pencil. We're now down to 1 pack. Once we did our first few cases,
we modified the packs accordingly, adding or removing items as
appropriate. Our rule-of-thumb that guides us to this day: If we use an
item more than 60% of the time, it stays in the custom pack.
We soon found out which items we were routinely wasting and were
able to prune our packs, one item at a time. Take dressings, for exam-
ple. One of our surgeons was using 2 Ace bandages, another was
using just 1. We had 2 Ace bandages in our packs, so we were just as
often throwing 1 out as using it. So we removed 1 Ace bandage from
our packs and pulled a second one separately for the surgeon who
prefers to double up on dressings. (Note: This surgeon uses the sec-
ond Ace bandage in a non-sterile fashion, so it's not necessary to keep
it in a sterile pack.)
