Improving Patient Care - Case Carts and the Operating Room

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Surgical Services

Vernon Alders
Corporate Director - Operational Excellence
Christiana Care Health System

Jim Rapier
IMA Consulting

Sterile Processing Department effectiveness can be measured operationally and clinically. While it is extremely important for Sterile Processing Departments to deliver timely and complete case carts to the OR, processes potentially affecting sterility must also be considered. Work processes and staff interdependencies have dramatic implications for patients and operational performance.

Christiana Care Health System's Perioperative Services Department has a history of dissatisfaction with internal processing of sterile instruments used in the delivery of care to patients.

A large, two-hospital health system with a combined 52 operating rooms, where more than 40,000 surgical procedures are performed annually, real and perceived failures in Sterile Processing were impacting staff and surgeon satisfaction and care to patients.

Using CCHSs internal consulting department, Operational Excellence (OE), Perioperative Services requested that a full assessment be conducted to identify the following:

- Opportunities to improve OR case cart processes - Completeness of case carts - Timeliness of case cart delivery - Quality of set processing

After conducting a current state assessment and analysis of data, OE researched best practice and formulated a future state model for OR leadership. Over 50 recommendations for improvement were identified. Major opportunities to improve performance along two dimensions include:

1) Operational Performance - Efficiency in which SPD processes sets, instruments and fills orders 2) Clinical Performance - Quality and sterility of set processing

Implementation of recommendations to date has resulted in a 73% improvement in the average number of completed case carts delivered to the OR.