Missing Instrumentation in Surgical Sets Final Presentation: December 13, 2016 Team 2 Team Clients Coordinators Jacob Homan Jania Torreblanca Matt Claysen Ivana Kosir -Manager, CSPD -Industrial Engineer, OR Timothy O’Neill Kerstin Rider Nicole Farquhar Conner VanDevelde -Supervisor, OR

Agenda Introduction Background Current Process Key Issues Methodology Findings & Conclusions Recommendations

Identify root cause of missing, extra or incorrect instrumentation Introduction Surgical sets have missing, extra or incorrect instruments Central Sterile Processing Department (CSPD) Operating Rooms (OR) GOAL Identify root cause of missing, extra or incorrect instrumentation OBJECTIVES Improve CSPD assembly process Reduce number of incorrect surgical sets Reduce search time for missing instruments Increase data reporting rate

16K+ instruments assembled per day Background 32 operating rooms 20K+ cases per year 16K+ instruments assembled per day We’ve already laid out the problem- the background could now go into how we want to approach it. We can also add numerical values We can make it visually appealing by using bubbles or some form of table- Ivana can do it, but I just want to have the final count of how much info we want to talk about here. $1.03M in instrument costs

Current Process OR runner searches for missing instrument OR OR opens instrument set OR uses instruments CSPD

Current Process OR runner searches for missing instrument OR OR opens instrument set OR returns instruments into the set OR uses instruments CSPD CSPD sends instrument sets through decontamination

Current Process OR OR runner searches for missing instrument OR opens instrument set OR returns instruments into the set OR stores instrument sets OR uses instruments CSPD CSPD searches for missing instruments CSPD sends instrument sets through decontamination CSPD sends instruments set through Sterilization CSPD assembles the instrument sets

Decreased Satisfaction Key Issues Missing Instruments Patient Safety Decreased Satisfaction Resources Wasted Satisfaction of Three Department Staffs & Physicians OR CSPD Supply Chain

Observations and Interviews Methodology Observations and Interviews Literature Search 25 hours of observations 15 Interviews 2 previous IOE teams 6 Detroit News articles about Detroit Medical Center

Data Collection and Analysis Methodology Data Collection and Analysis Surveys 12 hours of audits 75 cases analyzed 36 responses from CSPD 65 responses from OR

Marshmallow spaghetti tower Methodology In-service Pilot Two truths and a lie Marshmallow spaghetti tower Initial findings

Findings and Conclusions

Lack of Understanding between Departments Interdepartmental Relations Lack of Understanding between Departments Errors attributed to other department Both departments contribute to issue CSPD OR Grand Total Incorrect Cases 8 16 24 Total Cases 34 41 75 Error Rate 24% 39% 32% Source: November Audit Data (N = 75)

Lack of Understanding between Departments Interdepartmental Relations Lack of Understanding between Departments Source: Provided Qualtrics Data (N = 403)

Lack of Understanding between Departments Interdepartmental Relations Lack of Understanding between Departments Drop-off of reporting due to policy misunderstanding OR does not want CSPD to get disciplined CSPD is trying to meet quotas

Interdepartmental Relations Maintenance Increase procedural integrity, communication, and data reporting to reduce incorrect surgical sets Increase positive interaction between departments Team Building More buy-in to policies Restate Departmental Policies

Unstandardized Search Process Source: CSPD survey data (N = 30)

Unstandardized Search Process Search Area Benefit Problem Ask another processor -Other processors have more experience and knowledge -Tough to know who to ask -Processors are low on time Check other instrument sets -Instruments are mixed during surgery -Missing instruments are likely in sets that were used concurrently -No way to track which sets were used together

Standard CSPD Search Process Unstandardized Search Process Standard CSPD Search Process Reduce search time & improve CSPD assembly process Provide guidance on shifts without service leads Subject Matter Expert Help find instrument sets used together External Surgical Set Marker

Communication Breakdown Manufacturer names Confuses nurses and processors No substitutes More incorrect instruments

Communication Breakdown Are you able to identify instruments using the manufacturer name? Source: CSPD survey data (N = 30) OR survey data (N = 60)

Common Name & Allowable Substitutes Committee Communication Breakdown Common Name & Allowable Substitutes Committee Improve CSPD assembly and OR return processes Provide useful name for OR staff Common Names Fill gap between OR and CSPD Allowable Substitutes

Valuable Information Lost on Count Sheets Decontamination Count Sheet Valuable Information Lost on Count Sheets OR Notes added on count sheet Non-vital information Decontamination Count sheets thrown out Information lost CSPD May miss small mistakes Re-identify already known issues

Decontamination Count Sheets Improve CSPD assembly process Notes written in permanent marker Stored in bin in OR Short Term: Tags Populate notes when set is scanned Preferably through Censitrac Long Term: Electronic

Expected Impact CSPD OR Yearly Lower Upper Current Productivity Loss $175K $400K $25K $350K Future Productivity Loss $133K $320K $13K $264K Savings $42K $80K $12K $86K Total Savings $54K - $166K Findings based on CSPD survey data (N = 35) , OR survey data (N = 61) and salary data

Expected Impact Qualitative improvements Improving Interdepartmental Relations Reduces the number of incorrect surgical sets Standardizing Search Process Reduces the time spent searching for instruments Qualitative improvements Happier, and more productive workforce Improved patient safety Reduces the number of incorrect surgical sets SMEs, Common Name, Decontamination Count Sheets Improves the CSPD assembly process

Thank You! Questions?

Expected Impact CSPD1 OR Lower Upper Lower2 Upper3 Current Productivity Loss $175,000 $400,000 $25,000 $350,000 Future Productivity Loss $133,000 $320,000 $13,000 $264,000 Savings $42,000 $80,000 $12,000 $86,000 Findings based on CSPD survey data (N = 35) , OR survey data(N = 61) and salary data Assumed 10% reduction in search time and 1 less expected incorrect surgical set Assumed 0% reduction in search time and 0.5 less expected incorrect surgical set Assumed 0% reduction in search time and 1 less expected incorrect surgical set

Project Scope In-Scope Out-of-Scope Sets missing instruments Sets marked incomplete Inventory flow in OR Clinic sets Quick turnaround & main CSPD Loaner sets Set transportation between floors Surgitech sets Search process for missing instrument Implantables Cleaning, packaging, and sterilization