Improving operating room and surgical instrumentation efficiency, safety, and communication via the implementation of emergency laparoscopic cholecystectomy and appendectomy conversion case carts

In the perioperative environment, communication, safety, and efficiency are paramount to ensure the effective delivery of patient care. Often overlooked, however, is the role that surgical instrumentation plays in these aspects of perioperative care. Through an analysis of the sterile processing environment at Massachusetts General Hospital (MGH), we identified a large amount of instrumentation being cycled unnecessarily throughout the system. This pattern was particularly notable for laparotomic equipment that is sent to almost all laparoscopic cases so that it is available in the event of conversion to laparotomy. Prompted by this analysis along with the high case volume and low conversion rate of laparoscopic cholecystectomies and appendectomies, we redesigned the laparotomic instrument supply chain for these procedures by placing all laparotomic conversion instruments on dedicated emergency case carts. In one month following implementation we avoided cycling nearly 15,000 pounds of unused instrumentation through the perioperative environment and have increased staff safety and communication among perioperative leadership.