Becker's ASC Review

40 EXECUTIVE BRIEFING 1 EXECUTIVE BRIEFING Higher-acuity orthopedic procedures — such as total joint replacements of the hip, knee and shoulder — are increasingly shifting to ambulatory surgery centers as payers seek cost savings and physicians and patients embrace the convenience and effi ciency of these settings. As orthopedic case volume and complexity grow, ASC leaders are working to boost effi ciency and throughput while maintaining high-quality patient care. One major opportunity is reducing the number of surgical trays used in procedures. To learn how ASCs can streamline their surgical tray processes and the benefi ts of doing so, Becker's Healthcare spoke with Jan Chavez, a surgical technologist in Kansas, and Kyle Kemp, national director of business development at ONE TRAY®. Readiness is an ASC imperative According to Mr. Kemp, ASCs typically partner with medical device vendors that will provide the instrumentation and implants used by surgeons for a total joint replacement procedure. A few days prior to a procedure, the ASC will contact the vendor representative to ensure the delivery of instruments and implants for all upcoming procedures. The vendor then ensures these instruments and implants are onsite at the ASC. After receiving the instrumentation, the ASC processes all instruments and implants. This involves inventorying, cleaning and sterilizing each item, then conducting a second inventory. All instruments and implants are then placed in packaging systems and sterilized again. This process ensures that every instrument and implant is ready for surgery. However, ASCs face several challenges in having the right instruments ready for surgeons. Mr. Kemp observed that the process of readying all instruments for surgery can take up to fi ve hours, and in general, ASCs don't have enough washers or sterilizers to match their volume — presenting a constant challenge to prepare the quantity of instruments needed for that day's procedures. ASCs can also lack adequate space to store all of the instruments and implants needed for total joint replacements. Having worked with ASCs that are performing total joint replacements, Mr. Kemp frequently sees environments with hundreds of instrument trays, constant washing and sterilizing and continuous storage issues. Ms. Chavez's facility has eight surgical suites, all for orthopedic procedures, with two washers and four sterilizers. It is common that one surgeon will have up to 10 total joint replacement cases in one day, placing huge demands on the organization to have enough sterilized instruments ready. These pressures are amplifi ed due to limited space for washers, sterilizers and storage. Ms. Chavez explained that at her facility, upon receiving instruments from the vendor, staff members fi rst hand- wash every instrument, then put all instruments into a washer, which takes 40 to 50 minutes per cycle. Then, the instruments are placed in a packaging system and sterilized, which can take another 2 hours with cool time. In total, processing instruments at this facility can take over 3.5 hours per set. For a surgeon with 10 cases per day — with each case requiring approximately six trays — the processing and preparation challenge is immense. "I've got to fi gure out how to get trays done effi ciently. When a surgeon needs an instrument, they need it right now," Ms. Chavez said. "We're also limited by space, and I think every facility is limited by space." Less is more: Reducing surgical tray volume•to boost ASC performance

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