Surgical Instrument Tracking for the Royal Adelaide Hospital
Hospital sterilisation departments need to comply with strict standards when reprocessing surgical instruments, requiring specific workflows, operational parameters, and record keeping.
Previously, the Royal Adelaide Hospital (RAH) used a paper-based system to manage their workflows and compliance obligations which had limitations:
- Significant physical space was required to store documents.
- Reviewing historical data for investigations was time consuming.
- Processes for collating and summarising data for reporting were onerous.
- Ability to attribute specific events to individuals was very limited.
- Instruments were tracked in sets, not as individual instruments.
- Unable to track instruments once dispatched to theatres.
- Difficult to capture and attribute reprocessing costs.
The new RAH, a paper-light, technology-centric hospital with increased patient capacity, required a better approach to managing their surgical instruments and compliance obligations.
Our team worked closely with SA Health and the RAH Central Sterile Services Department (CSSD) to understand their requirements, map workflows, review dependencies between areas of the organisation, and implement an electronic asset management system that both met their requirements and significantly improved performance.
Adopting an iterative approach beginning with minimum viable product and progressively adding functionality, the team worked with the RAH CSSD and Getinge Australia to implement an asset management system built on Getinge’s T-DOC solution, designed to operate 24x7x365 and manage more than 100,000 unique items. This system was integrated into the SA Health environment and transitioned to become business-as-usual in the new RAH.
During this project, our team:
- Built a database of all items managed by the CSSD and developed a classification and naming scheme to identify all items in a clear and consistent manner.
- Specified methods for marking barcodes on items, supporting a variety of materials including stainless steel, wood, and plastics.
- Implemented electronic workflows for managing assets including onboarding new items, retiring items, and item-specific handling requirements.
- Tested and configured handheld scanners to optimise their ability to read barcodes on different types of materials.
- Developed a Business Continuity Plan to manually record and re-enter data when the system becomes unavailable.
- Developed a test regime for evaluating software updates, specifically covering functionality used by the RAH, and trained staff to undertake testing and assess software updates.
- Delivered training to ensure the CSSD became self-sufficient, including basic training for all staff, advanced training for power users, and administrator training.
- Embedded our team within the CSSD and Technical Suites to provide support during hospital opening.
- Integrated T-DOC with external systems including the RAH’s Patient Administration System to provide electronic linking of instruments and implants to patient records.
- Worked closely with the product vendor, Getinge, to resolve issues and develop enhancements based on prioritised needs of the RAH.
- Worked closely with network and hosting teams to establish, debug, and optimise IT infrastructure to support the 24x7x365 operation of the CSSD and Technical Suites.
- Developed user interfaces to support non-technical and English-as-second-language users by minimising text and using consistent layouts, symbols, patterns, and colours.
- Worked with cyber security specialists to support penetration testing and harden the system against cyber threats.
- Chaired a working group between CSSD, theatre staff and SA Health’s IT department to ensure healthy and proactive collaboration.
- Developed reports to track performance, non-compliances, and specific issues.
- Implemented a web-based ordering system with customisable templates to streamline the ordering process.
Capabilities we provided
Business and systems analysis
System design, implementation, and integration
Transition to operation
The system went live with the hospital opening and was hailed by Getinge Australia as one of the most advanced day-one activations of their solution ever achieved, inviting the team to present a case study to the T-DOC users’ group.
The team received letters of commendation from both the RAH’s Nursing Director and Getinge Australia, and the system remains core to the daily operation of the RAH CSSD today, a testament to the robust and enduring nature of the deployment.
Ease and speed of data recall
- Electronic logging of timestamps and user identity on every individual action provides a detailed, searchable history.
- Users responding to clinical incidents and operational questions in minutes, a process that previously took days.
- Visibility of last-known location for items, and associated user identification, enables quicker recovery of misplaced items.
- Electronic tracking of implants recovered an estimate $4m – $8m per year in lost revenue.
- Detailed electronic history encourages and enables accountability.
- Ability to add notes on-the-fly captures variations and non-conformance in real-time (e.g. customer asked for variation).
- Triggers, images, prompts, restrictions, and user-specific controls significantly reduce errors and damage to valuable medical equipment.
- Real-time alerting allows staff to respond quickly to process errors.
- Improved management of new and temporary staff by providing detailed cleaning instructions for specific items and restricting actions to certain tasks.
- Automated notifications when instruments are due for maintenance or have reached the maximum number of reuses.
- Staff, wearing full personal protective equipment, able to tag items with notes and flag items for repair on the spot, ensuring the message is passed to CSSD for review.
Data and analytics
- New insights into data enabled improvements and efficiency gains, for example improved visibility into stock versus demand uncovered resource constraints.
- Electronic ordering improves ability to sequence and prioritise orders.
- Automated stock management enables automatic fast-tracking of items to ensure they are reprocessed in time for the next procedure.
- Detailed and comprehensive reports provide deeper insights into operations, for example reporting on the number of items being returned unused.