Just-in-Time Surgical Case Carts to Improve Operating Room Efficiency

Just-in-time (JIT) principles are widely used for inventory management, including in healthcare to optimize surgical material purchasing. However, JIT has yet to be applied to the preparation of surgical case carts, containing all the material needed for a specific surgery. These are typically assembled one day in advance, increasing the risk of losing sterility, incomplete carts due to ongoing material use, and corridor congestion. In collaboration with a Belgian General Hospital, we explored the feasibility of JIT case carts, where materials are gathered just before surgery. Our study began with direct observations to identify challenges and opportunities. We then used simulation to evaluate 576 JIT-implementation alternatives, varying in buffer type and staffing schedules. Of these, the 217 alternatives that ensured timely readiness in the simulation were benchmarked using a data envelopment analysis with three outputs (buffer efficiency, required corridor space at peak hours, and overall space needed throughout the day) and one input (personnel costs). Seven alternatives emerged on the efficiency frontier, with one ultimately implemented after two pilot studies. Compared with the standard practice previously used, our improvement initiative led to a 67% cost reduction, reduced congestion in corridors, the elimination of incomplete carts, and a decreased risk of contamination by avoiding the stacking of materials. Furthermore, the new method does not require any nurses, so their availability for their core tasks increases. Overall, the JIT approach enhanced surgical logistics and addressed nurse shortages, making it a promising innovation for hospital efficiency.

History: This paper was refereed.

Funding: This work was financially supported by the Academic Research Fund, provided by the Flemish Government (Department of Economy, Science and Innovation).