Are Bigger Hospitals Safer? Not When it Comes to Surgical Instrument Reprocessing

There has been a tremendous amount of buzz recently over The New England Journal of Medicine (NEJM) article showing that bigger hospitals do not equal better patient outcomes.

Well, welcome to the party NEJM. Those of us cleaning, sterilizing, and supplying surgical instruments and equipment to Operating Rooms in these large hospitals could have told you that a long time ago.

For a host of reasons listed in other articles like these (here and here), merger and acquisitions of healthcare facilities rarely -- if ever -- have a positive impact on the state of things in a hospital's Sterile Processing department. In reality, as the complexity of services grow (whether that is through new service lines such as Robotics or the addition of associated off-site clinic reprocessing), the existing human and capital resources of these surgical instrument reprocessing departments undergo increased strain, become overwhelmed by poorly planned volume increases, and are often confronted with ethical dilemmas when their technicians feel they might be crossing the line into a process that is no longer safe for patient care.

The public would be astounded to know how many surgical instruments are used on them in major US hospitals every day with visible rust stains, deteriorating marking tape, and general disrepair. News outlets in this country wouldn't have enough minutes in the day to cover all the times someone else's bone ends up on a back table in an orthopedic case...every single day. If most accreditation surveyors actually knew what they were looking for in these departments, we'd see so many cases of immediate jeopardy, you'd think Alex Trebek was taking over CMS (may he rest in peace).