Improving perioperative efficiency in the management of surgical sets for trauma surgeries: the 4S approach.

Abstract Background The perioperative management of the surgical instruments and implants that comprise sets for trauma surgeries has been identified as a complex and resource-intensive activity due to non-standardized inventories, redundant surgical instruments and unnecessary sterilization cycles. The 4S Intelligent Trauma Care program aims to improve process efficiency and thereby reduce environmental impact by utilizing standardized inventories, a sterile implant portfolio, a barcode that enables a digital safety certification, and a digitized restocking service. ObjectiveThe objective of this study was to investigate the impact of the introduction of the 4S program for the management of surgical sets in open reduction internal fixation (ORIF) trauma surgeries.Methods This was a single-center, prospective, comparative study of ORIF trauma surgeries undertaken pre- and post-implementation of the 4S program (30 pre- and 30 post-implementation procedures). The primary outcome was the proportion of procedures with fewer than two sterilization cycles. Secondary outcomes were the number of sterilization cycles per procedure, set processing time across departments, total set processing costs, number of missing or damaged implants, number of cleaning cycles per procedure, time taken to assemble containers for sterilization, number of containers entering the autoclave per procedure, environmental impact, number of baskets entering the cleaning machine per procedure, and staff satisfaction.ResultsImplementation of the 4S program resulted in a reduction in the mean number of sterilization cycles required from 2.1 to 1.0 (p<0.001). Pre-implementation, only 30.0% of procedure sets were sterilized within one cycle, compared to 100.0% post-implementation (p<0.001). A reduction in the mean set processing time of 24.1% in the OR and 35.3% in the sterilization department was observed. Mean set processing costs pre-implementation were €81.23, compared to €50.30 post-implementation. Furthermore, implementation was associated with significant reductions in water and electricity usage per procedure, and increased staff satisfaction.ConclusionsThis study demonstrates the substantial time and cost savings, positive environmental impact and staff satisfaction that can be achieved by streamlining surgical set management through the 4S program. To our knowledge, this is the first study of this type and our findings are anticipated to be generalizable to other hospitals and surgical specialties.