Surgical instrumentation management can be problematic for a number of reasons. First, you must have the time to remove instruments from circulation. Instruments are often in short supply, so this can be difficult. Second, you must have the time to identify instruments in need of repair, other than when your customer (e.g., the OR) identifies an issue. Third, you must have a process to repair instruments that are not functioning up to par.
Scheduling Instruments for Repair
To say the least, the best-laid plans often are not enough when scheduling instruments for repair. Add-on cases, poorly designed instrument pick tickets, poor location tracking can and will throw a wrench into the process. I am sure you can come up with several other reasons. It is almost too obvious to say that you need to schedule repairs when the instruments aren't being used. This may include using weekends for repair issues. While most repair companies prefer not to come in on weekends or charge extra, it is still an option worth exploring and negotiating for it in your repair contract. Having weekend service or any service at all can create an additional staffing requirement. The volume of instrument sets needing decontamination and assembly often goes up when the repair truck shows up. You may need extra staff to help cover the increased volume. Ideally, plan instruments set repairs around usage schedules like OR block times for surgical specialties. Increasing the days the repair vendor is onsite can also help spread the volume and instrument tray usage, allowing for more trays to be captured by the repair technician.
Identifying Instruments for Repair
As I alluded to initially, you do not want to wait for your customer to identify performance issues with their surgical instruments. Poorly performing instruments can not only be a patient safety risk; it too can be a risk to the user. All instruments should be inspected for flaws and damage. Some specialty instruments call for extra attention (e.g., scissors, osteotomes, gouges, laparoscopic instruments, drills). As a best practice, you have to design instrument inspection into the staff's work practice and the productivity metrics of each tray being reprocessed. You also have to purchase the correct supplies for the technicians to use during the inspection process.
Instrument Repair Process
It is not enough to have your vendor show up onsite. You must have a well-designed plan for repairing the instruments. As previously stated, scheduling can have its pitfalls. That doesn't mean that you shouldn't have a plan. Preferably, your plan should be a proactive plan where instrument needs are met before issues arise. One way of doing this is to design a plan around usage. If tracking usage is difficult for your team, you will have to settle for a time-based plan. Usage is just as it is stated, and instrument sets are pulled based on the number of times they are used. It would be best if you worked with your repair vendor to set up usage metrics. However, the metrics should be continually monitored and discussed with your end-users. You may even find that some specialty instruments within the instrument sets need additional tracking and increased inspection. Using a use-based approach helps with the distribution of instrument sets by having only the most often used sets in need of review. Contrarily, time-based usage instrument repair is a systematic approach based on scheduled time intervals. Utilizing this approach can often have your repair vendor inspecting instrument sets with low utilization, which is not a good use of your time or theirs. One recommendation with this approach is to spread set types over multiple review points to not have all of one set type in need of review at the same time. A time-based repair process also puts more emphasis on managing instrument utilization with a first-in-first-out process.
In Conclusion,
Having surgical instrumentation in ill repair increases the risk to the patient, end-user, and facility. Lawsuits have been filed because of patient injuries due to faulty instrument care. The cost of repairing instruments far outweighs the dollars associated with lawsuits, the loss of your facility's reputation, and the loss of OR cases when injuries occur during surgery.