Education & Distance Learning Enthusiasts- More OR cases mean bigger CS units, headaches

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More OR cases mean bigger CS units, headaches

Healthcare Purchasing News - November 1, 2000

Asked the most toilsome task she oversaw in expanding an entire central service department - equipment, building and work stations - Laurie Blankenship groaned and said managing the mountainous e-mails that started two years ago when the project began.

Sounding like an interior construction foreman, the sterile processing manager at Inova Fairfax Hospital, Falls Church, VA, recalled the still-fresh experience.

"We coordinated the work of architects, engineers, electricians, plumbers and equipment managers. My best advice is to keep a running folder of issues going. I relied on e-mail to get information, and sometimes people don't get back to you, which made it hard to follow up on things."

Completed in March, the state-of-art department is fully automated and ergonomically designed. It is estimated to serve 45,000 surgical cases and baby deliveries in 2002.

Like many other successful suburban hospitals now experiencing growing surgery caseloads, Fairfax needed a larger sterilization facility. Such booms make meticulous planning essential. Surgery cases at Inova, for example, went from 28,862 in 1994 to 33,300 in 1999 - more than a 15% jump. The new sterilization digs will turn around medical devices for 59 operating rooms, up from 47.

To handle the volume, tunnel washers, a cart washer, gas plasma sterilizers, a steam sterilizer and customized workstations have been added. A conveyor belt connects the tunnel washers and instrument assembly areas, before which workers manually unloaded the instruments. Next year, floor tracks for guiding case carts into the tunnel washers will be installed.

Bar coding

In addition, a bar-coding system can monitor devices during every phase of the sterilization process, as well as record worker productivity that helps schedule more or less workers based on product volume.

Blankenship and clinical healthcare workers agreed that driving the recent rise of surgical patients are aging, health-conscious baby boomers who live in affluent suburbs near large cities.

Falls Church, 15 miles west of Washington, is such a village that has grown considerably. In 1990, the population in Fairfax County was 818,584. This year, it hit 968,225. The median family income is $72,000, and 56% of the residents have college degrees.

Fairfax Hospital has kept pace; in 1962, it had about 200 beds and now it has 656.

Accommodating the increase in patients are new specialty units, such as Fairfax's spinal surgery that serves patients from three northern Virginia hospitals in the Inova health system. In supporting the spinal center, sterilization technicians must process unusually large instrument sets, said Joan McKisson, administrative director of perioperative and anesthesia services at Fairfax.

Other new services that impact Blankenship are a trauma center, labor and delivery, orthopedics, cardiac surgery, neurosurgery, transplantation and a minimally invasive surgery unit.

McKisson said moving the case-cart pulling system from the operating room to sterile processing overcame a logistical problem.

"Again, OR didn't have the room any longer for case-cart pulling. That was a key change, but Laurie made it happen," she said. "We made a commitment to her department because the growth of all these medical services had to have lots of sterilized instruments."

Another hospital in the Inova system, Fair Oaks Hospital, Fairfax, VA, will break ground in 2001 for a $72 million expansion. Though building plans are not finished, a hospital spokeswoman said Fair Oaks' sterile processing floor will increase by 4,800 square feet.

More automation

Bob Von Kaenel, vice president of sales and marketing for Getinge/Gastle Inc., Rochester, NY, said many sterilization and central service departments are expanding due to hospital consolidations, yet staffs and resources are not necessarily keeping pace with such growth.

"To maximize productivity and efficiency, you must increase automation. That's why you see more central service departments today using automated conveyors and putting equipment on tracks, which is more ergonomically safe for workers," he said.

Advanced procedures for cancer, neurospinal, laparoscopic and heart surgeries have driven the construction of a new operating room unit and sterilization department at the 700-bed Norton Hospital, part of a seven-hospital system in Louisville, KY Also, interoperative magnetic resonance imaging for three-dimensional brain surgery will add to the caseload when the building is completed in late November.

Once located on the operating room unit, the rebuilt department is now one floor above, connected by a pneumatic tube, an elevator and dumbwaiter for transporting equipment and instruments.

Equipped and staffed to admit a large number of acute care cases, Norton Hospital serves not only the Louisville area, but also west-central Kentucky, and southern Indiana.

"We get patients who are sicker here than other hospitals. Yes, the entire country is aging, but we do many complex surgeries. Our acuity rates are very high," said Judy Bernhardy, Norton's director of surgical services.

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