At one hospital in the US, sterile processing was such an issue, the facility’s leadership decided to cut the number of surgical cases for a month just to work on improving it. They took the smart step of engaging with Sullivan Healthcare Consulting.
The facility also services 30 outside clinics. The average surgical volume was 25 to 40 procedures a day, with an average instrument reprocessing volume of 250 to 450 sets per day. The challenges were great. The biggest issue was experience of the sterile processing department versus the volume of instruments to be processed. That’s not unique to this facility. “The SPD was neglected,” one consultant said. “People tend to forget how critical that department is. As ORs expand, not all SPDs expand with them.” Sullivan’s consultants – including one who is a former OR nurse, perioperative manager and SPD manager – started identifying specific stumbling blocks.
In the area of staffing, only about half the staff had experience, and even those who did didn’t have current experience. Most staff had gone through on-the-job training that veered away from best practices. Hiring – or even identifying – staff with relevant experience was very difficult.
In the area of assembly, the staging process for instruments waiting for assembly and sterilization was unorganized and unstructured. Instruments were missing from trays or were in the wrong trays. Sometimes instruments were not documented properly or were not tracked as they should have been. There weren’t enough instruments and trays in inventory for the surgical volume. The instrument reprocessing volume overwhelmed assembly workstations. There were not enough stations to handle the job. These issues often led to frustration, particularly among surgeons.
In the area of instrument tracking, the program was dated and Tracking plans were only partially implemented.
In the area of interdepartmental communication, Collaboration was poor. The relationship between the OR and the SPD was almost non-existent. Each side blamed the other for inadequacies, because neither knew what the other side did. Different names for the same items stoked confusion in the department.
Seeing the issues enumerated, it’s no surprise the facility dialed back the surgical cases for a month to make improvements. That’s where Sullivan Healthcare Consulting came in.
First, staff was trained to align with current standards. That took people. Sullivan increased the number of personnel who help with hiring and training, and built upon that by improving the education involved in the training and orientation processes. Staff members were empowered through this education. In growing more knowledgeable about their responsibilities, the SPD staff became professionals, instead of merely workers. An SPD educator position was created and filled. In-services were documented and tracked. Annual competencies were developed, so the team would know expectations and be held accountable.
Then, from assembly stations to workflow, the entire department was restructured. Six new standardized assembly workstations were created with better tools, including access to manufacturer instructions to maintain effectiveness and high standards. Time to reprocess instruments was extended as necessary, when cases requiring the same low-inventory instrument sets were booked back-to-back. Tray inventory was increased, and reasons immediate-use steam sterilization was performed were identified, to make turnover of instrumentation more manageable. The rate of IUSS decreased from 18.4 percent to 3.5 percent in nine months. Metrics regarding set and sterilizer volumes and errors were collected monthly and examined. Corrective actions were taken when warranted. The patient error rate fell from 16.5 percent to 3.6 percent in 10 months. Case starts were improved when the supply distribution was reorganized. Now, a central supply department delivers sterile instruments to in-house clinics; a courier picks up instruments at the department every morning.
Two key personnel additions have made a tremendous difference: a new SPD manager – an OR nurse who was trained by Sullivan in sterile processing – meets with surgeons to discuss challenges and to identify areas for sustained improvement. And a new instrument tracking coordinator handles the whole tracking program, including monitoring quality assurance, keeping the system updated with information and new sets, instrument repairs and updates. The coordinator’s focus on these tasks allows supervisors to concentrate on daily patient flow. In addition, new tools and resources – which were sorely needed – have been added to help staff do their jobs better.
The days of walking into the department and seeing a myriad of instruments waiting for assembly are gone. Now, the instrument racks have only a minimal number of sets to be assembled and sterilized each morning. “When we left,” the Sullivan consultant said, “they were starting to develop a sense of ownership.”
Perhaps most important, before Sullivan came to this facility, crisis management was part of the everyday routine. Now, it’s almost unheard of. “We could not have done this without the support of the senior leadership,” Sullivan’s consultant said.