Surgery requires infrastructure
Numerous resources must be made available from various warehouses: Anesthetics, blood for transfusions if necessary, saline, further sterile goods including disposable materials such as sutures, canullas and infusion tubes.On the other hand, that also includes the sterilized reusable surgical instruments and surgical equipment assembled in surgical sets. If, for example, implants are still used, there are usually several of them in different sizes during the operation. All this must be provided, should be in the right place at the right time. This applies not only to elective procedures, where it is possible to estimate roughly what resources will be needed, but also to procedures that cannot be postponed in the course of emergency care. Before the surgeons start with their core tasks, a lot has to be coordinated.
Heterogeneous system landscapes
To date, we have mostly had to deal with completely different system landscapes in hospitals – this is where the problems begin. On the one hand, you have OR management, which is responsible for the occupancy of the operating rooms. In addition, you have material management, which manages the necessary resources. This includes disposables and reprocessed, sterilized instruments. And finally, you have medical controlling – the medical and cost-related documentation of what was done on the patients. All these individual processes run on their own systems and are effective, but they function like separate silos: there is little or no communication across the board. This results in a considerable expenditure of personnel and time; there are large redundancies and consequently long waiting times and, above all, high running costs, which impair the economic efficiency of OR management.
Hardly any digital communication
When it comes to the lack of digitalization, there are two weak points in particular: the pre- and post-processing of an operation. Both are still mainly run manually today. Prior to an operation, the sterile material must be prepared. It is ordered via telephone calls or even with the help of fax machines. Standardized surgical sets are then often used. About 120 instruments are located in the instrument baskets provided for this purpose. Even if only half of these are used, all instruments must be decontaminated right after surgery. This should be done as quickly as possible: Reusable surgical material wears out quickly because the chloride contained in the blood attacks the surfaces. However, the central sterile services department (CSSD), which is responsible for reprocessing contaminated goods, often does not know when an operation is finished. As a result, the instrument baskets on the trolleys waiting to be decommissioned end up sitting in the corridors of the operating wing for hours.
Load peaks at the wrong time
The decontamination of used – or unused, but on the same cart – instruments, is a very laborious process. Through various processes such as washing and heating, microorganisms are inactivated. This very personnel-intensive process is still usually carried out manually and completely analogously – in many hospitals, the trolleys to be decontaminated are labeled with sticky notes. Since elective surgery occupancy usually ends around 6 PM, the peak loads in the CSSD fall during the night. This results in tedious night shifts for staff and expensive night shifts for the clinic.
The analog, poorly synchronized, mostly manual processes around the surgical infrastructure are still standard in most hospitals worldwide. The impact is immense: In a large German university hospital, about 40 faxes per day are exchanged between the OR, the materials warehouse, and the CSSD; in total, there are about 14,600 manual interactions between these entities per year. The business unit manager in the operating room spends about 45 minutes every evening after the actual end of the working day on inventory correction postings. At a university hospital in the Netherlands, 81 percent of reprocessed surgical sets are not used within the following 24 hours – causing unnecessarily high stress levels among staff, which in turn encourages errors. The situation in many hospitals in the USA is similarly inefficient. Here, wasted surgical resources accrue per year on just one university campus at a cost of about $6.1 million – an environmental grievance as well. The actual value creation – operating – is unnecessarily complicated in this way. Contemporary digital communication can remedy this situation.
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