title: Lean principles to optimize instrument utilization for spine surgery in an academic medical center: an opportunity to standardize, cut costs, and build a culture of improvement.
abstract: METHODS
  Case study OBJECTIVE.: To optimize the utilization of operating room instruments for orthopedic and neurosurgical spine cases in an urban level 1 academic medical center through application of Lean principles.
  
  
  BACKGROUND
  Process improvement systems such as Lean have been adapted to health care and offer an opportunity for frank assessment of surgical routines to increase efficiency and enhance value. The goal has been to safely reduce the financial burden to the health care system without compromising care and if possible reallocate these resources or gains in efficiency to further improve the value to the patient.
  
  
  METHODS
  The investigators identified instruments as a source of waste in the operating room and proposed a Lean process assessment. The instruments and the instrument processing workflow were described. An audit documented the utilization of each instrument by orthopedic surgeons and neurosurgeons through observation of spine cases. The data were then presented to the stakeholders, including surgeons, the perioperative director, and representatives from nursing, central processing, and the surgical technicians.
  
  
  RESULTS
  Of the 38 cases audited, only 89 (58%) of the instruments were used at least once. On the basis of the data and stakeholder consensus, 63 (41%) of the instruments were removed, resulting in a weight reduction of 17.5 lb and consolidation of 2 instrument sets into 1. Projected cost savings were approximately $41,000 annually. Although new instruments were purchased to standardize sets, the return on investment was estimated to be 2 years.
  
  
  CONCLUSIONS
  Inefficient surgical routines may comprise significant resource waste in an institution. Process assessment is an important tool in decreasing health care costs, with objectivity provided by Lean or similar principles, and essential impetus to change provided by stakeholders.
  
  
  METHODS
  4.
authors: Departments of *Orthopaedic Surgery †Orthopedic Trauma, Neurosurgery, Orthopaedic-Neurologic Spine, and ‡Perioperative Services, Beth Israel Deaconess Medical Center, Boston, MA.
authors: David
authors: D
authors: Lunardini
authors: Richard
authors: R
authors: Arington
authors: Elena G
authors: EG
authors: Canacari
authors: Kelly
authors: K
authors: Gamboa
authors: Katiri
authors: K
authors: Wagner
authors: Kevin J
authors: KJ
authors: McGuire
mesh_terms: D000046:Academic Medical Centers / Q000191:economics / Q000592:standards*; D017046:Cost Savings / Q000191:economics*; D017048:Health Care Costs; D006801:Humans; D019637:Orthopedic Procedures / Q000191:economics / Q000295:instrumentation / Q000592:standards*; D058996:Quality Improvement / Q000191:economics*; D013131:Spine / Q000601:surgery*; D013525:Surgical Instruments / Q000191:economics / Q000706:statistics & numerical data*