title: Reducing otolaryngology surgical inefficiency via assessment of tray redundancy.
abstract: BACKGROUND
  Health care costs in Canada continue to rise. As a result of this relentless increase in healthcare spending, ways to increase efficiency and decrease cost are constantly being sought. Surgical treatment is the mainstay of therapy for many conditions in the field of Otolaryngology- Head and Neck Surgery. The evidence suggests that room exists to optimize tray efficiency as a novel means of improving operating room throughput.
  
  
  METHODS
  We conducted a review of instruments on surgical trays for 5 commonly performed procedures between July 5th, 2013 and September 20th, 2013 at St Joseph's Hospital. The Instrument Utilization Rate was calculated; we then designed new 'optimized' trays based on which instruments were used at least 20% of the time. We obtained tray building times from Central Processing Department, then calculated an overall mean time per instrument (to pack the freshly washed instruments). We then determined the time that could be saved by using our new optimized trays.
  
  
  RESULTS
  In total, 226 instrument trays were observed (Table 1). The average Instrument Utilization Rate was 27.8% (+/- 13.1). Our optimized trays, on average, reduced tray size by 57%. The average time to pack one instrument was 17.7 seconds.
  
  
  CONCLUSIONS
  By selectively reducing our trays, we plan to reduce tray content by an average of 57%. It is important to remember that this number looks at only 5 procedures in the Department of Otolaryngology- Head and Neck Surgery. If this was expanded city-wide to the rest of the departments, the improved efficiency could potentially be quite substantial.
authors.affiliation: Department of Otolaryngology- Head & Neck Surgery, Western University, 268 Grosvenor Street, London, ON N6A 4V2 Canada.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Chin
authors.affiliation: Department of Otolaryngology- Head & Neck Surgery, Western University, 268 Grosvenor Street, London, ON N6A 4V2 Canada.
authors.forename: Leigh J
authors.initials: LJ
authors.lastname: Sowerby
authors.affiliation: Departments of Anesthesia & Perioperative Medicine, Epidemiology & Biostatistics, Interfaculty Program in Public Health, Western University, London, Ontario Canada ; Center for Medical Evidence, Decision Integrity, Clinical Impact (MEDICI), London, Ontario Canada ; Lawson Health Research Institute, London, Ontario Canada.
authors.forename: Ava
authors.initials: A
authors.lastname: John-Baptiste
authors.affiliation: Department of Otolaryngology- Head & Neck Surgery, Western University, 268 Grosvenor Street, London, ON N6A 4V2 Canada.
authors.forename: Brian W
authors.initials: BW
authors.lastname: Rotenberg
mesh_terms: D002170:Canada; D003363:Cost Control; D017598:Efficiency, Organizational; D006801:Humans; D013517:Otorhinolaryngologic Surgical Procedures / Q000191:economics / Q000295:instrumentation* / Q000706:statistics & numerical data*; D040841:Resource Allocation
keywords: Efficiency analysis; Otolaryngology; Surgery