Revealing complex interdependencies in surgical instrument reprocessing using SEIPS 101 tools

Abstract

Sterile Processing Departments (SPDs) must clean, maintain, store, and organize surgical instruments which are then delivered to Operating Rooms (ORs) using a Courier Network, with regular coordination occurring across departmental boundaries. To represent these relationships, we utilized the Systems Engineering Initiative for Patient Safety (SEIPS) 101 Toolkit, which helps model how health-related outcomes are affected by healthcare work systems. Through observations and interviews which built on prior work system analyses, we developed a SEIPS 101 journey map, PETT scan, and tasks matrices to represent the instrument reprocessing work system, revealing complex interdependencies between the people, tools, and tasks occurring within it. The SPD, OR and Courier teams are found to have overlapping responsibilities and a clear co-dependence, with critical implications for the successful functioning of the whole hospital system.

Keywords: SEIPS 101; Sterile processing; Surgery.

Figure 1.

A SEIPS 101 Journey Map showing the usage and reprocessing steps of a surgical instrument tray through the reprocessing work system. Process phases are identified at the top and SEIPS factors in the leftmost column. Involvement of different team members during multiple process phases is represented by boxes which extend across those phases. Team members who are collectively involved across process phases are grouped together; all teams are shown to have roles which span multiple phases. Differences in team organization between departments are readily apparent, as the Courier Team has a collective structure across all process phases while the SPD and OR exhibit more specialization within individual phases and groups of phases. It should be noted that while the OR Team has responsibilities such as regularly performing procedures and turning over rooms for cases across the full length of this process, we did not choose to fully represent that here.