From paper trail to patient care

Hospitals should take care of patients, not paper.

For many hospitals, however, the manual processes involved in managing the inventory of instruments and tracking them through sterilization cycles are prone to error and can lead to cross-infections.

Bent on improving patient care and minimizing the risk of infection, The Ottawa Hospital (TOH) implemented an instrument tracking system dubbed, Alex Gold, to automate its processes across its three campuses, says Lynne Trott, director of logistical services at TOH. Indiana-based software firm TGX Medical Systems Inc developed the system.

In the past, instrument tracking was done manually on sheets and binders, explains Trott. Inaccuracies resulted from reliance on time-pressured hospital staff to maintain records that are often not updated on a regular basis, even as new instruments were brought in.

Requests by the OR department to locate instruments used on a specific patient meant spending a lot of time chasing the paper trail.

Sterilization technicians typically assemble sets of instruments on a tray based on the type of procedure being performed on patients. Once used, the instruments are sent to a decontamination area to be cleaned, sterilized, reassembled into sets, and then sent to sterile storage areas for reuse.

Lack of integrated information was a major issue. “We couldn’t guarantee we had accurate information on which tray was used for a specific patient. With Alex, we can now tie that to patient information,” says Trott.

The implementation project required a great deal of initial effort. It took about a year to fully implement the system across TOH’s three campuses, says Trott. The hospital needed to do a full inventory of instruments first, then load this information onto the database, along with cleaning and sterilization instructions for each instrument – a major task, as there are thousands of manufacturers with different instructions.

The instruments also needed to be bar-coded - with special strips that can withstand the heat and chemicals of sterilization - so they could be scanned and recorded within the system at every step of the cycle.

Last but not least, TOH needed to develop and execute a training program for 150 sterilization technicians.

TOH’s implementation was unique, as it was one of the first multi-site implementations of the system. But the average installation requires about two months, says Michael Good, CEO of TGX Medical Systems. “We did a lot of custom work at TOH beyond what’s in the packaged product, and we also did some design changes internally,” he says.

Alex was worth the effort, says Trott, as the ability to manage inventory and costs of instrumentation is important. “In the past, hospitals have not been able to manage that as an asset. In most cases, they don’t know the total inventory or the total dollar value of instruments. There’s no tool for budgeting or tracking maintenance costs.”

The system offers other benefits, such as information that is readily available right on the technicians' workstations. “In decontamination areas, technicians are totally masked, gloved and booted, so they can’t open up a book to find out what they’re supposed to do. They need extensive training, but that requirement drops dramatically with Alex,” says Kay Lee, manager of instrument systems for the Codman division of Johnson & Johnson, the Canadian distributor of the system.

Alex also offers the hospital the capability of tracking the number of times a set of instruments have gone through the cycle. “It flags a set when the cycles are complete so we can send the instruments out for maintenance. That’s something we never had the ability to do before,” says Trott.

The hospital had no tool in the past to look at the actual volume of items being processed, and the time and labour costs associated with that, she says. TOH can now determine if staffing is appropriate based on actual information, instead of estimates.

TOH has seen a decrease in errors in the processing of instruments, although the system was only implemented recently, says Trott. “We’re just starting to quantify that, thanks to Alex’s reporting tools.”

The system can also help hospitals share concrete information about best practices. “Going forward, there’s great interest in sharing this type of information so we can do some benchmarking and increase the pool of knowledge across Canada,” says Trott. “This is a huge step forward, as we weren’t in a position to move this to the next level until we had the tools to do so.”