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Personalized vs. Optimized: Dealing with the Challenge of Surgeon-Specific Surgical Trays 

How do you get out of a situation where the vast majority of your trays are surgeon specific?

How do I demonstrate the waste in processing?

How do I convince my administrators and surgical service leaders to support me in this initiative?

These are real questions from a sterile processing manager in the field, but they are likely familiar questions for countless other department leaders around the country. Regardless of where your particular facility sits on the spectrum of surgeon-specific trays, the likelihood of you having this conversation at some point in your sterile processing career is quite high. For some of you, it is a weekly, if not daily, headache. For others it is a settled process that took years to hammer out. This article will take a look at the reasons for and against surgeon-specific trays, as well as provide insight on how to work through the challenge as smoothly and effectively as possible.

What’s in a name?

When the terms “surgeon specific” or “surgeon special” trays are thrown out there in sterile processing conversation, what they typically refer to is an instrument set that has a doctor’s name on the label. An example would be something like “Dr. Levin’s Laparoscopic Set #1.”

What happens if you drop Dr. Levin’s name from the label and it just becomes “Laparoscopic Set #1”? What are the potential impacts of this change? Well, the answer to that question really gets to the heart of this entire debate. If there is no tangible difference in instrumentation between a surgeon-specific laparoscopic tray and a general laparoscopic tray, then the impact can be totally different than if the two versions of trays are drastically diverse from one another.

Here are a few illustrations to drive home the point:

  • Instrument availability/delays: If you have an inventory of eight General Laparoscopic Trays and two Dr. Levin Laparoscopic Trays, then dropping the surgeon’s name off the label could give you a total laparoscopic inventory of 10 trays (a 25% increase from your original eight). If your facility struggles to keep up with laparoscopic volume with current inventory, this kind of change can be an immediate positive impact to your overall instrument availability.
  • Vanity/culture: A common barrier to these conversations actually comes down to the culture shifts over recent decades from surgeon-focused purchasing to broader facility-focused inventory development. This means that someone told Dr. Matthews 10 years ago that the hospital was going to buy her three new orthopedic sets, so Dr. Matthews is under the reasonable misconception that those Dr. Matthews Orthopedic Trays are, in fact, hers. More on this point below.
  • Surgical comfort or quality: If there are actually specialty or one-of-a-kind instruments in surgeon-specific trays, then the decision to drop the name off the label can’t done in a vacuum. Like all artists, functionality and type of tools matter to our surgeons. Not all needle holders are created equal in their eyes; even our sterile processing teams don’t necessarily see the clinical difference between the two. Any change in tray labeling has to account for this reality.
  • IUSS rates: The number of immediate-use sterilization cycles can be impacted on both sides of this coin. If instrument inventory is unreasonably limited because of too many surgeon-specific trays, then IUSS rates creep higher to keep up with the demand on fewer available trays. At the same time, if particular surgeons are scheduling multiple procedures of the same type on the same day, limited inventory of their specific trays may pressure departments into higher IUSS rates. 
  • Turnover requests: Even if the challenges around balancing high volumes of surgeon-specific trays does not lead ultimately to IUSS cycles, they do put additional strains on daily department workflows due to increased turnover requests related to limited instrument trays. With each same-day turnover comes more opportunity for communication or process breakdowns that can negatively impact patient safety and cause frustration for customers in the operating room. 

Who owns it and how do we optimize it?
The real-life questions at the beginning of this article really center around two underlying themes. First, who really owns your surgical inventory? By this I mean both the financial responsibility but, more importantly, the logistical aspect of managing it as a surgical resource or asset. While surgeon users should be given wide latitude around deciding the critical tools they need to perform procedures, this can and should be balanced with their own surgical peers who are performing similar procedures in the same service line. The culture-based and vanity reasoning behind labeling trays with physician names has outlived its usefulness and often only brings undue complexity into the surgical asset management workflow. Financial and logistical ownership of these resources should be clearly positioned as hospital-owned generally, and specifically managed in a collaborative effort between the operating room and sterile processing.

Second, there can be no real, sustainable solution to surgeon-specific tray challenges without strategic conversations around optimization of service-line instrumentation. The success of any optimization project depends heavily on upline administrative support and buy-in from surgeon leaders, OR directors, and service-line advocates. The overarching object of these projects should be to identify what is different between your surgeon-specific trays in the same service line, answer the question of why they are different, and determine how that difference can be supported through standardization or a reduction of instrument complexity. This can be as simple as peel packing single specialty instruments all the way up to reorganizing entire trays based on collaborative approval. 

While surgeon-specific instrument trays are still common practice today, there are convincing arguments for reconsidering this practice based on the changing dynamics of asset management, tracking, and service delivery in sterile processing. Even though this discussion has been focused on physician names, the names we should be more interested in supporting during device reprocessing is that of the patient. Hopefully these insights assist your team in keeping those names as the real priority for improving your instrument availability and surgical asset management.

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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