Hide and Seek: Tracking Systems Do More than Monitor Instruments

How to Track Down the Right Tracking System for Your ASC

Wayne Root used to track information, tools and equipment manually and says he never wants to go back. Root, a registered nurse, is manager of sterile processing for the hospital and ambulatory surgery center (ASC) of the Saint Joseph Mercy Health System in Ann Arbor, Mich., and says tracking systems are the wave of the future.

“I wouldn’t want to have to track information (and equipment) manually,” he says. “It’s so nice to just be able to pull it up electronically. The other part of it is that in sterilization, the systems themselves will interface with your sterilizers and keep you from having to store huge amounts of paper records.”

Tracking systems are even useful at small facilities, says Mike Duckett, director of strategic initiatives for STERIS Corporation.

“Small facilities definitely can benefit from them, particularly when you interface directly to the sterilization equipment,” Duckett says. “(Then) you have the ability to capture the sterilization information automatically without having to handwrite, which typically saves the average facility 90 minutes of labor time a day.”

Efficiency Abounds

Staff efficiency is a huge reason to acquire an instrument tracking system, says Linda Condon, director of sterile processing for the department of surgery at Johns Hopkins Hospital and Health System in Baltimore. Condon has been using a tracking system at the hospital side for 12 years, and the ambulatory surgery side of Johns Hopkins has been using a version of it for two years that has been very successful, Condon says.

“(The tracking system) has expanded to being the real meat and potatoes of how the department functions,” Condon says. “Not only does it tell us what instruments we’re using, it tells us the cost of instruments. Everything is computerized; all of our records are online and are backed up by our server. We have bar codes on our sets so that when we scan our sets you can determine the location of where your inventory is. It’s a huge database where we can insert JPEG files or photos for the instrumentation.” This database makes the training of staff much easier, she adds. Otherwise, learning a vast network of instruments takes more time and requires more assistance from senior staff. The owners and operators of all ASCs — even small ones — should consider a system, Condon advises.

Good systems save money partly because they have “built-in constraints” about how an instrument should be handled, she says. That can save thousands of dollars in instrument repairs and replacements. A good system is also useful during instrument recalls. Condon has worked in ASCs and knows the instrumentation isn’t usually as varied in ASCs as in some surgical and regular hospitals, but says a tracking system is still helpful. “There’s no way it can’t be,” she says.

However, the usefulness of tracking systems is not always tangible or quantifiable, which means systems can be difficult to justify, Root says. Still, he’s certain that tracking systems help with efficiency, and he agrees with Condon that the system makes staff training much easier.

“If I’m not having to do ‘rework’ and have my staff scramble around and search for a particular set — if I can find it on my tracking system — then I can save a lot of man hours,” Root says. “Not only does it give you a count sheet listing the instruments that go into that set, it comes up on the computer and will actually give you the fine nuances of putting that set together. If there’s a particular instrument and you’re not sure what it looks like, you can hit a button and it will show you a picture of the instrument.”

Gaining Popularity

Instrument tracking systems are getting more popular in the ASC and surgical hospital industries, Duckett says.

“We’re starting to see quite a bit of interest,” Duckett says of the Censitrac Instrument Management System. “Part of our program is a modular system with an entry point that would fit in an ambulatory-type environment.” The system includes a touch screen, wireless and handheld scanning technology that works with any vendor.

“We’re starting to get more and more interest because (surgery centers) have to comply to the same record keeping when it comes to sterilization as all other facilities do,” Duckett says. “They want to use the system to drive compliance.”

While tracking systems are harder to validate in small facilities, they are indeed becoming popular in ASCs partly because of compliance with the Joint Commission and other authorities, Condon says.

“Ultimately, this streamlines all that documentation,” Condon says of her instrument management system, instacount®PLUS by Aesculap, Inc. This instrument management system software uses barcode technology and offers real-time data. The program manages instrument inventory and sterile processing flow, automates sterilization records, tracks instrument use, documents employee productivity, tracks time required for other activities in the sterile processing area, tracks set maintenance by use, and assists with quality assurance documentation.

Instrument tracking systems are sometimes called instrument management systems, and the latter term is more accurate, especially for ASCs, says Michael Mancebo, a director at TGX Medical Systems. A TGX system called Alex Gold is well suited to ASCs, Mancebo says.

“(Systems) are very beneficial for any size facility,” Mancebo adds. “Think about it as a business case. Most centers have upwards of $500,000 worth of instrument inventory — this includes scopes and power equipment — not factoring in the amount of money spent on washers and sterilizers. Why not spend $30,000 to know where all of it is; how it’s being processed.

Who is processing it? Are they doing a good job reprocessing it? Do you have enough to reprocess or are you just flashing? Do you have too much? The list goes on. I find it amazing more facilities don’t have a system.”

Instrument tracking/management systems are also becoming more popular in surgical hospitals, according to Root.

“I travel around to lots of different facilities across the country and people either have an instrument tracking service or they’re in the process of getting one,” he says. “(It’s great for) being able to maintain and keep track of huge volumes of information.”

Root also uses instacount®PLUS and says he’s upgraded it over the years. Most systems seem to be pretty similar to each other, he believes.

“I have had other people present systems to me,” Root says. “My impression is that they all pretty much do the same thing. I didn’t go, ‘Oh my God — I wish I had gotten that one instead.’ With most of them it’s a matter of how you use them and the data you put in. You get out what you put in.”

Trends

There are many other trends on the market, and one of the most prominent involves interfacing with a surgery scheduler so that trays can be prepared days in advance, Mancebo says. However, the hot topic this year is radiofrequency identification (RFID) technology. According to RFID Journal, RFID is a generic term for technologies that use radio waves to identify people or objects. There are several ways to do this, but the most common is to store a serial number that identifies the object of interest (and sometimes information about it) on a microchip that is attached to an antenna. The reader converts the radio waves into digital information that can be used on a computer.

RFID has potential, but that potential is not yet being met, Mancebo says. “Unfortunately, the dollars associated with it (are) keeping this technology from being easily accessed by the masses,” he says. “RFID is where DVD players were years ago. They used to cost $500 at high-end retailers, and now you can get a $40 unit at the gas station. Until RFID sensors make it down to the instrument level, (facilities) will be limited.”

RFID technology requires planning so that the proper infrastructure is in place to support the new technology, he adds.

While RFID may not be as mainstream as it could be, it is certainly being used. Radianse Reveal Asset Tracking, by Radianse, uses active-RFID and real-time location technology. The system allows staff members to find equipment and to know instantly whether it’s available, has the special features they may want, etc. Radianse Reveal typically has a return on investment in 12-18 months, product representatives say. They cite improvements in efficiency, Joint Commission compliance, preventative maintenance, etc.

Such assistance helps with the everyday problems of healthcare, says Paul Tessier, an engineer and executive vice president at Radianse.

“Imagine the value of a system (that) automatically checks in advance that the right surgical equipment, devices and accessories are in the room where they will be needed, presets alerts that notify the right staff if equipment is missing, and (provides) an immediate and reliable way to find the missing pieces,” Tessier says. “The goal, of course, is to be sure the rooms are equipped as needed to keep procedures on time, (which is) important for efficiency and satisfaction.”

“Where is my equipment?” is a question that Radianse Reveal makers try to obliterate. Searching for items is not only a waste of employee time, it’s potentially dangerous for patients since it can interfere with surgery. A good system will ensure that assets are accessible and last as long as possible. The data that comes back can be used to “find and fix bottlenecks in surgical processes,” says Susan Niemeier, RN, MHA director of clinical operations at Radianse.

“Being able to pinpoint where low inventory items are located is particularly valuable,” Niemeier adds. “By reducing search time, surgical teams have more time for direct patient care, which improves the experience for everyone involved.”

Potential consumers of RFID technology should be aware of what sterilization temperatures and instrument cleaning agents are necessary, says Joan Spear, MBA, RN, CNOR, instrument management systems field operations manager with Aesculap.

What to Look For

Tracking/management systems may not be optimal for every facility staff. Therefore, it is important to consider many factors when deciding whether to purchase a system.

Some good questions to ask, according to Spear, are the following:

• What are my goals?
• How can I use technology to reduce repair and replacement costs?
• How can I target instrument purchases to meet the greatest need?
• Can I assure my inventory is maintained?
• Should I automate sterilization records?

The answers to these questions will vary greatly from facility to facility, and some might not always be relevant.

Mancebo has worked in two ASCs and a same-day surgery hospital and says that most ASCs do not have nearly the logistical nightmare of instrument tracking that hospitals have. Keeping track of trays is not typically a big issue, but many other areas of running an ASC can still be helped by an instrument tracking/ management system.

“There is more to instrument tracking than instrument tracking,” Mancebo says. “You need to look for a system that can help with sterilization record keeping, staff consistency, biological monitoring and implant tracking. You need a system that will tie both the surgical side and the instrument reprocessing side, and make them work as one. In addition, people tend to forget that repairs and dollars spent on maintaining instrument sets is a big issue, and we need to start tracking where that money is being spent. Lastly, can the system help with tracking the many loaners that come into (a) facility?”

According to Duckett, the first question a potential purchaser should ask is just how robust of a tracking system they really want.

“What we found out is that there isn’t a one-package-fits-all kind of scenario out there,” Duckett says. ASC staffs have far different needs than the staffs at standard hospitals, and probably don’t require as comprehensive a system.

“What a lot of managers may be asking themselves is, ‘Just what do I need and do I have to pay a lot for a system I may only use a percentage of?’” Duckett says. ASC solutions should meet the primary objective of managing inventory through count sheets for instrument tray lists.

“If I was a manager of an ASC, I would be wondering if there was a system that fits my need right now for managing the content of my trays, because that’s really my primary need, but something that’s scaleable and that can grow as my ASC grows,” Duckett adds. “I may want to have the ability to manage them now and have one repository for managing my tray lists, but in the future I may want to be able to actually track the instrumentation throughout the facility. I may want to put my instruments on a maintenance schedule, but I may not be wanting to do that right now either for budgetary reasons or because I may not want to put that kind of energy into it right now.”

According to Radianse product literature, one important question to ask when thinking about an RFID system purchase is, what is the true cost of installation, use, maintenance and expansion?

“When you evaluate a system, consider all costs rather than just the initial purchase of active RFID tags, receivers and/or exciters and additional access points, as well as location software,” the literature states. “There are at least two areas of significant hidden costs.”

That includes the tag and its battery. Tag price can range from $10 to $70.

“For patient tracking, battery life need only be greater than length of stay, such as a disposable tag that lasts up to 30 days,” the literature continues. “For assets, the lifecycle should be at least two and may be as many as seven years, allowing battery replacement to be done during normal maintenance cycles. Remember, new technology should streamline rather than complicate processes.”

Creation of a complete and accurate database is valuable for small and large facilities and therefore, a tracking system should be considered, Spear says. “Monies must be used wisely in both settings and true savings require the use of technology,” she says. “For instance, if an item with a limited life (specific number of uses) is used, there must be some way to assure usage is tracked. In addition, sets loaned to other facilities can be tracked to prevent loss.”

Your facility staff may be keeping track of instruments and their maintenance manually with ease and success, but if not, multiple options are available. 

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