The Problem
Operating rooms (ORs) generate both the largest revenue and incur the greatest cost for the hospital. Their efficiency is essential to providing a high level of care at an affordable cost to the patient. Unfortunately, an estimated 78 – 87 percent of instruments in the OR go unused, introducing unnecessary costs in the form of cleaning and processing, delayed surgical operations due to supply mismanagement, increased workload of nursing assistants, and increased instrument wear [1]. For every operation, a balance exists between adequate supply and oversupply. Because the data to describe what instruments are important to an operation does not yet exist, hospitals have erred on the side of oversupply at a significant detriment to efficiency in both cost and time. This is a well-recognized problem; quality improvement studies focusing on instrument supply reduction have been published by multiple institutions [2-10]. Despite the success of these exercises, the implementation effort required across surgical teams retracts from the corresponding cost savings. More efficient methods for gathering instrument usage data are required to enable hospital administrators in maximizing efficiency while ensuring the efficacy of surgical operations. The focus of this DIHI-funded project was to develop and test a proof-of-concept RFID system that could be integrated into the OR to measure instrument usage autonomously.
Our Solution
The principal design criterion was to gather data without impacting existing OR workflows. During an operation, tagged instruments enter the field of view of antennas focused on the surgical site. This data is analyzed and compiled into a list of used instruments. The system identified a possible supply reduction of 46% in craniotomy for tumor operations and 66% in CMC arthroplasties. In order to quantify how many surgeries are necessary before an accurate master list is identified, we calculated the number of instruments added to the master list for each of the last four craniotomy for tumor operations and the last eight CMC arthroplasties. These are plotted in Figure 1. As expected, the number of instruments added to the master list decays with each follow-on surgery. Although there is not enough clinical use data to define the number of surgeries necessary to predict an accurate preference card, the addition of instruments decays to within one new instrument per surgery in both surgery types before 10 surgeries are monitored.
Impact
The RFID system has outlined the need for supply optimization in neurosurgery, orthopedics, plastics, and urology. It has been shown to accurately gather the data required to improve supply efficiency. An average 55% reduction can be achieved and leveraged to significantly reduce the cost of operations for health systems. This project exclusively supported the research of 1 PhD student in engineering and provided research opportunities for 4 medical students. Two publications are currently being drafted, one describing the design and testing of the system, the second analyzing the clinical data gathered. The concept of instrument tracking with RFID has garnered significant interest across the DUHS community as a result of this project. Follow-on investment from Innovation Jam stakeholders was secured, and studies are currently in design targeting the reorganization of common instrument trays between surgeons based on RFID-gathered data and expansion into transplant surgeries. A company (Mente, Inc) was formed to translate the technology and a license for the technology is currently in negotiation. The team continues to work towards securing further follow-on funding to support the design effort required to scale the technology throughout the Duke Hospital System.
References
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