​​​​Nimfa Velez
Nimfa Velez, Surgical Instrument Processor, Central Processing Department at Toronto Western (Photo: UHN)

Staff in the Central Processing Department (CPD) at Toronto Western Hospital are so good at their jobs that you've probably never even heard of them.

The CPD cleans and sterilizes all the scalpels, forceps and sundry tools used in surgery. It is an exacting job – a bone fragment as small as a grain of sand missed during cleaning can cause a deadly infection.

Altogether there are more than 4,000 trays, each one containing dozens of different instruments ranging from scalpel handles to power drills.

A surgeon may need as many as 15 trays for one operation. Sometimes the team has several hours to pull together the order, but when a trauma victim needs surgery they have only minutes.

"When we get an urgent call from the OR, it's a life-or-death situation," says Sherryl Merritt, Manager, CPD, Toronto Western Hospital.  "Those orders are always top priority for us."

Did you know?
  • More than 13,000 surgeries are performed every year at Toronto Western Hospital.
  • The Toronto Western Central Processing Department maintains more than 4,000 surgical trays.
  • Some trays weigh, more than 13 kilograms (or as much as a bor​der collie).
  • Surgeons require as many as 15 surgical instrument trays for every procedure, each tray containing dozens of individual tools.
  • Tools are completely disassembled and examined for pieces of bone no bigger than a grain of sand.
  • A tray is decontaminated in a washer/disinfector, then set up for sterilization which requires as long as four hours.​

To cut the time it takes them to prepare an order, the team reorganized the inventory in the department.

Moving the most frequently used supplies for spinal surgeries to the front of the aisles, and the less-used items to the back, reduced the average distance travelled by more than half.

"There's no way our manager could have figured out where to put everything," says Nimfa Velez, surgical instrument processor, CPD. "We're the ones that know what gets used the most and where it makes sense to put them."

Merritt says: "They've done a way better job optimizing the layout than I ever could."

Observations from the Lean coaches working with the team revealed that they were interrupted five to 10 times an hour on average with calls from the OR requesting additional equipment for a procedure in progress.

The team worked with nurses from the OR to analyze two weeks worth of data. The most frequently requested items are now on a cart in the centre core and easily accessible for nurses when needed, cutting the number of calls for those items by almost half.

"We can't be siloed, we need to work hand in hand with OR staff in order to meet their needs," says Merritt. "They are wonderful about working with us to do that."

During the event, the OR team challenged CPD to set a goal of turning around all urgent cases in 15 minutes or less. The CPD team didn't think that was possible but the results so far speak for themselves: 97 per cent success.

"Big change isn't easy but I'm so proud of the way my team has embraced it," says Merritt.

Toronto Western CPD Team
Toronto Western CPD Team: (L to R): Nimfa Velez, Surgical Instrument  Processor; Lori Fredericks, OR Patient Care Coordinator for Spine; Maria Mendonca, Surgical Instrument Processor; Michael Gabate, Surgical Instrument  Processor; Oliver Furness, Lean Process Improvement Coach; Lystra Shah, CPD Educator; Roger Ruaro, Lead Hand Surgical Instrument  Processor; Sherryl Merritt,  Manager, CPD; Noel Talaver Surgical instrument Processor; Laura Prieto, Lean Process Improvement Coach; Renata Gurdak, Surgical Instrument Processor.
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