Streamlining surgical trays for common pediatric urology Procedures: A quality improvement initiative. Issue 4 (August 2022)

• Record Type: Journal Article
• Authors: Shaw, Allison; Chan, Yvonne Y.; Arora, Hans C.; Aguilar, Jazmina B.; Schechter, Jamie; Gong, Edward M.; Chu, David I.; Yerkes, Elizabeth B.; Matoka, Derek J.; Seager, Catherine M.; Bowen, Diana K.; Lindgren, Bruce W.; Liu, Dennis B.; Maizels, Max; Cheng, Earl Y.; Johnson, Emilie K.
• Is Part Of: Journal of pediatric urology. Volume 18:Issue 4(2022)
• Page Start: 412.e1
• Page End: 412.e7
• Publication Date: 2022-08
• Subjects: Operating rooms -- Pediatrics -- Cost savings -- Instrumentation -- Quality improvement; DMAIC Define, Measure, Analyze, Improve, Control -- GPT Groin-Penis Tray -- GU Genitourinary -- QI Quality Improvement -- OR Operating Room -- PRN Pro Re Nata; Pediatric urology -- Periodicals; Urologic Diseases -- Periodicals; Urogenital Diseases -- Periodicals; Urologic Surgical Procedures -- Periodicals; Child; Infant; Urologie pédiatrique -- Périodiques; Appareil urinaire -- Maladies -- Périodiques; Pédiatrie; Urologie; Pediatric urology; Périodique électronique (Descripteur de forme); Ressource Internet (Descripteur de forme); Electronic journals; Periodicals; Electronic journals; 618.926
• DOI: 10.1016/j.jpurol.2022.06.023
• Languages: English
• ISSNs: 1477-5131

Abstract

Summary: Introduction: Procedures involving the external genitalia are the most common pediatric urologic operations. Our group identified excess instrumentation for these cases to be a potential cause of operating room (OR) inefficiency at our large, freestanding pediatric hospital. This quality improvement (QI) initiative aimed to streamline surgical instrumentation for the most-performed pediatric urologic procedures at our hospital. Material and methods: Six Sigma DMAIC methodology (Define, Measure, Analyze, Improve, Control) guided this multidisciplinary, iterative QI effort. A stakeholder team utilized data review, direct observations, and multiple in-person discussions to create a new "Groin-Penis Tray" (GPT) to replace a larger tray for the 90 most common pediatric urologic procedures. Suture preference cards and expectations about which sutures would be opened for each case were updated. The primary outcome was estimated yearly cost-avoidance due to reduced sterile processing. Additional outcomes included: instruments opened/case, % cases with complete trays, Mayo stand set-up time, and % cases with unused sutures. Balancing measures included: total median OR time and tray weights. Baseline and post-implementation measures were characterized and compared. Results: A QI professional, 10 pediatric urologists, 2 pediatric urology fellows, and multiple OR and sterile processing staff members participated. The Summary Figure compares baseline and post-implementation measurements. The number of instruments opened/case decreased from 146 to 65. Annual sterile reprocessing costs decreased by >$51, 000. Median Mayo stand set-up time decreased from 7.3 to 3.5 min (p < 0.001). The number of cases with complete trays increased from 7/20 (35%) to 11/20 (55%, p = 0.34). The new GPT is 2.7 kg lighter than the prior tray. Median OR time remained stable (baseline: 91 min; post-implementation: 102 min, p = 0.44). The number of cases with suture waste decreased from 78% to 0% immediately post-implementation but increased to 40% one year later. Discussion: This systematic, iterative QI process spanned the course of ∼2 years, including planning, building, and updating new trays, then assessing longer-term success via the control phase. The new GPT is used for most pediatric urologic procedures at our hospital, and benefits include sterile reprocessing cost savings and ergonomics. Our team gained valuable experience related to assessing QI project scope, determining key stakeholders and roles, and strategies for sustainability that we will apply to future initiatives. Conclusions: Streamlining surgical trays for common pediatric urologic procedures at a large freestanding children's hospital using established QI methodology reduced OR cost by >$51, 000/year and Mayo stand set-up times without compromising balancing measures. Summary Figure Baseline and Post-Implementation Measurements. Summary Figure