(769) Rationalization of Obstetric Hysterectomy Trays: A Quality-Improvement Initiative

While obstetric hysterectomy is a rare event, it is associated with high morbidity and possible mortality. Surgical instrument trays with inappropriate instruments may contribute to intraoperative disorganization, causing increased costs and delays during these critical cases. We aimed to improve OR efficiency by rationalizing surgical instrument trays for obstetric hysterectomy cases.

Study Design: This is a prospective quality improvement study critically appraising obstetric hysterectomy instrument trays at a single urban academic institution. Qualitative surveys were distributed to surgical technicians and senior surgeons (Maternal-Fetal Medicine and Gynecologic Oncology) to identify targets for improvement. Existing obstetric trays were inventoried and compared to gynecologic hysterectomy trays to facilitate removal of unnecessary instruments and supplementation of necessary missing instruments. Post-rationalization instrument lists were approved by senior surgeons prior to tray modification and cost analysis.

Results: A total of 4 trays containing 176 instruments were rationalized to 2 trays containing 129 instruments (27% reduction). Nearly one third of instruments (N=55/176) in the pre-rationalization trays were deemed unnecessary. The post-rationalization trays had 77% crossover (N=99/129) with the pre-rationalization obstetric hysterectomy trays and 23% crossover (N=30/129) with gynecologic hysterectomy trays, reflecting the inadequacy of the original trays to include all necessary instruments. Based on institutional case volume for obstetric hysterectomies, tray rationalization amounted to $4075.91 savings in purchase costs and $690 annual savings in tray processing costs.

Conclusion: Interdisciplinary appraisal of surgical instrument trays can effectively improve their clinical appropriateness while also reducing costs. Future steps for quality improvement will integrate the rationalized trays into a simulation curriculum to ensure familiarity and competency of all operating room staff and surgeons with the updated obstetric hysterectomy trays.