We also eliminated suction tubing from our packs, and we reduced
the number of lap sponges from 20 to 15 (most patients are under a
tourniquet, so we didn't need that many). When you remove items
from your packs, you have to sit down with your doctors and con-
vince them to give the change a chance, and then clearly communi-
cate the changes to your nurses. You also need to keep preferences
cards current to reflect items eliminated from packs that will need to
be picked separately.
About 80% of the contents of our packs are standard. The rest we
call "idiosyncrasies" — items specific to each doctor that we pull sep-
arately, including suture, saw blades and surgical blades (some like
them bigger, some like them smaller).
The benefit of streamlined packs is huge. Not only will it decrease
the amount of inventory and storage space you need, but it'll also
lessen the amount of waste you produce — once you open something,
you have to throw it out — and the time it takes for your nurses to
pick for cases.
We also streamlined the number of instruments that we use in a
case. It's been said that a typical total joint case has an average of 120
items on a preference card. We got ours down into the 80s by stan-
dardizing what our docs use and keeping our surgeons' preference
cards accurate and up to date.
We took our instrument trays down to a minimum as well. A typical
total knee set contains about 8 instrument trays. Working with our
vendors and docs, we were able to bring that down to 4. We simply
eliminated those instruments that our docs didn't use. When you drill
down deeply enough into your sets, your surgeons will say, "I don't
really use it" or "I know it's on my tray, but I don't really need it."
Our central sterilization department also benefited from us having
fewer instruments on fewer trays. Not only did they have fewer items
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