title: Applying lean methods to improve quality and safety in surgical sterile instrument processing.
abstract: BACKGROUND
  Surgical instrument processing is critical to safe, high-quality surgical care but has received little attention in the medical literature. Typical hospitals have inventories in the tens of thousands of surgical instruments organized into thousands of instrument sets. The use of these instruments for multiple procedures per day leads to millions of instrument sets being reprocessed yearly in a single hospital. Errors in the processing of sterile instruments may lead to increased operative times and costs, as well as potentially contributing to surgical infections and perioperative morbidity.
  
  
  METHODS
  At Virginia Mason Medical Center (Seattle), a quality monitoring approach was developed to identify and categorize errors in sterile instrument processing, through use of a daily defect sheet. Lean methods were used to improve the quality of surgical instrument processing through redefining operator roles, alteration of the workspace, mistake-proofing, quality monitoring, staff training, and continuous feedback. To study the effectiveness of the quality improvement project, a before/after comparison of prospectively collected sterile processing error rates during a 37-month time frame was performed.
  
  
  RESULTS
  Before the intervention, instrument processing errors occurred in 3.0% of surgical cases, decreasing to 1.5% at the final follow-up (p < .001). Improvements were observed in multiple categories of error types, particularly the assembly errors of packaging (from 0.66 to 0.24 errors per hundred cases, p = .004), and foreign objects (0.17 to 0.02 errors per hundred cases, p = .025).
  
  
  CONCLUSIONS
  Surgical instrument processing errors are a barrier to the highest quality and safety in surgical care but are amenable to substantial improvement using Lean techniques.
authors.affiliation: Center for Health Services Research, Virginia Mason Medical Center, Seattle, USA. craig.blackmore@vmmc.org
authors.forename: C Craig
authors.initials: CC
authors.lastname: Blackmore
authors.forename: Robbi
authors.initials: R
authors.lastname: Bishop
authors.forename: Samuel
authors.initials: S
authors.lastname: Luker
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Williams
mesh_terms: D000046:Academic Medical Centers; D006801:Humans; D017053:Infection Control / Q000379:methods / Q000592:standards*; D017146:Models, Organizational; D061214:Patient Safety / Q000592:standards*; D011183:Postoperative Complications / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control; D011785:Quality Assurance, Health Care / Q000379:methods / Q000592:standards*; D013242:Sterilization / Q000379:methods / Q000592:standards*; D013525:Surgical Instruments / Q000382:microbiology / Q000592:standards*; D014861:Washington