4 2 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • J A N U A R Y 2 0 1 6
• Initiate all blocks and store patient beds
outside of the operating room.
• Develop custom packs to include sterile
supplies, non-sterile cleanup kit and
anesthesia set-up kit.
• Standardize positioning, prepping and
draping based upon the surgical
approach and procedural level to be performed by team.
• Team turns over their own rooms, and the circulator moves sets to the dirty cart throughout
the case, a "clean-as-you-go" approach.
• Develop "swing," "flip" or "double occupancy" criteria, including the timing of when to initi-
ate block for next case and skin-closure routine by physician assistant, nurse practitioner or
private scrub.
• Prepare case carts the day before surgery and insist that vendors bring in loaner sets 24
hours before the case day. Reserve dedicated vendor space near central sterile for vendors
to put together loaner sets that they bring in.
• Develop a formalized communication process for patient flow issues (Nextel phones).
• So you don't tie up your capital in inventory, let vendors place their implants and instrument
sets on your shelves. This is known as consignment inventory.
• Develop total joint sets with the minimal number of instruments to facilitate setup and
turnover (2.5 hours). The average TJR set includes more than 100 instruments, yet it's not
uncommon to use less than half. For example, there are 8 to 12 osteotomes in a set, yet we
only use 2 curved and 2 straight osteotomes.
• Monitor and decrease flash sterilization rate by acquiring adequate numbers of instrument
sets to match case volumes. Transition from blue wraps to caskets for instrumentation.
— Mark Gittins, DO
Dr. Gittins (mgittins@msn.com) is an orthopedic surgeon at New Albany (Ohio) Surgery Center.
10 Tips for Total Joint Efficiency
PRACTICAL PEARLS
