The struggles of increasing inventory and more complex procedures have you searching for space & Manpower?
As we struggle to resume normal operations following the Covid-19 Pandemic, facilities are finding themselves struggling to keep up with the back log of surgical procedures. To add to this matter the fact that many hospitals have shut their doors. This has led to patients seeking care at an already overburdened neighboring healthcare facility. With the increase of procedures comes the burden of more instrumentation and inventory to support these procedures.
The CSSD Factor
While these procedure are getting scheduled the supporting instrumentation is more than likely coming into a sterile processing department that is already struggling to keep up with demands. To put this into perspective a bit, for each surgery scheduled there will be an accompanying 3 - 15 sets of instruments needing to be processed. Now take into account that each set can contain 50+/- instruments each, this amounts to a great deal of work to an already, in most cases, struggling department. The CSSD not only has to face this but 9 times out of 10, they are out of space to expand even if they wanted to. Add to this that capital is always at a premium under normal circumstances let alone on the tail of a global pandemic. Healthcare systems are searching for an answer to the ever increasing need for space. Many have taken the step outside by organizing an off-site Centralized Sterile Processing Site, which has helped a bit. However the struggles of logistical consistency has been a new hurdle they have had to overcome.
System Owned Clinics
With the ever growing need for quality CMS pushed for clinics that use reusable instrumentation follow and meet the same criteria as the hospital sterile processing department. With this edict came a new burden for the CSSD as many clinics began sending instruments in to be processed. Again this is on top of the other instrumentation and equipment that this department has to process. As this has become the normal state of work in a department already strapped for human resources, the addition of this workload can require up to 3 - 4 FTEs to manage the clinic workload over a 24 hour period. To add to this the fact that this must usually be absorbed by the current staffing model. Also this work must follow suit and be done within the same space that is already tight.
Loaner Trays
Loaner trays for those who do not know are the supporting instrumentation for total joint repairs, spine & implant procedures. This area has been a very hot topic within the CSSD world for a number of years for many different reasons.
The number of trays needed for a single case can be up to 20 trays (revision cases can exceed 50)
The complexity and difficulty to clean the instrumentation
Time it takes process
timing of logistics from the manufacturer
While these are just a few items the long and short of it is that it is a difficult subject as it affects both the manufacturer and the hospital combined. Due to the amount of time to process many hospitals have put a minimum of 48 hour prior to procedure check-in for the supporting instrumentation, as well as a 48 hour window for pick-up following. From a manufacture standpoint this is problematic as they may only have a limited inventory in the area and at a cost ranging from $50,000 to over $100,000 per set, makes it difficult to manage the usage. At current most of these sets are seeing only 1 -2 turns per week due to timing and constraints. Furthermore this is another impact on the CSSD as it struggles not only to meet the human resources to accomplish this work, but also the space in which to do this work, and once complete the space to store safely prior to the procedure. As you can see there is a recurring theme that is continuing to erupt, pun intended, as CSSD strives to meet the ever increasing demand.
ASC Factor
As we begin to come out of the pandemic patients are turning to the ambulatory surgical center (ASC) for their elective procedures. With CMS change allowing more total joints to move to the ASC has lead to a flourish of activity within these smaller organizations. As with the previous conversations space is always a concern. The majority of ASCs consist of patient prep and post op areas that serve 2 - 4 OR suites. This OR configuration is usually accompanied by a small yet functional sterile processing department. Again with the influx of procedures moving to the ASC the matter comes in around space and the ability to safely process the items needed to support the procedures. The increase of total joints moving toward the ASC does not change the need of supporting instrumentation to perform these cases, let alone the space to process and then store these items for the upcoming procedure.
Endstage
Many health systems have combined or built their own ASCs to help manage an maintain patient procedural volumes, and in some cases this means that the larger hospital sister takes on the responsibility of processing these sets and getting them back to the ASC for use. Yes this means that the same CSSD that has had to absorb the increasing procedure volumes, clinic volumes, loaner trays, and now ASC volumes, is it any wonder why CSSDs are struggling to keep up with the demands placed upon them. Healthcare facilities need to take action as I alluded to earlier, just like a volcano the pressures being placed on the CSSD is getting to the point of eruption which means setting them up to fail. This is very detrimental as it could come in the way of shortcuts taken to meet demand which could result in a lack of quality and efficiency, which could lead to a higher SSI (surgical site infection) rates. Bottom line is we are at an endstage where we need to quit practicing insanity, and start looking outside the box.
Third Party Sterilization
There has been many connotations around the use of a third party sterilization services as a viable option to help alleviate the pressures felt by the internal CSSD. The fact of having an off-site processing center or third-party partner can be just what the doctor ordered. While maintaining a consistent workflow and extensive quality control measures at every step, can provide the facility with far more transparency and tracking information than they have at present. Furthermore the movement outside of the brick and mortar hospital can help preserve and maximize the current footprint.
The Sterile Processing World is changing and we must push forward to reach new heights. Working together to seize the opportunities that lay ahead of us and maximize all resources that are at our fingertips to accomplish our goals of being instrumental in the safety of the people we serve.
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