Higher-acuity orthopedic procedures — such as total joint replacements of the hip, knee and shoulder — are increasingly shifting to ambulatory surgery centers as payers seek cost savings and physicians and patients embrace the convenience and efficiency of these settings.
As orthopedic case volume and complexity grow, ASC leaders are working to boost efficiency and throughput while maintaining high-quality patient care. One major opportunity is reducing the number of surgical trays used in procedures.
To learn how ASCs can streamline their surgical tray processes and the benefits of doing so, Becker’s Healthcare spoke with Jan Chavez, a surgical technologist in Kansas, and Kyle Kemp, national director of business development at ONE TRAY®.
Readiness is an ASC imperative
According to Mr. Kemp, ASCs typically partner with medical device vendors that will provide the instrumentation and implants used by surgeons for a total joint replacement procedure.
A few days prior to a procedure, the ASC will contact the vendor representative to ensure the delivery of instruments and implants for all upcoming procedures. The vendor then ensures these instruments and implants are onsite at the ASC.
After receiving the instrumentation, the ASC processes all instruments and implants. This involves inventorying, cleaning and sterilizing each item, then conducting a second inventory. All instruments and implants are then placed in packaging systems and sterilized again. This process ensures that every instrument and implant is ready for surgery.
However, ASCs face several challenges in having the right instruments ready for surgeons. Mr. Kemp observed that the process of readying all instruments for surgery can take up to five hours, and in general, ASCs don’t have enough washers or sterilizers to match their volume — presenting a constant challenge to prepare the quantity of instruments needed for that day’s procedures. ASCs can also lack adequate space to store all of the instruments and implants needed for total joint replacements.
Having worked with ASCs that are performing total joint replacements, Mr. Kemp frequently sees environments with hundreds of instrument trays, constant washing and sterilizing and continuous storage issues.
Ms. Chavez’s facility has eight surgical suites, all for orthopedic procedures, with two washers and four sterilizers. It is common that one surgeon will have up to 10 total joint replacement cases in one day, placing huge demands on the organization to have enough sterilized instruments ready. These pressures are amplified due to limited space for washers, sterilizers and storage.
Ms. Chavez explained that at her facility, upon receiving instruments from the vendor, staff members first handwash every instrument, then put all instruments into a washer, which takes 40 to 50 minutes per cycle. Then, the instruments are placed in a packaging system and sterilized, which can take another 2 hours with cool time.
In total, processing instruments at this facility can take over 3.5 hours per set. For a surgeon with 10 cases per day — with each case requiring approximately six trays — the processing and preparation challenge is immense.
“I’ve got to figure out how to get trays done efficiently. When a surgeon needs an instrument, they need it right now,” Ms. Chavez said. “We’re also limited by space, and I think every facility is limited by space.”
Increasing efficiency by reducing trays
Innovative Sterilization Technologies (IST) helps ASCs improve efficiency in two ways.
EZ-TRAX™ enables ASCs to reconfigure their instrumentation into far fewer trays, which saves time in processing and readying instruments, and decreases an ASC’s costs.
Mr. Kemp notes that their process efficiency is approximately 2 hours faster and lowers cost by reducing the number of trays used. He outlined that an ASC spends about $75 per tray in processing costs.
In one example, an ASC worked with a vendor that provided 15 trays for each knee replacement procedure. By using EZ-TRAX™ this ASC was able to consolidate its instrumentation for this procedure to just four trays. While there are other similar examples, on average ASCs use EZ-TRAX™ to go from seven trays to three trays, which still yields significant time and cost savings.
The other benefit is the ONE TRAY Sealed Sterilization Container, essential for rapid turnover — sometimes saving up to 2 hours per case (depending on sterilizer and facility).
Ms. Chavez’s facility has been able to go from six trays to two trays. With fewer trays, processing time, sterilization time and storage needs have decreased.
Based on their experience, having fewer trays provides advantages for vendors — who are typically extremely hands-on and engaged — and staff members, who now have fewer trays to assemble and an easier way to assemble them.
At Ms. Chavez’s facility, not only has this shift improved efficiency, but it also improved staff satisfaction and morale. Ensuring that proper instrumentation is always prepared and ready is now more manageable. The surgeons and staff have what they need and can focus on ensuring that patients are cared for, without worrying about having the proper instrumentation.
Assessing the opportunity
As more orthopedic procedures shift to ASCs, most ASCs initially try to accommodate this volume by working harder and faster, Mr. Kemp observed. He also stressed that in conversations with leaders, that’s not a sustainable solution for long-term success. ASCs need to explore systematic ways to improve operational efficiency and organizational capacity.
Mr. Kemp has seen many ASCs start their journey to improved efficiency by undertaking a discovery process. Such a process involves looking objectively for bottlenecks and sources of in efficiency, and then exploring possible solutions. Once ASCs review their processes and analyze the issues associated with their large number of trays — and quantify the time savings, cost savings and reduced storage needs — they understand the value in migrating to a tray-reduction solution.
When evaluating potential solutions, Mr. Kemp stressed the need to account for regulatory requirements for facilities and medical device manufacturers.
Change management
Based on Ms. Chavez’s experience, the benefits of EZ-TRAX™ and ONE TRAY® are significant. Her facility is using fewer trays and saving time and money. The instruments are sterile, ready and easier for everyone involved.
In migrating to these solutions, the most significant challenge experienced wasn’t technological, financial or operational — it was overcoming the organizational inertia related to changing to a new, unfamiliar process.
Ms. Chavez acknowledged that for ASCs with a high volume of orthopedic procedures, making any process change can feel uncomfortable. Still, she encouraged ASCs to start small — for example, by trying one orthopedic medical device vendor. Once they see the reduction in trays along with the time and storage savings, she predicted, they’ll be on board.
Mr. Kemp’s experience supports this. “Most of our customers who adopt ONE TRAY® and EZ-TRAX™ save over 3 hours between the washer, disinfector, all the way through to delivery to the OR,” he said.
Both encouraged ASC leaders to embrace change even if it initially feels uncomfortable — because doing so can improve patient outcomes, efficiency and staff satisfaction.
“ONE TRAY has really been a huge advantage to us,” Ms. Chavez said. “It creates an efficient flow to have reduced the number of trays, and we are ready to go for all of our facility’s cases.”
