A robotics company specializing in medical applications suggests
that hospitals can benefit from lessons learned in lean manufacturing.
Every hospital has a sterile processing department where in an average month it can process more than a million surgical instruments. Processing hundreds of types of instruments with very similar characteristics requires an extensive learning curve on the part of employees. It can take an employee up to six months of training to be able to differentiate between the multitudes of surgical instruments. This fact, coupled with the repetitive assembly-line nature of the work, results in a very high employee turnover rate. The sterile supply process is a labor-intensive and costly process that directly affects the hospital's main profit center, the operating room (OR). Hospital administrators are constantly dealing with problems within the department, including counting mistakes, delays, broken instruments and the potential for unsterile equipment entering the OR. These problems directly affect scheduling, costs and even patient safety. Administrators who are tasked with lowering costs and increasing efficiency while maintaining patient safety are constantly looking at improving the sterilization process.
One company with direct ties to several prominent hospitals recognizes that the sterile instrument process is essentially an assembly line. Robotic Systems and Technologies (RST), of Bronx, N.Y., suggests that hospitals can benefit from lessons learned in manufacturing by using the tried-and-true automation techniques manufacturers employ to improve efficiency and quality.
“When you think about it, the sterile processing department's tasks, for the most part, they consist of counting, sorting, inspecting and processing instruments, just like an assembly line,” says Dr. Michael R. Treat, associate professor of clinical surgery at the College of Physicians and Surgeons of Columbia University, an attending surgeon at the New York-Presbyterian Hospital and founder of Robotic Systems and Technology. “Automation can perform these tasks precisely, automatically and reliably 24 hours a day, seven days a week, allowing administrators to cut costs, re-deploy valuable employees to more challenging tasks, reduce errors and ultimately protect patients.”
RST, with the help of grants, initial seed funding from Columbia University and private investors, set out to put a team of engineers on the task of researching and developing ideas for using automation to help hospitals.
In a hospital, surgical instruments come in, are put into inventory, used in operations, are counted and accounted for after the operation, are then sent to sterile processing and back into inventory where the process repeats. This is a logistical challenge for hospitals. Missing or broken instruments can cause serious delays in the OR. Delays can cause patients to be under anesthesia for longer than necessary. Poor instrument counts can lead to instruments being left behind, possibly in a patient. Considering these factors, there is tremendous value in having a system less prone to human error in the process to do instrument prep and pack. RST sees instrumentation processing as an ideal location to apply lean manufacturing principles, and utilizing robotic techniques is a logical extension.
The company developed the PenelopeCS system to help automate key functions in the hospital's sterile supply department. The system uses RST's Bagel software and vision system and an Adept Viper six-axis robot from Adept Technology. The Adept Viper six-axis robot is a high-performance articulated robot designed specifically for precision applications. The robot is fitted with a magnetic-end effector, allowing it to pick up the instruments.
A hospital's sterile processing department has a dirty side, where instruments are washed down and disinfected, and a clean side, where they are prepped, packed and sterilized in an autoclave. Working on the clean side of sterile processing, the PenelopeCS robot performs counting, sorting and inspecting of instruments. The robot ensures that each instrument tray sent to the OR contains the correct instruments per the count sheet and that they are all in good working order. Furthermore, as these instruments are loaded, PenelopeCS will seamlessly update the hospital's inventory control system to provide traceability while reducing the workload on sterile supply staff.
The company's engineers have developed a robust and sophisticated robotic control language called Bagel. The Bagel software allows PenelopeCS to formulate high-level goals, such as unloading trays of instruments or sorting instruments into stacks, and create a series of individual steps to accomplish those goals. If the operator interrupts PenelopeCS in the middle of this process, the system will remember the preempted goal and the last completed step so it can resume the process after taking care of the operator's request. RST has also used Bagel to capture an extensive knowledge base of information about surgical instruments: their types, shapes, synonyms, physical characteristics and so on. PenelopeCS can use this knowledge base in conjunction with a proprietary machine vision system to identify surgical instruments. Third-party identification systems can also be integrated into the system to use barcodes to identify individual instruments.
“From our research, we estimate that hospitals adopting the Penelope CS system will be able to improve quality, utilize labor more efficiently and reduce the costs of processing surgical instrument trays by 23 percent,” says Dr. Treat. “We further predict that hospitals can expect a return on investment in less than 18 months.”
RST has many other potential hospital robotic applications in development, including an inspection application to make sure instruments open and close properly, are sharp and can cut. Other RST applications include an OR surgical assistant that can assist the surgeon by handing him/her the instruments he/she requires by utilizing a voice-recognition system.
There are at least 5,800 hospitals in the U.S. alone that could benefit from this technology. A pilot program is in progress at a prominent New York hospital.
Rush LaSelle is director of worldwide sales and marketing,
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