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.