Process Redesign for Improving Traceability of Medical Instruments: Barcode vs RFID

Afrooz Moatari-Kazerouni ESG-UQAM, Montreal, Canada

Under the direction of Ygal Bendavid

LATECE Seminar May 6th, 2015

Laboratoire de recherche sur les technologies du commerce électronique

Presentation outline

• Traceability: what, why, how?

• Case study context and approach

– Documenting “As-Is”

– Evaluating “What-If”

• Traceability value proposition

2

Traceability is…

“The ability to track forward the movement of products through specified stages of the supply

chain and trace backward the history, application or location of products under

consideration.”

3

Why track & trace?

Reducing Asset Cost

Efficient Workflow

Retain Surgical Items

4

Infection Control

Costly Time

Technician Training

How track & trace?

5

Context of study

• Case study at a hospital in Montreal, Canada

• Construction of a new building

– Dilapidated infrastructure

– Space deficiencies

• Transfer of the most acute and critical cares to the new infrastructure

– Central Sterilization Department (CSD), Operating Room (OR)

6

– Canadian Council on Health Services Accreditation

– Operating Room Nurses Association of Canada

Why implementing a traceability system?

Streamlining and improving the process in new building

7

“Past is experience, present is experiment, future is expectation”

8

PAST

Scanning single instruments

Incomplete

instrument tagging

Corrupted database

Hardware malfunctions

No formal process

PRESENT

Scanning instrument trays

Complete crate

tagging

Updated database

New hardware

Designed process flow

FUTURE

RFID technology

RFID tagging and antenna installation

Integration with ERP

system

Design process flow

Traceability system is important for…

Keeping records of disinfection cycles

Reducing mistakes in assembling

9

Linking patients with instruments

Locating medical instrument at time

Perform What-if Analysis Measure, simulate and analyze

(prospective) alternatives Model the future processes

TO-BE Analysis

FEEDBACK

Model the current processes (traceability of

equipment)

AS-IS Analysis

Select one scenario, manage transition (pilot project )

and monitor performance

Implementation &

measurement

- Objectives - Stakeholders - Inputs/outputs - Control - Information systems

- Performance monitoring frameworks

- KPIs - Stakeholders/Roles - Information systems

Understand the current hospital’s business

processes

- Simulation Tools (Arena)

- Business process tools (Visio; Aris/Software AG)

Data gathering

Using different options - Manual data capture - 1D and 2D bar codes (item level) - RFID technologies (item level) - Hybrid options (RFID + bar code)

Analytical approach

• Data collection: Onsite observations, interviewing employees, reviewing reports

• Methodology: – Developing different scenarios on

traceability system – Mapping business process (MS Visio) – Simulating the scenarios (Arena®) – Evaluating and comparing

performance of different scenarios

11

As-Is process flow between OR & CSD

12

What is scanned?

13

1 2 3

4

(4) Reusable resistant 1D barcode on the outside of crates: scanned at the CSD.

(1) Preparation crates (2) one time use 2D barcode label on the set/crate or (3) on the blue wrapped sets: scanned at the OR before surgery.

To-Be process flow between OR & CSD Traceability Throughout the Case Cart Preparation Process – High Level Mapping

OR-

Ster

ile C

ore

OR-

Gen

eral

M

anag

emen

tCS

D-So

iled

Case

Ca

rt Z

one

CSD-

Clea

n Zo

neCS

D-St

erile

Zon

eCS

D-St

orag

e Zo

neM

ater

ial M

anag

emen

t an

d Pu

rcha

sing

OR-

Ope

ratin

g Th

eatr

eCS

D-So

iled

Zone

Legend

Determine the surgery list for next

day

Get a case cart

Pick items from carousel and shelves

Transport case cart to OR-sterile core via clean elevators

Take the cart inside operating theatre

Surgery starts

Pick rest of items from Sterile Core

Surgery ends

Nurse put Soiled items In case cart and leave it in Soiled Holding Zone

OR attendant transport case cart to CSD via

soiled elevator

Empty the case cart

Wash the soiled case card in

washing machines

Decontaminate and wash the

intruments

Park the soiled

case cart

Case carts are ready to be used

Assemble the instrument

sets

Sterilize instrument

sets

Restock carousel

and shelves

Instruments are ready to

be used

Opera

Carousel System

Order based on the purchasing

demands

Receive ordered

items

Record and de-box items

Restock carousel

and shelves

Items ready to be used

ERP system: Logibec

Restock the sterile core

storage

Items are ready to be

used

Park the case cart near the

operating theatre

Items should be stored in

CSD?

Transport items to CSD

Transport items to sterile core

NO

Preparing

case cart

Operating

Theatre and

Sterile Core

Reprocessing

of soiled

instruments

Material

Managem

ent

Once a surgery list is planned, A

preparation list request Is

transferred to CSD (about) 24hrs in

advance; at 9pm of the day before surgery by the

latest

The preparation of case carts starts during the night shift (10pm-6am). When the night shift employees arrive, the CSD supervisor provides the printed preparation list.

OROR

CSDCSD

MMMM

A,B

Responsible from OR (nurse, team leader…)

Sterilization department employee

Responsible from material mgt (store keeper, employee…)

Purchasing demand

CSD: Central Sterilization Department

OR: Operating Room

ORMS: OR Management System

Flow of information In ERP

Beginning/end of a process

Employee/system interaction

Transport of items or case cart

Operation

Decision

Links between high level processes and detailed level processes

Links between different sections

of detailed level processes

Print & attach preparation list to each case cart

Scan the cart/s (barcode on the preparation list)

Instrumental

Scan the case cart and

instrument sets

Opera/Instrumental

Scan the instrument trays and the case cart

Instrumental

Scan the tray for opening the

assembly recipe

Instrumental

Generate production label & attach to the set

Scan the production label (recording which sterilization machine)

Instrumental

Record itemsCSDCSD

CSDCSD

CSDCSD

OROR OROR

OROR

OROR OROR

MMMM

CSDCSD

CSDCSD

CSDCSD

CSDCSD

CSDCSD

CSDCSD

MMMMMMMM

Yes

Process flow scenarios

• Scenario 1: traceability with barcoding and case cart

• Scenario 2: traceability with RFID

15

Reprocessing of instruments at CSD

Traceability at tray level

Scenario 1: Barcode and case cart

16

Reprocessing of Soiled Instruments in CSD

Ass

embl

y Zo

ne

Dec

onta

min

atio

n-W

ash

Zon

eSt

erili

zati

on

Zone

OR

-Op

era

tin

g T

he

atr

e

Scenario1: Barcoding and Case Cart System

Soak the soiled

instruments

Disassemble & brush soiled instruments

Put in crate/wrap

instrument set

Steam sterilization

possible?

Sterilize items by steam

Leave sterile items to cool

Take out sets from cart and to the

decontamination

Washable with ultrasonic machine?

Use ulterasonic

Use mechanical

washer

Take clean instruments to assembly table

Check and sort instruments

Assemble the set

Include filter paper & chemical

indicator

Sterilize items by STRAD

Sets are ready to be sent to storage zone

Yes

No

Scan the barcode on

crates

Employee log in to the

system

Scan trays for opening the

assembly recipe

Instrumental Instrumental

Generate production label and attach to set

Scan production label (record

sterilization info)

Scan and record the

sterilized set

No Instrumental Instrumental

Instrumental

Take the cart inside the

operating thetreSurgery

Scan barcode on the instrument

sets

Put soiled instruments in crates and cart

Transport to CSD via elevators

Count instruments and check within

system

Leave instruments to

cool down

Verify with checklist

Yes

Transport to sterilization zone

Scenario 2: RFID technology

17

Reprocessing of Soiled Instruments in CSD

Ass

embl

y Zo

ne

Dec

onta

min

atio

n-W

ash

Zon

eSt

erili

zati

on

Zone

OR

-Op

era

tin

g T

he

atr

e

Scenario2: RFID Technology

Soak the soiled

instruments

Disassemble & brush soiled instruments

Put in crate/wrap

instrument set

Steam sterilization

possible?

Sterilize items by steam

Leave sterile items to cool

Take out sets from cart and to the

decontamination

Washable with ultrasonic machine?

Use ulterasonic

Use mechanical

washer

Take clean instruments to assembly table

Check and sort instruments

Assemble the set

Include filter paper & chemical

indicator

Sterilize items by STRAD

Sets are ready to be sent to storage zone

No

Read the RFID tag on crates

Employee log in to the

system

Read crate’s RFID tag for opening the

assembly recipe

Read crate’s RFID tag (record

sterilization info)

Read crate’s RFID tag to record the

sterilized set

No

Take the cart inside the

operating thetreSurgery

Put soiled instruments in crates and cart

Transport to CSD via elevators

Leave instruments to

cool down

Yes

Transport to sterilization zone

Read RFID tag on instrument sets

Verify with checklist

Yes

Simulation with ARENA

• Arena Discrete Event Simulation Software

– Enables modeling and simulation of business processes

– Designed for analyzing the impact of changes involving significant and complex redesigns associated with (logistics) processes

18

Imitate

Application

https://www.arenasimulation.com/

Simulation with ARENA

19 Arena User’s Guide

Building the simulations

Barcode simulation

20

oper at ing t heat r eTake t he car t inside

inst r um ent set sScan bar code on

Sur ger ycr at es and car tinst r um ent s in

Put soiled

t o decont am inat ionf r om car t and t ake

Take out set s

cr at eScan bar code on

Soak br ushDisassem ble_ T r u e

F a ls e

machine

Wash wit h ult r asonic

Use ult r asonic

washUse m echanical

t o cool downLeave inst r um ent s

t o assem bly t ableTake inst r um ent s

r ecipeopenning assem bly

and scan f orLog in t o syst em

sor t inst r um ent sCheck_assem ble_

Assem ble t he setpaper

indicat or and f ilt erI nclude chem ical

wr apPut set in cr at e or

and at t ache t o setpr oduct ion lablel

G ener at e

st er ilizat ion zoneTr anspor t t o

lableScan pr oduct ion T r u e

F a ls e

possible?

St eam st er ilizat ion St eam st er ilizat ion

st er ilizat ionSTRAD

st er ilized setScan and r ecor d

Leave t o cool downzone

send t o st or ageSet s ar e r eady t o

syst emcheck wit hin

inst r um ent s_Count

washer sTr anspor t t o

checklistVer if y wit h

zone

CSD_Decont aminat ion

CSD

f rom O R t o

CLean elevat or

OR-Operating Theatre

CSD-Decontamination

CSD-Assembly

CSD-Sterilization

Traceability with Barcode

ult r osonicAssign set f or

m echnical washAssign f or

st eam st er ilizat ionAssign set t o

st er ilizat ionAssign t o STRAD

O RSet s com es out of

Set s r eady t o st or e

Average time set in system

# sets ready to store

Average cost of resources

0 0 0 0

0 0 0 0

0

0

0

0

0 0 0 0 0 0 0 0 0

0

0

0 0

0

0 00

0 0

0

Nu mb er o f rep ro cessed sets

Ti me14401380132012601200114010801020960900840780720660600540480420360300240180120600

Sets 0

S C A N N E R

S C A N N E R

S C A N N E R

S C A N N E R

0.00

0.00

0.00

RFID simulation

21

t heat r einside oper at ingTake t he car t

set son inst r um entRead RFI D t ag

Sur ger ycr at es and car tinst r um ent s in

Put soiled

decont am inat iont ake t o

f r om car t andTake out set s

on cr at esRead RFI D t ag

Soakbr ush

Disassem ble_ T r u e

F a ls e

machine

Wash wit h ult rasonic

Use ult r asonic

washUse m echanical

cool downinst r um ent s t o

Leave

t o assem bly t ableTake inst r um ent s

assem bly r ecipet ag f or openningand r ead RFI D

Log in t o syst em

sor t inst r um ent sCheck_assem ble_

Assem ble t he setpaper

indicat or and f ilt erI nclude chem ical

or wr apPut set in cr at e

setand at t ache t opr oduct ion lablel

G ener at e

st er ilizat ion zoneTr anspor t t o

st er ilizat ion inf ot ag t o r ecor d

Read cr at e RFI D T r u e

F a ls e

possible?

St eam st er ilizat ion st er ilizat ionSt eam

st er ilizat ionSTRAD

st er ilized sett ag t o r ecor d

Read cr at e RFI D

downLeave t o cool

zonesend t o st or age

Set s ar e r eady t o

washer sTr anspor t t o

checklistVer if y wit h

zone

CSD_Decont aminat ion

f r om O R t o CSD

CLean elevat or

OR-Operating Theatre

CSD-Decontamination

CSD-Assembly

CSD-Sterilization

Traceability with RFID

ult r osonicAssign set f or

m echnical washAssign f or

st eam st er ilizat ionAssign set t o

st er ilizat ionAssign t o STRAD

of O RSet s com es out

st or eSet s r eady t o

Average time set in system

# sets ready to store

Average cost of resources

0 0 0 0

0 0 0 0

0

0

0

0

0 0 0 0 0 0 0 0 0

0

0

0

0

0

0 00

0

0

Nu mb er o f rep ro cessed sets

Ti me14401380132012601200114010801020960900840780720660600540480420360300240180120600

Set

s

0

S C A N N E R

S C A N N E R

S C A N N E R

S C A N N E R

0.00

0.00

0.00

Simulation results comparison

22

30 replications 24hrs each

407

14

341

375

519

16

353

387

0

100

200

300

400

500

600

All resources.busycost

System number out Set.VA time Set.Total time

RFID

Barcode

Traceability system: value proposition

23

Reduce: - Packing time - Storage level - Counting time - Set accuracy

- Free up time for medical care - Proactive alert to ensure sterile process - Reduction of retain surgical instruments

Reduce: - Instrument disappearance - Surgical cancelations - Cost of repeated surgeries - Lawsuits

Toward a smart hospital

With RFID…

– Upstream traceability

– Fast recall

– Patient safety

– Accurate statistics

– Cost neutral

24

What is management’s perception about cost of

RFID and ROI?

Thank you!

UQAM, School of business 315 Ste-Catherine est Montréal (Québec) Canada H2X 3X2

Afrooz Moatari-Kazerouni moatari_kazerouni.afrooz@courrier.uqam.ca