Measuring intraoperative surgical instrument use with radio-frequency identification

Objective: Surgical instrument oversupply drives cost, confusion, and workload in the operating room (OR). With an estimated 78-87% of instruments being unused, many health systems have recognized the need for supply refinement. By manually recording instrument use and tasking surgeons to review instrument trays, previous quality improvement initiatives have achieved an average 52% reduction in supply. While demonstrating the degree of instrument oversupply, previous methods for identifying required instruments are qualitative, expensive, lack scalability and sustainability, and are prone to human error. In this work, we aim to develop and evaluate an automated system for measuring surgical instrument use. Materials and Methods: We present the first system to our knowledge that automates the collection of real-time instrument use data with radio-frequency identification (RFID). Over 15 breast surgeries, ten carpometacarpal (CMC) arthroplasties, and four craniotomies, instrument use was tracked by both a trained observer manually recording instrument use and the RFID system. Results: The average Cohen’s Kappa agreement between the system and the observer was 0.81 (near perfect agreement), and the system enabled a supply reduction of 50.8% in breast and orthopedic surgery. Over 10 monitored breast surgeries and one CMC arthroplasty with reduced trays, no eliminated instruments were requested, and both trays continue to be used as the supplied standard. Setup time in breast surgery decreased from 23 minutes to 17 minutes with the reduced supply. Conclusion: The RFID system presented herein achieves a novel data stream that enables accurate instrument supply optimization.研究目标：手术器械供过于求会推高手术室（operating room, OR）的运营成本、引发器械配置混乱并增加手术室工作负担。据估算，有78%~87%的手术器械从未被使用，诸多医疗系统已意识到优化器械供给的必要性。过往的质量改进举措通过手动记录器械使用情况，并要求外科医生核查器械托盘，平均实现了52%的器械供给缩减。尽管这些举措量化了手术器械供过于求的程度，但以往用于识别所需器械的方法均为定性方法，不仅成本高昂，且缺乏可扩展性与可持续性，还极易出现人为失误。本研究旨在开发并评估一套用于测量手术器械使用情况的自动化系统。材料与方法：据我们所知，本研究首次提出了一套利用射频识别（radio-frequency identification, RFID）技术实时采集器械使用数据的自动化系统。我们在15例乳腺手术、10例掌骨关节（carpometacarpal, CMC）成形术以及4例开颅手术中，分别通过经过培训的观察员手动记录器械使用情况，以及RFID系统同步进行器械使用追踪。结果：该系统与观察员记录结果之间的平均科恩κ一致性系数（Cohen’s Kappa agreement）为0.81，属于近乎完美的一致性；且该系统可使乳腺手术与骨科手术的器械供给量减少50.8%。在10例采用缩减后器械托盘的监测乳腺手术以及1例掌骨关节成形术中，未出现被移除器械被再次申请使用的情况，且该缩减后的托盘至今仍作为标准供给方案被沿用。乳腺手术的术前准备时间从23分钟缩短至17分钟。结论：本文所提出的RFID系统可生成一种新型数据流，能够实现精准的手术器械供给优化。