Tuesday, October 25, 2016

12:04 AM
By Sally Parker

Abraham (Avi) Seidmann, Greg Dobson, and Vera Tilson
Operating rooms are some of the most expensive areas in acute care delivery at most hospitals. For successful operations, they rely on the timely delivery of the appropriate sterile surgical instruments for each procedure on hand—and that’s where the expense becomes a significant factor.

Preparing those instruments for even routine surgeries is a complex and time-consuming task. The hospital materials management department sterilizes, stores, and delivers to the operating room trays that contain multiple instruments packaged specifically for the way each surgeon performs an assigned procedure. After surgery, the instruments are washed, packaged back in various specialty trays, sterilized, and returned to storage. While surgical instruments are one of the largest expense inventories in the hospital in terms of number of items, cost of initial investment, and cost of ownership, they are managed by various ad hoc methods—meaning it’s hard to realize any savings.

Simon professors Greg Dobson, Vera Tilson, and Abraham (Avi) Seidmann recently tackled the problem with co-author and surgeon Anthony Froix, MD, ’12S (MS), ’13S (MBA) (not pictured). In “Configuring Surgical Instrument Trays to Reduce Costs,” published in IIE Transactions on Healthcare Systems Engineering, they looked at how trays should be configured, from the size of the pan in which the tools are sterilized to the types and number of instrument sets needed for each procedure.

They discovered that the hospital sterile processing department (SPD) and surgeons could have competing goals. SPD managers want to limit the costs of owning, maintaining, and using trays and instruments; for example, they might prefer to provide one tray with instruments for multiple surgeons who perform identical or similar procedures. Surgeons, on the other hand, prefer trays packaged only with the instruments they might use in a surgery, since the presence of extra instruments causes staff confusion and complicates the mandatory post-surgical counting done to make sure that no instrument is left behind within a hidden body cavity.

The number of decision variables and constraints grows exponentially with the number of possible surgeon-procedure pairs. “It’s an extremely hard problem to solve. The size of the problem is astronomical,” Dobson says. Prior studies looking at that problem failed to develop useful methodologies that can tackle the above complexity faced by a real-life-surgery rooms’ problem. For this research, Tilson designed an efficient optimization algorithm that best configures how instruments should be delivered for surgical use. Initial analyses with hospital data show significant savings compared with current practice.

Obtaining data from busy surgeons remains the biggest hurdle for future work in this area, Dobson says. Still, co-author Seidmann is confident that “over time, our research results and methodology have the potential to change the way surgery rooms and instrument management systems are designed and implemented in almost all hospitals around the world.”

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