during and after a typical day case surgery list [3].
Three procedures, treating ACLs (anterior cruciate ligament repair), hernia repair and laparoscopic cholecystectomies, were included in the study. The data showed that the total time saved over one year could exceed 65 hours, the equivalent of more than eight working days. The authors of the study concluded that “even cautious interpretation of the data suggests that the widespread introduction of custom procedure trays would go some way to improving efficiency targets in UK day surgery units, thereby addressing one of the Healthcare Commission’s major concerns”. According to the data, there is potentialf or faster pick and set-up times for theatre staff, increased patient throughput, faster response times for emergency procedures and a reduced risk of infection. By reducing the number of items that have to be opened for each procedure, there is a potential to reduce the risk of infection for the patients. Another advantage highlighted in the study is that correctly specified custom procedure trays almost eliminate the risk of picking errors. For theatre managers, there is the opportunity to improve stock and cost control, to identify total procedure costs more easily and to manage staff resources more effectively.
Historically, surgical procedures most suited for conversion to custom procedure trays are those that require many medical devices to be routinely picked every time. However, custom procedure trays should not be limited to certain specialities, such as ophthalmics or orthopaedics, or to typical environments, such as day case surgery or emergency surgery. On the contrary, custom procedure trays may well be used for all areas of surgery. This is the experience of Helen Staples, who has completely converted an NHS (National Health Service) District General Hospital and an NHS Acute University Hospital Teaching Trust in the UK:
“Day case surgery is the ideal scenario for the implementation of custom procedure trays, as proved in the Kingston Hospital NHS Trust time and motion study. However, in projects at other NHS Hospital trusts, it has been demonstrated that the principles and benefits can be adopted in all areas of surgery where many medical devices are routinely ‘picked’ for a given procedure. “In the high spend perioperative environment, widespread acceptance of custom procedure trays across all specialities and procedures, whether major or minor, ensures consistency in practice and quality standards. The switch from multiple-use theatre textiles to single-use products also assures a constant standard in infection control for the patient and surgical team at all times.”
(Helen Staples, Trust Theatre Procedure Pack Coordinator, Southampton University Hospitals NHS)
Helen Staples emphasises the advantages of consistency throughout a Trust. Her experience is that the use of custom procedure trays leads to improved cost control, encourages an across-the-board standardisation of products, and makes it easier to trace individual tray components. Another, very important factor is that staff can be confident that the same high quality standard of perioperative care can be applied to any given procedure.
In France, a government initiative, the “Hospital 2007 Plan”, has been launched to promote modern hospital management techniques and increase efficiency in public hospitals – including purchasing methods. This, and other legal and political issues, has led to a greater focus on efficiency in the health care sector. Related to this, in 2004 an independent French advisory board, consisting of clinical directors, pharmacists, theatre managers and nurses, compiled an inventory of the advantages of custom procedure trays in order to get a clearer picture of the benefits of their use. One of the overall conclusions of the advisory board was that custom procedure trays offer potential to improve efficiency in purchasing, storing and handling medical devices ahead of interventions. Cost reductions can be achieved as a result of simplified logistics processes, minimised waste through reduced packaging, significantly shorter preparation times and faster theatre turnarounds.
Another issue highlighted by the advisory board was that devices in a tray must comply with European Standards, both individually and as an entire package. It was also emphasised that the risk of infection can be reduced by having fewer individual packages of medical devices for an operation. Traceability can also be improved.
In conclusion:
The use of custom procedure trays containing single-use medical devices increases efficiency in terms of working procedures for theatre staff, logistics systems, theatre turnaround and cost control. All areas of surgery could benefit from the use of custom procedure trays and the most efficient step is to convert a whole hospital, not only parts of it.
It is vital that healthcare units and authorities in European countries exploit this potential. They should also constantly strive to further improve systems and processes so that the health care sector can meet the challenges that lie ahead. Custom procedure trays represent an important step in helping hospitals to satisfy greater demands for efficiency, while also ensuring a high level of patient safety.
References:
1. Emmerson A M et al, J.Hosp.Inf. 1996; 32:175-90.
2. Improvement of operating theatre capacity by the use of procedure trays. Study of the cost benefits of using
custom procedure trays in operating theatres. Klinik-Management-Consulting in Germany, 2002.
www.klinik-management.com.
3. The Benefits of Using Customised Procedure Packs to Increase Day Surgery Unit Efficiency. A time and motion study. Emma Duffy and Annie
Smith, Day Surgery Unit, Kingston Hospital NHS Trust, Surrey, October 2005.
4. Why change to custom procedure trays? Reflections and prospects. Report from the “Custom Procedure Trays” advisory board’s meeting, Paris, March 2004.