Updated: Apr 7, 2022
Productivity metrics are essential for keeping a business's financial health in check. The issue we run into with Sterile Processing is that there is little to benchmark against other than instrument-level reprocessing.
We typically find an ill approach to budgeting in Sterile Processing utilizing OR case volume or sterilization volume as the benchmark for product worked hours.
Why OR Volume and Sterilization Output Doesn't Work
If you have spent any time working in an OR or with an operating room, especially if you have worked with multiple hospital locations, you already know that the amount of instruments sets can vary considerably by type of OR case. Even cultural environments in health systems can change the number of instrument trays used within an OR case type. Lesser managed hospitals can and do allow physician preference to dictate OR instrumentation, which often leads to an overabundance of instrument processing, not necessarily usage. Better managed systems drive consistency. OR cases do not provide good predictability of instrument volume.
Sterilization output is similar to OR case volume in that there is little predictability in instrument volume. Even within a singular health system, the variability of instruments within similar tray types can vary significantly. Apples-to-apples comparisons are near impossible.
The Other Missing Components
Often when standardizing the metric process for worked hours per unit (WHPU), the metric used fails to include several essential tasks completed in the sterile processing environment.
The decontamination process. Often tray metrics do not include how long it takes to clean the instruments. Typically, an additional 50% of work hours, compared to the hours needed in prep/pack, need to be added to the metric to complete the process.
The sterilization process. Although more minimal than the decontamination process, WHPU occurs in the handling of the sterilization process as well as the stocking process.
OR case development. Case cart picking is another task that is often left out of the WHPU metric. Depending on the volume of OR cases, a substantial amount of productive hours can be used in a Sterile Processing Department for this task.
Fixed WHPU. While most hours in Sterile Processing are variable, certain positions are not. Often supervisory positions are included in the variable hours. These positions may or may not vary depending on volume. They also may not produce instrumentation.
Other tasks, patient care equipment reprocessing, delivery of instrumentation to patient care floors, equipment testing, stock supply management, education, etc., are often lost in the WHPU metric.
What Does Work
Instrument level tracking is the most consistent way to track volume and provide a fair assessment of WHPU across networks and for national benchmarking. We can't say an instrument is an instrument because of the variation in testing protocols and cleaning processes, but we can offer an average time assessment for each instrument reprocessed. Doing so will compile relevant data. The bulk of work in most Sterile Processing departments comes from the reprocessing of instrumentation. Benchmarking the complete reprocessing cycle of an instrument is the best approach. It, however, isn't the endpoint of coming up with a comprehensive WHPU metric.
The Final Score
Instrument reprocessing is complicated. The time it takes to reprocess instrumentation has been understudied. One instrument tracking company helped build a general standard by evaluating the time it takes to inspect various instruments and adding data collection points in their software. Recently, during conversations with our clients, two major healthcare firms metrics for instrument tray reprocessing were disclosed. One is a hospital system and the other a consulting firm. We found it interesting that the WHPU was roughly the same at 24 minutes per instrument tray. Using the averages, a median result from the instrument tracking vendor's research, of 7 seconds per instrument in decontamination and 14 seconds per instrument in prep/pack, the 24-minute metric averaged the tray production to around 98 instruments per tray. That sounds reasonable. However, when adding in time for decontamination and sterilization handling, the average amount of instruments per tray drops to 65 or less. This is only for standard stainless steel instruments and does not include robotic instruments, laparoscopic instruments, orthopedic specialty, etc. So you can see where the rub is. The WHPU used in scores of hospitals underserves the department by inaccurately measuring instrument tray production and misses many operational components of the Sterile Processing Department.
At Evolved Sterile Processing, our consultants have a greater focus on sterile processing. With our decades of experience, we will help you develop better processes and educational resources for your staff.