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Application of Lean Methodology for Improved Quality and Efficiency in Operating Room Instrument Availability
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2013
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Lean ManufacturingEngineeringSurgeryImproved QualityOrthopaedic SurgeryMedical InstrumentationLean ThinkingSystems EngineeringSurgical OutcomesSurgical PlanningLean MethodologySurgical Quality ControlDesignOutcomes ResearchQuality ControlSurgical InstrumentationLean 5SLean Software DevelopmentIndustrial DesignQuality AssuranceLean Instrument InterventionPatient SafetyMedicineSurgical Innovation
Advances in surgical instrumentation reduce morbidity and recovery time, yet their growing complexity increases surgical risk and burdens the operating room supply chain. The study aimed to improve operating room instrument availability by developing and validating a Lean 5S approach that sorts, simplifies, sweeps, standardizes, and enforces self‑discipline. The Lean 5S intervention was applied to minimally invasive spine surgery, measuring a 70 % reduction in instruments and a 37 % decrease in setup time, and later validated on deep brain stimulator cases. The results showed substantial waste reduction, improved efficiency, and potential annual savings of $2.8 million, demonstrating that Lean methodology enhances quality while lowering costs.
Advances in surgical instrumentation allow surgeons to treat patients with less morbidity and shorter recovery time. However, the increasing complexity also adds to surgical risk, and to operating room supply chain burden. To improve the quality and efficiency of operating room instrument availability, we developed and validated a Lean 5S approach consisting of sort (determining instrument usage and waste), simplify (removing unnecessary instruments), sweep (confirm availability of needed instruments), standardize (all trays the same for a given procedure), and self-discipline (monitor success). The primary outcome was reduction in unnecessary instruments delivered to the operating room. As a secondary analysis, we evaluated the effect of the Lean instrument intervention on surgery times. We reduced the number of instruments for minimally invasive spine surgery by 70% (from 197 to 58), and setup time decreased 37% (13.1-8.2 min, p = .0015). We also report subsequent validation of the approach on deep brain stimulator cases. We conclude that complex surgical procedures offer opportunities for substantial waste reduction, simplification, and quality improvement, with potential institutional annual cost savings of $2.8 million. We demonstrate that Lean methodology can improve quality at lower cost.