Growing orthopedic (ortho) and spine surgical volume raises an important question: can ASC support structures handle the increased workloads and regulatory requirements without increased financial pressure? Sterile processing (SPD) is at the heart of the ASC support structure directly impacting the center’s ability to succeed operationally and financially. Whether you’re building new, renovating, or living with your current SPD, sterile processing can become a strategic growth lever, which can do more than simply process instruments.
Real-life Example
Total Joint Specialists operates four ASCs in the greater Atlanta area. In 2019, the idea of offsite sterile processing was rejected, as it wasn’t the industry standard. However, the market, and specifically Total Joint Specialists’ volume, began growing and shifting in ways that made onsite sterile processing inadequate and undercapacity. Their decision to renovate their first ASC SPD was accomplished without impacting surgery schedules when Lacey Dyer, Surgical Investors & Advisors, arranged for STERIS to process all instrumentation at their Offsite Reprocessing Center (ORC). The ORC trial worked seamlessly, and the once-rejected idea of offsite sterile processing was now becoming an operational strategy.
Since then, Total Joint Specialists have opened three more total joint ASCs, of which two were constructed without the cost or space associated with SPD capital equipment. Emily Arce, Director of Total Joint Operations, led the effort to streamline logistics to transition from onsite to offsite sterile processing. The surgical teams are now free to focus on surgery instead of sterile processing and the center’s labor costs, training and competency requirements, and regulatory requirements have all been reduced. The Total Joint Specialists team then partnered with STERIS to build a new prefabricated modular ORC in Atlanta to serve their four ASC’s needs. The STERIS ORC is specifically designed for offsite sterile processing to maximize space and reduce capital costs. Critical to the team’s continued success has been Lacey and Emily’s weekly process meetings and quality reviews which drive consistency, continuous improvement, and surgeon satisfaction.
Total Joint Specialists orthopedic surgeon, Charles DeCook, MD, joined The Ortho Show Podcast by Scott Sigman, MD., and shared the following. “There’s no way we’re going to let SPDs continue as they currently are,” he told Dr Sigman, referring to current practices as antiquated. “We need to put this in specialized hands,” he continued. “It needs to be offsite…not only in the hospitals, but in ASCs as well.”1
SPD Capacity and Performance
ASCs have more functional choices today than ever before when deciding on sterile processing alternatives to meet their operational requirements. Five years ago, before total knee arthroplasty surgery was approved for ambulatory surgery centers, having one sink, one washer, and one sterilizer may have been sufficient. Today’s multi-specialty ASCs and those performing vendor-heavy joint and spine procedures now need functional sterile processing operations on par with full-scale hospitals. This means ASCs need to understand their SPD organizational capacity and operational performance requirements.
Organizational capacity is based on the expected SPD workload, manufacturer instructions for use (IFU) processing requirements, regulatory and industry standards requirements, and timeframes in which the work must be accomplished. This data allows the calculation of equipment, utility, space, and labor requirements. Converting your requirements into hourly needs for each process step allows you to easily understand operational bottlenecks and capacity restraints, as well as calculate SPD’s operational hours. Insider tip: if you’re performing total joint arthroplasty, most vendor trays have sonic washing requirements that may exceed your current sonic capacity.
Operational performance addresses SPD’s ability to manage people, process, and technology to complete the work in a compliant and efficient manner. Without organizational capacity, operational performance becomes a difficult job. Additionally, moving from a traditional ASC SPD setting to a hospital-equivalent SPD requirements may uncover a large processing gap in knowledge, ability, and resources. Operational performance ensures all employees who perform SPD tasks are fully trained with documented competencies, staff follow standardized work instructions, and compliance to processing IFU and regulatory standards is documented. Strong operational performance also means employees are able to manage the operations, vendors, and work streams efficiently to meet surgical needs, and the ASC is able to recruit and retain SPD staff.
To ensure organizational capacity and operational performance, ASCs have the following functional SPD options:
Functional SPD Options
The following options provide various degrees of operational and financial performance that can be tailored to the ASC’s current and future requirements.
- Expand Onsite SPD Hours of Operations: Expanding SPD operating hours leverages the physical equipment capacity already installed, but it may result in backlogs of instrumentation as well as staff potentially working alone at night. Backlogs of dirty used instrumentation can negatively impact an instrument’s passivity layer as bioburden dries. It also promotes the growth of biofilm, which becomes more difficult to clean and sterilize. While this option incurs no capital investment, it does have operational limitations and drawbacks.
- Expand Onsite SPD Capacity: If space allows, expanding onsite capacity by adding additional equipment allows processing to expand within current operating hours. Insider tip: decontamination is usually the most difficult to expand and meet IFU requirements between manual cleaning, sink and sonic requirements, and automated washer requirements.
- Supplement SPD Capacity Through Offsite SPD Solutions: For ASCs located near an offsite reprocessing center (ORC), they may be able to pay a per-tray fee to leverage their services for peak volumes or all vendor trays as an example. Per-tray fees allow expenses to be directly tied to revenue volumes while minimizing or eliminating onsite construction and capital investment.
- Move 100% of SPD Processing Offsite: Thinking outside the box, as shown in the previous real-life example, is to move your SPD operations completely offsite. ASCs grouped in a geographical area can leverage their combined volumes to purchase offsite services or partner with STERIS to review strategic options. To maximize financial benefits, ASCs should leverage their business relationships with vendors and negotiate partnerships for offsite processing that reduce capital investment while controlling operating expenses.
To learn how STERIS helps ASC Customers optimize their SPDs to achieve their goals, click here.
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