DOI: 10.5061/dryad.ksn02v75s
title: Measuring intraoperative surgical instrument use with radio-frequency identification

description: Objective: Surgical instrument oversupply drives cost, confusion, and
 workload in the operating room (OR). With an estimated 78-87% of
 instruments being unused, many health systems have recognized the need for
 supply refinement. By manually recording instrument use and tasking
 surgeons to review instrument trays, previous quality improvement
 initiatives have achieved an average 52% reduction in supply. While
 demonstrating the degree of instrument oversupply, previous methods for
 identifying required instruments are qualitative, expensive, lack
 scalability and sustainability, and are prone to human error. In this
 work, we aim to develop and evaluate an automated system for measuring
 surgical instrument use. Materials and Methods: We present the first
 system to our knowledge that automates the collection of real-time
 instrument use data with radio-frequency identification (RFID). Over 15
 breast surgeries, ten carpometacarpal (CMC) arthroplasties, and four
 craniotomies, instrument use was tracked by both a trained observer
 manually recording instrument use and the RFID system.
 Results: The average Cohen’s Kappa agreement between the system
 and the observer was 0.81 (near perfect agreement), and the system enabled
 a supply reduction of 50.8% in breast and orthopedic surgery. Over 10
 monitored breast surgeries and one CMC arthroplasty with reduced trays, no
 eliminated instruments were requested, and both trays continue to be used
 as the supplied standard. Setup time in breast surgery decreased from 23
 minutes to 17 minutes with the reduced supply. Conclusion: The
 RFID system presented herein achieves a novel data stream that enables
 accurate instrument supply optimization.
description: Data from the RFID system was recorded, cropped to remove reads
 recorded before and after the reported start and end time of the surgery,
 and written to a .csv. Chronological RFID logs for each surgical specialty
 are in respective folders. The first column is EPC, which is the unique
 identifier of the RFID tag. The .csv entitled 'Decoder' links
 EPC numbers to instrument names for all instruments that were tagged. The
 second column is time. Note that in some RFID logs, there are EPCs that
 are not present in the Decoder. This is because other RFID tags were
 present in the operating room. Ethnography logs are the observers lists of
 used instruments. These lists are inclusive, so if an instrument is not in
 a list, it was not recorded as used in that surgery. Times next to each
 instrument correspond to the onset of use of the instrument. For some
 logs, many unique onsets of use were able to be recorded; for others, none
 were recorded. Two observers simultaneously recorded use in two surgeries.
 In one surgery their observations were congruent; in the other, they
 differed. Differing ethnography logs for equivalent case are denoted with
 the ethnographer's last name appended to the .csv name.
description: RFID log times recorded during the breast surgical oncology pilot
 experienced drift until a clock synchronization was performed before
 surgery 16. The relative times are correct, but the offset for absolute
 time is uncertain. RFID clock drift did not occur in orthopedic surgery or
 neurosurgery.