1. GARBOLOGY IN THE OR Final Presentation April 18, 2017 IOE481 Team 12
. Andrew Fountain Kim Kellman Colin Pitawanakwat
Kathryn Zebus
Final Presentation April 18, 2017

2. Agenda Introduction Background Methods Findings & Conclusions
Recommendations

3. 1.
INTRODUCTION
Kim

4. Support Team Clients Coordinator
Steve Harrington- OR Informatics Manager
Nick Martin - Supply Chain Manager
Coordinator
Josh Pigula - Financial Analyst

5. gar bol o gy
noun
the study of a community or culture by analyzing its waste

6. 2.
BACKGROUND
KIm

7. Current Process Service Lead prepares DPC
Circulating RN records item usage during case
Perioperative Tech stocks cart for case
Unused supplies returned

8. Current Process Service Lead prepares DPC
Perioperative Tech stocks cart for case
Circulating RN records item usage during case
Unused supplies returned
Planned
Trashed
Documented

9. Key Issues Overstocking Shortages Billing
Excess of inventory causing expired supplies
Shortages
Items used and not documented are then missing from inventory
Billing
Inaccurate billing to patients due to inaccurate documentation
Kim End

10. To deliver accuracy metrics on planned vs documented vs trashed
Goals & Objectives
To deliver accuracy metrics on planned vs documented vs trashed
Observe a case in the OR
Perform Analysis
Kathryn -
Collect wrapper waste
Catalogue the trash

11. 3.
METHODS

12. Project Scope In Scope: Focus on UH OR: 4, 13, 17, 31, 33
Focus on Mott:
OR: 5, 6, 9, 10, 19
Out of Scope:
OR’s outside of UH and Mott
Implants and Davinci
Problems related to billing, staffing, sterilizing

13. February 20 - March 10 Collected from 10 ORs Catalogued by the team
3 weeks
February 20 - March 10
113 bags
Collected from 10 ORs
4,498 wrappers
Catalogued by the team

14. Planned vs Documented vs Trashed
DPC Accuracy
Documentation Accuracy
Difference between Planned and Trashed
Differences between Documented and Trashed

15. Data Stratification
By Room
By Item
Kathryn
By Service
By Site

16. 4. FINDINGS & CONCLUSIONS
Colin: 16-27

17. Overview DPC Accuracy Documentation Accuracy
DPC - Documentation Accuracy Correlation
Cost Analysis

18. DPC Accuracy % Trash on DPC (69.5%) 10 Returned items per case
13 Additional items per case
Include Pareto Chart at the end
7700 hrs getting items/year

19. Documentation Accuracy
Missing from Trash Avg Qty: 15
Undocumented Avg Qty: 7
Include Pareto Chart at the end

20. Distribution of Documented Items that were Not Found in Trash
Missing from Trash
Distribution of Documented Items that were Not Found in Trash
(N = 113, Mean = 23.29)

21. Impact of over-documenting
15 items
540,000 items/yr
Missing from trash each case
inventory issues
Scaled by ~36, cases/yr
$ 25,000
$8 M
during 3 weeks
annually

22. Impact of undocumented items
260,000 items/yr
Undocumented each case
inventory issues
Scaled by ~36, cases/yr
$ 8,000
$2.6 M
during 3 weeks
annually

23. Undocumented Quantities
Undocumented Quantities per Case
(N = 113, Mean = 7.22)

24. Undocumented By Site Undocumented Quantities per Case by Hospital Site
While this study could have inaccuracy because of small sample size, it does appear that there is no significance between site, service or room.
(UH: N = 78, Mean = 9.6 and Mott: N = 35, Mean = 6.15)

25. DPC Accuracy Correlation
Scatterplot of % Trash on DPC vs Undocumented Quantity
Slide with each
(N = 113, Mean Missing from Trash Qty = 22, Mean % Trash on DPC = 69.52% )

26. 4.
RECOMMENDATIONS
Andrew

27. Potential Solutions $ $$ $$$ $$$$ Fix DPC Training Barcode Scanning
Aim for accuracy and edit recurring errors
Training
Increase awareness of documentation process
Barcode Scanning
It’s not barcoding that is the solution; it’s the standardized work flow.
RFID System
Most advanced tech, but most expensive.

28. Fix DPCs
Nurses are retrieving 13 additional items per case during surgery
Nurses spend 7,700 hours retrieving items each year
However, no correlation between DPC matching trash increasing accuracy of documentation

29. Training Training sessions for circulating nurses
Create awareness to improve documentation
Will increase efficiency of process and accuracy

30. Barcode Scanner
Ease of implementation - scanning already occurs in ORs
Henry Ford Health System decreased errors by 95% - believes standardization is key.
Will increase inventory accuracy

31. RFID System Pros RFID Tags Most accurate Least work in OR Cons
Example of RFID tags on
surgical supplies
RFID Tags
Cons
Most expensive
Most set-up intensive (tagging all products)

32. Expected Impact Increased accuracy of inventory
Reduction of on-hand inventory
Increased availability of circulating nurses
Special thanks to all the people who made and released these awesome resources for free:
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Improved reliability of supplies billed to patient

33. Special Thanks to Steve and Nick and their expert computer skills
Questions?
Special Thanks to Steve and Nick
and their expert computer skills