Instrument Management Standardization in Multiple Facilities Shouldn’t Require a Paper Trail

Hello, everyone, and welcome to another episode of consensus brought to you by Census Technologies. I'll be your host for today, Gabrielle. And I am thrilled to be joined right now by Robbie Miller, who'll be talking to us today about standardizing applications of your instrument tracking system across multiple facilities, not just one. So here today, to share his expertise with us is Robbie. So Robbie, welcome to podcast. Well, thank you, Gabrielle. Pleasure to be here. Absolutely. So to start off, let's give our audience just a brief introduction about yourself. So name title, your facility, as well as just talk a little bit about your role within your facility and what you do on a day to day basis. Yeah. I have to. So as you said, I'm Robbie Miller. I'm a sterile processing department manager at Saint Joseph Hospital and Medical Center in Phoenix, Arizona. Been here for about twenty five years with more than twenty years experience in leading sterile processing departments. Here, and I also, play a a essential role as a subject matter expert in my enterprise, which is common spirit health. We're a hundred and forty two hospitals across twenty eight states, and I do a a great deal of work, not only supporting my local department here, but also, pushing forward as an enterprise, in the SPD forum. And so we're gonna talk about Sensatrack here today. Which is the tracking system that we're using in our enterprise and here at my facility. Well, Robbie, in your opinion, what do you think makes instrument management systems critical resources necessary for process success. No. Great question. You know, when I think about these instrument management systems, which are that they're not tracking systems, they're management systems. It's really five key components that I think of, that these systems do for us. So the first one is asset management. And so we start thinking about what resources do we actually have? When are we using them? They allow us to manage those assets with respect to repairs, refurbishment, and there's actually quite a bit of cost savings that we can realize if we effectively employee systems to to manage our assets. The second component's electronic documentation, and so if you think about account sheets, the load documentation, high level disinfection, sterilization, we can record qualification testing, and and do all sorts of different quality assurance monitoring, and keep all of our documentation electronic, which, prevents us from you know, storing boxes and boxes of documents in a warehouse somewhere and paying those fees. Much quick, quicker to access them as well. And then the third thing is is we can really, design, process, structured process that drives patient safety regulatory compliance within our department. We can design workflows. We can set our staff up for success especially in this complex environment that they're working in with so many different instructions for use. It's really, really essential that we use these systems to give them the tools to be successful, which ultimately keeps our patients safe. The fourth thing is is these systems provide us with objective data for reporting So we can look at things like quality, asset usage, productivity, which we're gonna talk a little bit about today, which has been a key focus for us within our, enterprise. And then the fifth thing, of course, is instrument traceability. Again, they're not instrument tracking systems. They're instrument management systems, but instrument traceability is a key component to what these systems have to offer us. It is important that we deploy them to track through our departments as well as all the way patient to have that traceability in place. Well, you actually just recently transitioned your instrument management system, two cents a track. So what was that process like? What management system did you use prior to Sensatrack? What kind of differences have you seen thus far? I mean, I that's a loaded question. So Let's start with the transition. What was that process like? Absolutely. So, yeah, we were utilizing impress and we had been using that application for about fifteen years here, and we recently converted the Sensatrack, really because Impress was being sunset as an application. And we thought Sensatrack had a lot to offer, and certainly, you know, with respect to our goals as a department and as an enterprise, since the track could help us achieve those goals. And I think after working with a tracking system for so long, there were there were definitely pros and cons to a conversion like this, a conversion that we had to embark upon. But ultimately I think it's gonna work out wonderful for us. So When we kinda think about, you know, what was great about this, we had a foundation of understanding the concepts of how a tracking system works because we've been using one. Prior to using a tracking system when we did things in a more archaic fashion, and we were, implementing a tracking for the first time, we really had no idea what they conceptually did. And so we didn't have to learn that piece, which was helpful for our staff in dealing with such a big transition because they understood those concepts of what am I trying to do in decontamination or assembly or sterilization? Or tracking to the patient in the in the in the operating room. We had a clear understanding of what our goals were with the application of the system this time. Or we didn't have that before. And some of those goals actually changed now that we had a a a better understanding of what these systems had to offer us. As well as what the Sensatrack application specifically had the capability to do, and some of those goals we're gonna talk about today. I also really, really loved that we had, a phenomenal data transfer capability in in this transition. The Sensatrack team was absolutely wonderful in their support and helping us migrate the data from our existing system to our new system them seamlessly quickly, and and effectively. Our initial, implementation was was quite arduous in uploading all the information for the first time building count sheets and everything that goes to establishing, establishing a system for the first time. But this time, it was very, very fast in in in dumping all of our data, our photographs, our count sheets, and everything that we had right into the system quickly. And there was a quite a few lessons that we had learned from our past experience on how to implement the system successfully. So specifically, for example, technology printing was huge nightmare for us the first time we implemented a tracking system, getting labels and count sheets to function properly with all the computers within the department was was a real, real difficult undertaking. And this time, we we virtually had no issues because we had learned from those past lessons. And then, another pro is just Sensatrack has quite a bit of advanced features to offer that our former impressed system did not Some of those we've already taken advantage of at a local facility level, as well as part of the standardization work across our enterprise, And then some of these advanced features were yet to implement, just because we are a relatively new user. But there were some challenges without a doubt. There's fundamental differences in tracking systems. Although they all do similar things, they do fundamentally different, worked differently. And our staff, we had to really support them in those changes. For example, the sterilization module was completely unique and different from what we were used to, how we loaded documentation, biological indicator information, load contents, that type of thing. And then another challenge for us was really learning reports all over again. There's a lot of reports in the system, but we had to kind of play around within it and learn what reports had real value to us, and got us the information that we were seeking in order to solve the problems that we're faced with within our unit. And then with this implementation, we face some new challenges. One that we are gonna talk more about today, and more about at the conference that's coming up with that Census is holding, in Nashville, the CTOT Conference. And that is the standardization work that we did with this system across our enterprise. So again, as I mentioned before, common spirit health is a is the largest nonprofit system in America, and we're a hundred and forty two hospitals strong and growing, and we're actually working to standardize how we deploy SENSE attract in the SPDs across our entire enterprise and the benefits the debt comes with. Well, out of the many features you just mentioned there, what are some of you think the most most highlighted or, I guess, some of your favorite features, what does your team happen to utilize the most? Well, I think as a as a leader and a system administrator, there's quite a few wonderful components to the application, but I'll I'll discuss a few. System controls, are really, really important that we can control how the system is being utilized based on roles and responsibilities. So that's something that, we've really taken advantage of. Again, the reports I find value in quite a few reports. I love the extensive customization of the reports that Centrec has to offer. As well as I love the ability to schedule reports for routine review, whether we're looking at instruments that are marked missing from sets, especially if they're critical instruments or maintenance reports or our sterilizer or high level disinfection load auditing, that we do on a weekly basis to make sure we don't have any gaps. We really worked hard to build in tools to support the staff in performing the complex processes that they're doing in SPDs that are consistent with standards and instructions for use as IFUs to keep our patients safe. So For example, scope trace. We've implemented scope trace here, and building in the the steps to process a flexible scope which, you know, is very, very complex in nature, to help our staff, especially as a teaching facility where we take a lot of SPD students in really understand what steps they need to follow. We've also really been exploring the new AI technology that Census is developing within the application to help us set objective goals with the staff as we coach them, as we develop them, or we just work to celebrate their success. We have that objective data to celebrate them, or to coach them up. And then finally, again, as we talk about, you know, standardization and and the value We've really taken advantage of the complexity level tracking, to help us achieve both individual facility goals, and system goals, with respect to labor productivity. Well, why did you end up going, towards the direction of standardizing your instrument tracking system process across multiple facilities. What made you, wanna follow that route of standardization? Yeah. So, you know, first, we had quite a few hospitals within our system that were all on the legacy instrument management system. That was being sunset. So we actually with a deadline of that system being sunset, we're doing, a large number of conversions to the Sensatrack application in a relatively short period of time. Some were due to other circumstances, but the reality is many of them needed to convert from one system together. All while we do have some enterprise goals, that we're trying to achieve to really fundamentally change some of the objective measures in in sterile processing. And so we also were implementing numerous facilities that had never had a tracking system. So we we begin standardizing really first to deploy a playbook for facilities on how to deploy the system to help each other determine, you know, how do we actually go live with this application and do it successfully? So the playbook was really the kind of the initial initial piece. And then as I had talked about before, we do have some enterprise goals, of better managing our assets on hand a specific example of this is we have embarked upon a six million dollar saving initiative, specific to flexible scopes and better understanding at a system level what flexible scopes we have on hand, how they're being utilized, where they might be utilized best and actually relocating those assets rather than buying new ones, it's helping us achieve those financial goals. And then additionally, we have another significant, goal that we're working on specific to productivity. And when I say productivity, this is kind of one of those holy grail problems, that every SPD encounters. It's how many staff, how much labor are we allotted or we given for the work that's in front of us? And so most, SPDs today are functioning on a metric that is OR minutes, but all too often, OR minutes is not, you know, relative of the work that's actually coming through the unit. Many of us are centralized and processing instruments, or invasive devices for units outside of the operating room and we need to capture capture that. So, we're working to actually change that metric from or minutes two items processed based on complexity and fully tracked by the Sensatrack application. Well, what does the process look like to get multiple facilities, using their system in the same way? Just what are some of the elements of the Sensatruck platform? That can be almost universally applied. No. Great question. And and this is not an easy task without a doubt. It it requires collaboration on multiple fronts. I think it it really starts with developing a task force representative of a whole. This is a working group. It's a small working group where you can actually impact change. And so this task force, it does need to consist of of of people, within, you know, a specific regions or divisions or if, you know, you're just in a local community but have multiple facilities. Then in addition to that task force, you do need, a communication or a collaborative group of some kind. A group where you can spread information where you have access to to collaborate with all of the stakeholders within the group of facilities that you're trying to partner with. And then in order to make this happen, you do need an executive sponsor to support the effort, communicate the goals to the real decision makers, right, the people with the money. And so it's important to have that executive sponsor, perhaps some some somebody elevated in in the Perioperative services role at a system level. And then you also need to collaborate with Census themselves, to determine how to achieve or organizational objectives and utilize their expertise on the application to do that. So you'll need to bring them and partner with them. But there are a number of areas of the application that we can consider for universal application. And it's all about what goals you have, that you want to achieve. So some of those things that you might wanna consider, and it starts with the basics like naming conventions and formatting You know, for example, we use all caps in our system. You will not find lowercase letters. It keeps it very uniform for everybody when they're reading documents, count sheets, that type of thing. Owners ID, if you're looking to, you know, manage your assets across multiple systems, how are you distinguishing those assets from one facility to the next? There's numerous administrative lists that you can consider to standardize. For example, access levels. What access levels do we have at a local or a national level and what capabilities do they have? Workstation groups to set them up so all of your computers are designed the same. You can utilize efficiency task list for specific non instrument reprocessing tasks. So we're talking about building supply case cards, doing durable medical equipment, doing code cards, these types of things that aren't necessarily assembling, or sterilizing an instrument tray. And then you can certainly look at competencies and standardize the competencies that are being deployed quality events. This will help you develop, key performance indicators, those KPIs. And if we're all looking at the same key at the KPIs, we can really have some objective metrics to improve our processes. This is gonna help with regulatory processes like load documentation expectations. What are you documenting in your loads? What is the minimum expectation? Lot numbers for BIs? Lot numbers for CIs? You know, biocide expiration dates with your high level disinfection, since the track offers so many fields I think it's important to kinda create that playbook, for what fields at minimum are each facility going to use because there's benefits in that. Complexy levels as we talked about. You can standardize maintenance intervals. How frequently are we sending trays out based on if they're soft tissue instruments or instruments that are being used in bone, for example, which might need care, a little more frequently. We can set it as our count sheet design and the components on those count sheets. To meet minimum expectations like a three person count, to ensure instruments aren't left behind inside of our patients. We that we we uh-uh created standard label designs for containers, peel packs, flexible scopes, loaner trays. So the labels look the same in every system and the components that are on those labels, like tray weights, for example, you will see that in every system from a regulatory standpoint. Scoped trace, we can we can certainly work to standardize how we deploy scope trace or a loaner link And then, it was discussed in our organization that it will absolutely be required to use interfacing for, one source and with the EHR that that that organization is using the electronic health record. So you you you have to utilize that interfacing body with the system. So these are all things that you could consider, within the application to standardize. But again, it's about what goals do you have and let's focus on those items that will help us achieve those goals. Well, what are some of the main challenges that come with this standardization that we're talking about. And, how did you find ways to rectify any kinds of challenges that may have been brought up with this process? Yeah. It without a doubt, there are challenges. I mean, we're all siloed even within our own hospital, the departments are very siloed. So When we start trying to break down those silos from one SPD to another SPD, a sister facility in your organization as most of us are part of a larger healthcare system. We do need to find ways to break down those silos and communicate and collaborate. And I think it starts with really just getting people involved early and giving them a voice that was essential having them have some buy in to the process. And and make sure that we were covering, all the components that were important to people based upon, what they're trying to accomplish with their tracking system. Them. We need to make sure people understand why we're doing this and how it can benefit their unit specifically but also how it benefits the organization as a whole, seeing everything big picture. And actually, many welcomed the help because again, especially when you're implementing a system for the first time, it can be pretty overwhelming. You don't fully understand conceptually what these applications can do. And if you have that expert resource, you know, they welcome that help, which also helps in standardizing, ensuring that knowledge. We did have to develop, a number of communication tools within the project. You know, Zoom conferences, no do share communications, a lot of email. And then we utilize task force representatives that were a representative of each division to actually partner with people in that division those leaders local that they might have closer working relationships with. And then it was really about creating that template, that playbook, that we could pass something out, something that was hands on that people could read through and say, okay, this is what I'm doing with the system. I need to set it up this way. Well, what are some of the benefits now moving on to the benefits, post challenges of multiple facilities within a network standardizing their instrument tracking system usage? Yeah. So there's there's numerous benefits to realize here. We can have consistent SOPs, those standards of operations within the organization. Staff training is a lot easier, especially if if staff might float from one department to another or actually move from one facility to another, assist resilio transfer, they can, you know, virtually, you know, jump right in, and they're gonna know what's going on how to use it. Regulatory compliance is probably you know, one of the biggest pieces in one of our biggest risks, you know, our documentation is complete. It's electronic. It's accessible. And then really, you know, I think it's important. Serviers are seeing a consistent practice. You know, I don't want a surveyor to go into one of my sister hospitals and see one thing, then come to mind and see something completely different. That opens up the rabbit hole that we're gonna talk about it. And so when we can drive a consistent practice, they're seeing a consistent practice. Those surveys are so much easier to get through. We can improve quality with the KPIs that we can actually monitor with the objective data. Reports can be standardized for running at the local facility or enterprise wide data, again, with those access levels at the national level, that they can run reports on what assets we have, which helps us with that asset management piece. We talked a little bit about the productivity, but certainly If we can standardize how we deploy them, we might be able to change our productivity metric from or minutes to items processed based on complexity level, which we have found in our pilot test to be a far better metric, in in determining how much labor resources we need to properly do the work that's in front of us. And then, of course, there's cost savings. You can save money in a number of ways. There's also cost avoidance ways to deploy these systems. For example, the maintenance, a piece of this, how often are you sending things out, for refurbishment? Is that based on time or usage or those reallocation of unused assets? Well, what are some of the data points that you look at most often you find when managing your SPD And how is that helpful to see the same data points across facilities, for, benchmarking and, additional things of that nature. Yeah. So when it comes to those KPIs these key performance indicators, We look at unit KPIs. We look at individual KPIs. From a unit perspective, we love to look at total c containers complete. These are reports that are within your application. We also love to look at total critical items, in a container as we we certainly want to achieve a one hundred percent objective. With those critical items being available in the trays. What's the average turnaround time on our trays? We look at case card error rate on time start, delays due to instrumentation issues. Bio burden event rates is a big one that we monitor. Complete documentation rate. So we look at, you know, our sterilization loads. How many of those loads have complete documentation as as a key performance indicator. And then, of course, immediate use steam sterilization rate and reasons. From an individual perspective, We do look at items process per shift, what the staff's, individual complexity level, the trays that they're touching are, their personal documentation audits and how they're performing with respect to their high level disinfection sterilization documentation. And then we look at load sterilize, by the staff and and how many containers are in them, how many PO packs are in them, all part of the evaluation process. And so, you know, benchmarking across our facilities at this stage has been more on determining appropriate labor requirements has been our goal, that we've been pilot piloting. But again, as talked about, we're also really looking at where we have underutilized assets that can be re appropriated to reduce costs. As I mentioned, the the flexible scopes, for example. And so I think, you know, from a personal standpoint, benchmarking my employees' performance is very helpful in managing my unit, but we also have identified some key, areas where we can grow this at the enterprise level. Well, Robbie, I'm gonna before we start closing up the conversation here, let's focus on some actionables, in what ways can standardize processing sets staff up for success, and and their complex roles in the sterile processing field today as well as just, you know, some final advice to other hospitals who are looking to standardize their instrument management systems. How do they set their staff up for success. I mean, if they want to apply this network wide, I mean, where should they start? I mean, could you give us some pointers on that? Yeah. So as I talked about before, you know, those five core concepts that instrument management systems provide us, one of the biggest is process design. Because again, you know, our staff are working in a very complex environment making high risk decisions every day And so by deploying standards, it it can really streamline, the education, the onboarding, and the results. In compliance as well as profit process efficiencies, which ultimately result in patient safe outcomes, those patient centric outcomes that we're all striving for. And again, it is about the process design to set the staff up for success. I often say it's, you know, most problems aren't people problems. They're process problems that we need to work on, and the tracking system can be that tool to build, in those process designs. There's so many details for these staff to remember in these standards and used that that we're all accountable to. So building the standards, you know, the drive quality can help the staff be successful in meeting these expectations. I'll give you a specific example. So just look at your count sheets for, you you know, for example. First of all, if we can design a standard count sheet that is gonna have three complete counts, one for the sterile processing technician, one for the first count in the or, one for the second count after the case, you know, we can prevent these, these adverse events from happening where instruments are are left behind. We can build into those count sheets things like lubrication, what needs to be lubricated, what lubricant do you use? Where do you place the lubricant? You can put pictures in with the exact point where that lubricant needs to go. If you think about a DaVinci Stapler with the seven lubrication points, it's complex stuff to remember. You can build in things on your count sheet like testing rogers, doing a punch test on your caracins, that kind of thing, or doing, insulation on your laparoscopic instrumentation. It's a reminder of that I need to do this. It's documenting that it did get done. And then you can, provide pictures exactly how to do that. You can use assembly notes to resolve missing items, for example. If you've got things that are missing from the tray, you can put a note in that will prompt the the the technician to put that back in into the set. Scope trace, functions very similarly. You can build in the leak tests. The the cleaning verification process, whether you're using ATP or something else or the drying cabinet connections, which can be a little bit complex with so many different flexible scopes. So you can design these right into the in into the the couch sheet into the system so that staff know exactly what to do rather than trying to have to remember it all. The quick link to one source can access those ifUs, Again, photos are huge. Put photos in. We have more than five thousand photos of our sets and instruments in in in our system. Aiding them and being successful in their role. Well, Robbie, for those listening in, right now who are interested and want to learn more about Sensatrack, what you do, instrument tracking system application standards. Are there any type of events coming up, that you'd like to kinda pitch here, for people to come visit? Yeah. So, again, I'm gonna talk more in-depth about this at the upcoming, CTuck conference that Census is is hosting in Nashville in September, reach out to your local, census representative and and get more information about that. And we're gonna walk through, some of these, these simple things that you can do in order to realize a standardized product with your instrument management system. And it might be helpful for those of you who want to, have more broad goals across your organization, or they might just be great tips for you to deploy at your local facility and how to best utilize these complex systems to achieve your personal goals within your own department? Well, thank you so much, Robbie. That closes up the conversation for today. Really appreciated you coming on the podcast to, discuss your instrument tracking system application standards. Across multiple facilities, we learned a lot. It was a pleasure to have you on the podcast. Thanks for having me, Gabriel. Absolutely. And as always, if you'd like to learn more, please visit census dot com and look for podcast wherever it is you get your podcast at. I've been your host Gabrielle. Thanks for tuning in.