John R. Harper MBA/HCM, CRCST, CHL, CIS; David Kelman PE
The Central Sterile Supply Department (CSSD) has always been at the heart of the healthcare facility, and like the heart itself is hidden away and sometimes taken for granted until it has a blockage or strain that makes its presence felt. Just like a blockage in a vessel in the heart from too much buildup of plaque restricting blood flow, this too can happen in CSSD.
The onset of tighter regulations facing healthcare systems and reimbursement guidelines surrounding accreditation, many healthcare systems that have acquired and integrated medical clinics were faced with some unexpected decisions. To ensure that the medical clinics comply with the same standard requirements for the sterilizing of reusable instrumentation. To comply with these standards, what was the impact to the medical clinics? The medical clinics would have to comply with AAMI ST79. This would require significant investment of time and money to revamp their sterile processing area. At a minimum, a physical separation of decontamination and sterilization/clean areas. In a majority of the cases this meant upgrading sterilization equipment (as from my own experience), the equipment was out of compliance. Staff retraining and documentation to ensure that the staff follow the standard requirements of procedures, daily testing, and proper function of equipment with its coinciding documentation and record retention. As these investments would have to be repeated for each medical clinic acquired and integrated into the healthcare system, the easy solution was to utilize and tap the existing resource space that was already in compliance with the standards and requirements of ST79, the healthcare systems hospital Central Sterile Supply Department.
Initially when healthcare systems acquired medical clinics, this started out as a small influx of instruments which was manageable, but as more and more medical clinics were added to a healthcare system this became a growing issue. CSSD’s mission has been supporting the operating room surgical instruments, ER, Labor and Delivery, and other hospital based departments. As the strategic direction of the healthcare system has been to incorporate a significant network of medical clinics under their umbrella, and the CSSD having to expand its mission to sterilize all instrumentation for the healthcare system . But as the push to maintain standardization, which now includes the clinics within the system, the focus was to have a hospital based CSSD take on this workload. Again, just like a bit of plaque in an artery, instruments started building up in CSSD. The main issue of this concern again comes down to a workload being able to be sustained and meet the needs of the departments it serves.
The influx of medical clinic volumes coming into CSSD has caused an issue to arise, which lies in the flow of work. Meaning that in some cases medical clinic instrumentation requires nearly 15% - 30% of the CSSD staffing resources to process. The result is a flow blockage, not just for the medical clinics, but all departments that require sterilized instrumentation from the CSSD. This becomes a very real issue as CSSD leaders are forced to reprioritize the workload. Which in most cases means playing fire fighter and focusing work on a more immediate basis due to low staffing resources and other urgent emergent workloads, which causes an inability to plan and operate efficient operations of the CSSD.
The onset of adding the medical clinics to the healthcare system was not a significant impact, but just like eating fast food, the ill effects creep in and can cause quite a bit of turmoil in the way of poor quality, missing instruments, and even delayed or canceled cases due to sterilization issues.
It is time for healthcare to evolve and realize that there are other ways to vent this pressure. Just like a stent in a vessel, an outsourcing alternative or dare I say and “ALLY”, can help bypass the overburdened department, and allow the focus to go back to its core business of servicing the operating room.
Conclusion
Almost all healthcare facilities across the country are facing similar issues, whether it be from medical clinic instrumentation, an influx of vendor loaner sets, or continued surgical procedural increases. The bottom line is the fact that this increase in instrumentation volume workload was not anticipated and continues to be a blockage of flow through the department. Once the industry realizes that quality and efficiency can be achieved outside the healthcare systems’ brick and mortar, there can be a great advancement in safety and quality for all the providers that utilize reusable instrumentation.
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