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On-Time Case Starts: Start with Sterile Processing

If you want to insert your sterile processing department into a high-level C-suite conversation, bring up the impact your team has on on-time case starts. Besides sheer surgical volume, there are few other metrics with as much facility focus today as ensuring that surgical cases are beginning on time, every time. The reasons this metric is important are evident. Every minute wasted waiting on anything—whether it’s a late doctor, an untransported patient, or unavailable instrumentation—is an expensive minute, with many calculations putting the cost above $100 per minute. Add to that the snowball effect that happens to operating room schedules when the first case of the day starts late, which impacts every other case in that room for the day—potentially prohibiting any opportunity for add-ons later in the afternoon—and you have everyone’s attention for any idea to get it fixed. Which brings us to sterile processing.

When it’s your fault, own it and work it in your favor
For good reason, most sterile processing leaders and departments do not want to be listed on any kind of reasons for case delays list. I used to hate getting email notifications that a particular procedure had been delayed because of something that our sterile processing team did or did not do. I knew that I had to spend the next hour or so trying to figure out what happened, and then even more time with the rest of my team figuring out a game plan to ensure that it did not happen again. Plus, every time a delay was caused by my team, I felt a little bit of my soul melt away, along with a little bit of the respect and trust that we had worked so hard to cultivate with our operating room customers.

I eventually realized that there was actually a bright side to being listed as a primary contributor to case delays; you’re invited to things like executive meetings where the sole focus is fixing those problems. This ultimately means you get what every sterile processing leader wants more of: support. When this realization took hold, instead of fighting the metrics or trying to find excuses, I came right out and owned the problems. “Yes, as a matter of fact, that tray was not available for Dr. Samuel’s case,” I would explain. “And if we want to keep that from happening again, we need to invest in expanding his tray inventory to support his heavy ortho days.” It was amazing to see the budget open up to fix these case-delay metrics when all kinds of other reasons had failed in the past. Instead of running from it, our team began to use these challenges to get the things we really needed to make lasting improvements for our SPD and ultimately for our customers in the operating room.

Getting in the weeds and finding the root causes
Lest you think simply owning the problems makes them all go away, it’s important to take a quick look at the practical ways your team can get into the weeds of OR case delays and fix the root causes that track back to your sterile processing team.

One of the most common causes of SPD-related case delays is dirty or incomplete data. This can be anything from incomplete preference cards or pick lists to inaccurate count sheets. Surgical technicians who are setting up a room for a particular case may realize halfway through that the tray picked from the preference card doesn’t have that one widget that Dr. Levin loves to use for her salpingectomies. When she calls down to your sterile processing department to request another tray that has that widget, she finds out that it’s not sterile because no one knew it would be needed for a first case today. This kind of dynamic plays out in a hundred different ways, but the reason never changes: somewhere along the way, an important data point got lost between the OR and SPD. They never told us they needed it, we never had a reason to check, and it ends up on the case-delay list.

In addition to dirty data, workflow breakdowns are a big contributor to instrument-related case delays. Typically this plays out in one of two ways. Often there are physical layout challenges, such as not enough sterile storage area in sterile processing to store the entire instrument inventory, so some trays are kept in SPD and others must be stored in the operating room core. These poor physical layouts create consistent barriers to ensuring all the correct instruments get on the correct case cart at the correct time, usually because different teams are responsible for each different area, which adds unhelpful layers of complexity to the system. The other way workflows break down is through cultural and process issues. We covered one example of this in-depth in the article “Stop, Lock, and Roll: The Upside to Locking Things Down in Your SPD,” which discusses the negative effects of plundering case carts in the OR and a great, easy solution to fix it.

Whether it’s dirty data, poor physical layouts, or broken cultures, it is important for your sterile processing team and hospital administrators to come to terms with the fact that there is rarely going to be an easy fix that will take care of all instrument-related case delays tomorrow. That being said, it is wise for SPD leaders to take advantage of the increased attention around case delays and bring the specific root causes forward to have the kinds of high-level conversations that can really get things changed. Take special care to drill down to the very bottom of the breakdowns, resist the temptation to blame individuals, and then leverage the moment to start implementing a real, sustainable improvement.

What are you waiting for? Let’s help our ORs get started on time!

Feature articles exclusively for Ultra Clean Systems by Weston “Hank” Balch, BS, MDiv, CRCST, CER, CIS, CHL

Weapon of Mass Microbial Destruction * Professional Clean Freak * Podcast Host * Safety Addict * CS/SPD Consultant

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