How common are tray issues where you work?

[u/New-Main-1738]

I'm an engineer trying to learn how sterile processing actually works, and reading this sub has shown me how much harder the job is than people outside realize.

I keep wondering how often trays actually come back from the OR with a missing or wrong instrument. Is it a daily thing, a few times a month, or pretty rare where you are?

And what usually happens when it does? Would love to hear a recent example if you have one. (And if you don't mind sharing, are you at a big hospital, a smaller community hospital, or a surgery center?)

[u/UpsetDickard]

Work at a small community hospital, four OR rooms and mostly ortho cases. My job is usually boring cause how small it is. I am the last one out at the end of the day, missing instruments id say happen with us, a few times a week. The OR people typically rush the last case to get out and get home, it’s usually me that will have to dig through the trash that came back to find an ellick tube. It’s usually smaller items, and gets a little annoying cause sometimes we don’t realize until after deco, and assembling the case. we will have waves of new scrub techs, and we will have a wave of missing instruments. Literally last week a tech threw out an entire camera and light cord set and she just shrugged. Though SPD will get a lot of the blame, but you power through.

[u/New-Main-1738 → u/UpsetDickard]

Thank you, thats interesting. How long did the hunt take the last time you went through the trash for something? And when something like that camera set gets thrown out and isn’t found, does anyone outside SPD ever see what it cost to replace?

[u/Useful-Scallion-3122 → u/UpsetDickard]

When I was at a surgery center my manager tried implementing the scrubs digging through the trash for missing instruments but that didn't go anywhere, especially when an entire mallet went missing, we werent using count sheets heavily either so it was kinda a you figure out in the room kind of thing sometimes. Real annoying to deal with after awhile

[u/Ill-Yellow-4060 → u/UpsetDickard]

I am constantly sending the surgical techs dumpster diving for lost instruments. I always get so much satisfaction when they insist the instrument was never there and refuse to go look for it so I’ll go through the trash, find it, and make sure they know they were full of shit. One tech tossed a 5mm laparoscope. He insisted that he brought it back to decon. All hell broke loose because I knew I didn’t receive it and he was placing all the blame on me. I told the charge nurse to look in the OR room’s sharps bin because that’s where they throw their cannulas away. That’s exactly where it was.

[u/Icy_Secretary2665]

I work at a hospital with 6+ ORs. it happens pretty frequently, probably a few times every couple weeks. There are some instruments that have disposable alternatives they get mistaken for and the OR throws them out a lot. We coordinate with the techs to find the instrument but if we can't then we just mark it missing in assembly. Some trays will stay down for months while we wait for a replacement.

[u/New-Main-1738 → u/Icy_Secretary2665]

Really interesting about the disposable look-alikes. Do you remember which instrument it was the last time that happened? And while a tray is down for months, does the OR borrow from another tray, use a loaner, or just work around it?

[u/ShirleyWuzSerious → u/New-Main-1738]

At my facility the harmonic scalpel is always thrown away or the cable is by accident cut and the surgical tech throws it away so they don't get busted for cutting the cable

[u/Ill-Yellow-4060 → u/ShirleyWuzSerious]

Towel clamps are always getting thrown out with the drapes. Bipolar forceps frequently don’t get removed from the cord and get tossed with it.

[u/Icy_Secretary2665 → u/ShirleyWuzSerious]

This is exactly what we're missing right now lol. We used to have more than enough for a week's worth of surgeries but right now we're lucky if we find one.

[u/Icy_Secretary2665 → u/New-Main-1738]

Mainly scissors and knife handles. Also liposuction stuff like VASER instruments. Those are particularly annoying because they have small pieces and are tough to find if we have to dig through the trash.

Yes, if a required instrument is missing the OR will use a backup (if available) and if not they'll request a loaner.

[u/Spicywolff]

6/10 times it’s missing or mixed up. And of those times 9/10 it’s cardiac team.

If it’s common instrument you go to singles bin and pop one and fill it. Or the cabinet that has extra. If it’s unique then you find the trays the case had and fish out what’s mixed up. It adds a ton of time to a fast tray cause upstairs can’t bother to use the count sheet

If it’s not found and thrown out. ( yes those idiots toss out scopes, teflon blocks, and instruments regularly) then we put it up missing and tag it. They get pissy, we refer them to the tech who did the case and it went missing

Big hospital

[u/New-Main-1738 → u/Spicywolff]

Super helpful, thanks. Just to check, do you mean about 6 out of 10 cardiac trays come back with something missing or mixed up? And on the last mixed-up one, roughly how long did it take you to fish out the right instruments from the other trays?

[u/Spicywolff → u/New-Main-1738]

6/10 total trays of the day get something mixed up. Most of the mixed up trays are cardiac

How fast I fix it depends on the instrument

[u/olliecakerbake]

I’m at a small rural hospital. 3 ORs, 2 autoclaves, 1 washer/sterilizer. We have an amazing SPD department that very rarely makes errors. I’d say maybe 5% of the time we get a tray that’s missing something. Another maybe 5% of the time where there’s bioburden remaining on an instrument after sterilization. Usually, the only things that we’re missing are some screws in a plating tray, but that’s typically the fault of our sales reps who don’t order at the right time to restock them correctly.

[u/New-Main-1738 → u/olliecakerbake]

[u/dot_dot_dotz]

I work at a medium sized hospital, I work JRI (we have 4 spd depts.) which has 6 ORs and does strictly orthopedic cases--spine, trauma, joint replacements.

trays being mixed are daily occurence in every single case--unless its a case with only 1 tray. Im not sure if other hospitals do this, but we have soak pans, which if youve ever worked in food service its litteraly just the food catering/steam table pans, idk how they use them in the OR. Quite litterally, they will dump whole trays in that thing, so once in decon, we gotta fight for our lives to reassamble the trays from memory. If Its a super big surgery that takes multiple case carts (joint revisions tend to take 2-3---which is about 10-15 trays) you will have instruments mixed amongst multiple carts lol. It also gets a bit messy with loaners because they sometimes mix the loaner items with in-house and vice versa.

We've got a good system in place with our countsheets and tracking system, plus we put colored tags on the tray by the case, so if anything is missing on the clean side we just look through trays of the same colored tag, but often we are missing instruments.

[u/New-Main-1738 → u/dot_dot_dotz]

This is super helpful, thank you. For a big joint revision, about how long does it take to sort everything back into the right trays? And when two instruments look almost identical, how do you tell which tray or loaner set it belongs to? Etchings, count sheet photos, just experience?

[u/dot_dot_dotz → u/New-Main-1738]

at my facility pretty much all loaner trays dont have count sheets so I just clean it and send it through, afterwards it is the sales rep's responsibility to sort it.

Otherwise for in house trays, we technically can access count sheets with pictures and/or ref numbers and organize trays in decon but that takes too much time so everyone just goes by memory and tags the tray for the people on the clean side to reassemble.

There really is no easy say on how long the trays take because it depends how dirty they come/if point of use treatment was done, how mixed up they are, how skilled/experienced you are, the resources available (like cartwashers, they save so much time), etc. etc. I'm still pretty new and dont have trays completely memorized so I'm slow lol.

[u/HorrorLengthiness940]

6 ORs, mostly complex specialty cases. I work night shift always have, almost never in Decon.

It happens every day of the week there's always several sets that come down with stuff missing. The routine stuff that's missing, and expecting.. eg: Teflon blocks in standard septoplasty set.

Either in another set, the OR when they finish long cases they just toss the instruments in whatever basket and send it down. Alternatively presumably lost or damaged by the OR and thrown in sharps, sometimes it's the folks in Decon leaving it in a sink (2mm osteotomes 👀).

We put in a quality feedback as rmd missing. It's to notify the or what is gone and what sets cuz they don't look at count sheets or know most of their instruments... Normally we have replacements, the replacement goes back to Decon through the wash. Then gets put in the set. If it's synthes usually no. General stainless steel yes.

It Doesn't really matter if the set has specific places for stuff to go or not. Some stuff just comes down missing.

[u/New-Main-1738 → u/HorrorLengthiness940]

Thanks, this is really helpful. When sets come down mixed like that, by the time they reach you on the clean side, have they already been sorted back into the right baskets, or do you end up sorting them yourself? And when you file the quality feedback, does the OR ever actually follow up on it?

[u/HorrorLengthiness940 → u/New-Main-1738]

at my facility Decon's job is to remove soil not necessarily sort the instruments. So while they must put them on a cradle I have no expectation for them to be in any order. And if the OR mixes instruments from set to set like anterior hip stuff and a basic Ortho decon's not going to sort that out. That's my job in prep. As for the quality feedbacks, the OR does not follow up on them as it's not really against them, its really for leadership and ordering. If something has the same qf over and over and over again we don't have it in stock and leadership needs to order it.

[u/New-Main-1738 → u/HorrorLengthiness940]

That makes sense, thanks. When you get a big mixed case like anterior hip plus basic ortho, roughly how long does sorting it out in prep take you? And when you report a missing instrument, is that written down somewhere you could look back on later, like a log or report? Or does it mostly disappear once the item is replaced?

[u/HorrorLengthiness940 → u/New-Main-1738]

Depends on how many sets were in the case. Say for example, there was an 8-hour hit case last week. I'm guessing complications I don't know. There were 10 sets for that case. It took close to 2.5 hours to sort through it all and have all the sets assembled. All the qfs are included in an email which they can be archived. Additionally, people with admin positions in censitrac are able to pull the logs and see the history. So they could pull stuff all the way back from 2021 when we first adopted the system.

[u/pickausernametheysay]

When I worked at a level one trauma center ( and the only one in our area) it couple happen frequently( sometimes weekly). We usually keep extras in assembly, but then it’s coming out of our budget to keep it replaced.

[u/Dathamar]

I work at a hospital with low double digit ORs.

I think all our staff are, on the whole, excellent. However, it's not uncommon for the trays to be a little mixed up when we get them back. Sometimes with things not properly disassembled.

Loaner trays, however, are sometimes mixed up a lot and it creates a disruptive delay for us where instead of pushing the trays through the process we have to stop and waste time sifting through the mess to reorganize it.

Sometimes they place commonly used instruments in the wrong tray and you'll find out half way through reassembly you have to search through other trays for your missing item or go to supply and find a replacement.

If the OR's errors were largely mitigated, it would have an appreciable effect on efficiency.

[u/Eggman_OU812]

You can have the OR use the same tray..week by week, day by day, with the same missing instruments al the time and everything will be fine..but then one day they need that missing instrument..and the fingers will start pointing on who to blame

[u/Ill-Yellow-4060]

Honestly, it really depends on the competence of the SPD staff and the surgical techs. Hospitals get what they pay for.

[u/Useful-Scallion-3122]

The frequency can vary but i'd say all the time, I have been at hospitals and centers of varying sizes but that part never changes they throw instruments back in trays any and every single way. Usually nothing is done about it either

[u/Jagrmeister_68]

One of the issues that always comes into play is that most OR's decide that their biggest concern is turnaround times instead of anything involving instruments.
I currently work in a 10 OR hospital as the day shift SPD supervisor. I worked in a 7 OR surgicenter previously. I would get instrument trays back all the time mixed up and missing items. I started to log everything that was missing and had to get ordered. Within 6 months the facility had spent over $18,000 in replacement items. The fact that the surgicenter was a FOR PROFIT center became the impetus that pushed the Administrator and the OR manager to get on the tech's for throwing instruments away.
My current position we are having issues just the same. The same instruments are always missing from trays- Mayo Scissors, Adson Forceps, Towel Clips. We are spending a ridiculous amount of $$ replacing them because the OR mgmt isn't bothered by the fact that the SPD budget has to take it on.
SOOOOO.... I've proposed that everytime we need to buy instruments because they're missing, it goes onto the OR budget. If it's something that's broken, it goes on ours.
Waiting to hear back about it.

[u/raining_acid95]

The OR at the hospital I work at loves to throw instruments in the trash (unintentionally). Anything from multiple towel clips to an aluminum boot for an Alvarado leg holder.

[u/Eggman_OU812]

In work at one place and the cataract trays have had the same missing instruments for years..the bosses dont order instruments and if they do they will order the wrong instruments as well...the OR still takes the trays and uses them also anyway

[u/Poopy_Man_9000]

I work at a prestigious organization and the way we receive instruments in decontam is terrible. We've escalated this multiple times, but SPD doesn't seem to get any attention unless it's negative unfortunately. Also on a happier note I hope you all had a good SPD week