Nov 18, 2014The management of surgical instruments poses a unique challenge to health-care workers. The tools are small and easy to lose when being cleaned or sanitized, or during use in surgery, yet a mistake related to managing tools could prove devastating to a patient's health. An unsterilized tool could cause an infection, while in rare cases, tools may be left inside a patient following surgery. Two Japanese hospitals have installed a radio frequency identification system that tracks surgical tools being used on a patient, during cleaning and sterilization, and while in storage, thereby reducing the risk of errors to zero, says the technology provider, KRD Corp. (KRDC).
Shimane University Hospital was the first to adopt KRDC's Surgical Instruments Safety System (SIMSAFE) in 2011, and the Japanese Red Cross Wakayama Medical Center followed with a similar installation in 2013. Next year, Kochi Medical School Hospital will become the third Japanese health-care provider to deploy the SIMSAFE system.
Shimane University Hospital, a 600-bed facility located in Izuma City, underwent a reconstruction and expansion in 2011, and chose at that time to install an RFID solution to track its surgical instruments. Since then, the hospital told KRDC, the technology has brought surgical-tool management errors to an end, while reducing the amount of time employees spend searching for a particular surgical instrument from one or two hours to a few minutes. SIMSAFE, says Tsutomu Sawa, KRDC's VP of development, makes it "possible to know whether and when a particular surgical instrument comes back from the operating room."
During the past year, Shimane University Hospital has also implemented a data-analysis function in the SIMSAFE software, enabling the facility to determine which surgical tools are being used and which are not. The software has reduced the number of instruments the hospital needs in inventory by about 20 percent, thereby making it more efficient for personnel to locate the tools they require, as well as reducing the quantity of new tools it needs to buy.
Shimane University Hospital conducts approximately 20 surgical procedures daily. The hospital has 190,000 surgical tools, including scalpels, pins and clamps of various sizes for specific types of operations. The tools are stored in Shimane's central supply room, which houses five machines for washing tools and eight for sterilizing them. These instruments are packed in metal containers that serve as kits for specific kinds of procedures. Since some tools may be removed from a container during surgery, while others might not be used, they must be carefully accounted for after each procedure, and must be returned to the container and eventually be resterilized for reuse during another operation.
Prior to the RFID system's installation, the facility reports, tracking each tool's location and status was a manual and time-consuming process.
In some cases, a tool might end up missing, and staff members had to search for it in the operating room or the cleaning and sterilization area.
In 2009, KDRC released its passive high-frequency (HF) 13.56 MHZ RFID ceramic tag (compliant with the ISO 15693 standard), intended for use on surgical instruments. A year later, the company introduced SIMSAFE, which consists not only of KRDC's tags and software, but also RFID readers connected to an Advantech HIT-W121 or UTC-520 display terminal, to capture the ID numbers of tagged instruments at the sterilization and cleaning area, at storage egresses and within surgical rooms. KDRC also offers PDA devices for handheld reading that transmit data to the terminal via a Bluetooth connection.
In 2011, Shimane University Hospital attached a SIMSAFE ceramic RFID tag to each of its tools, as well as to the metal containers used for storing them. The tags range in size from 6 millimeters by 5 millimeters by 2.5 millimeters (0.24 inch by 0.2 inch by 0.01 inch) to 7.4 millimeters by 6.5 millimeters by 2.6 millimeters (0.3 inch by 0.26 inch by 0.01 inch). Each is embedded in a ring of steel that is typically welded to the side of an instrument or container. When surgeries are scheduled, the patient's ID number, the procedure to be conducted and the tools required for that procedure are listed in the SIMSAFE software, residing on the hospital's own database and integrated with its patient-management system. Employees log into the SIMSAFE software to prepare for surgeries, and can view which items they will need for a particular patient.
To assemble a container for that patient, workers use a SIMSAFE reader to capture each tool's tag ID, and an M3 Mobile handheld to interrogate the container's tag, thereby marrying those tag IDs to the patient. In the event of an error, such as the wrong instrument being chosen, or one that had not been sterilized, an alert is displayed on the terminal's LCD screen. The handheld is used to read container tags, Sawa says, because placing the large metal box on the desktop reader would be inconvenient for the staff; however, he adds, the container tag could be read via a desktop reader if a customer chose to use it in this way.
Once fully packed, the container is sealed and placed on a cart that is wheeled into storage, passing through a fixed reader portal consisting of KRDC's own reader and antennas. The portal captures the ID numbers of the containers and the tagged tools stored within, and displays an alert only if a mistake has been made—for instance, if a container or tools do not match those required for upcoming surgeries.
At the time of the procedure, the container is removed from storage and is again passed through the reader portal. The read event at that time confirms that the container is being removed, and the system again displays an alert only in the event of a mistake (such as the wrong container being removed for the surgeries scheduled that day, or an expiration date being reached on the sterilization process, since sterilization must be conducted again after a certain amount of time has passed).
In the surgical room, staff members typically use another SIMSAFE reader to capture the IDs of all tagged tools to be used on a given patient, thereby ensuring that there are no mistakes. The surgical staff can read each tag as the tools are used during the procedure. Once the operation is complete, all tool tags are read once more, and if any item is discovered to be missing, the SIMSAFE software displays an alert.
Following surgery, Sawa says, the system tracks the tools through the cleaning and sterilization processes. A staff member reads the tools' tags via a reader connected to an Advantech terminal as they are washed. Later, in the sterilization section, a worker uses the M3 Mobile handheld with a Bluetooth connection to scan the container tag, as well as an RFID location tag installed at the sterilization section, in order to prove that sterilization did, in fact, occur. In that way, if an employee neglects to sterilize or wash an item, the software detects that error and issues an alert to the appropriate staff, instructing them to locate that instrument and complete the necessary processes.
The system has provided not only error reduction but efficiency improvements, Sawa reports. Before the RFID system was installed, two to three workers needed five to six hours to prepare the equipment for patients scheduled for surgery on any given day. That amount of work time has been reduced by 75 percent, he says, adding, "The total work reduction for the operation and sterilization departments results in a savings equal to or greater than $300,000 per year."
By analyzing the data amassed via the SIMSAFE system during the past year, the hospital has not only been able to reduce the number of surgical instruments it needs, but has also found that it can perform a greater number of surgical procedures per day. "Since the working time can be shortened by introducing the system," Sawa says, "it is possible to increase the number of surgical operations without increasing the staff."
What's more, Sawa notes, the technology improves the efficiency of emergency surgery preparation, since employees can very quickly locate the necessary tools.
