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Original article
Just-in-time delivery of sterilised surgical instruments
  1. A CP Guédon1,
  2. T J Rakers1,
  3. L S G L Wauben1,
  4. F C Meeuwsen1,
  5. V Hoeijmans2,
  6. M van der Elst3,
  7. J Dankelman1,
  8. J J van den Dobbelsteen1
  1. 1Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
  2. 2Department of Information and Communication Technology, Reinier de Graaf Gasthuis, Delft, The Netherlands
  3. 3Department of Surgery, Reinier de Graaf Gasthuis, Delft, The Netherlands
  1. Correspondence to Annetje Guédon, Department of Biomechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands; a.c.p.guedon{at}


The unavailability of the required surgical instruments at the start of a procedure is undesirable. It causes delays and stress in the operating room (OR), which can lead to additional risks for the patients. Issues with availability of surgical instruments may become visible just before the start of the procedure but are induced earlier in the delivery process. Therefore, efficient and safe supply chain management is essential. Just in time (JIT) is a concept widely applied in industrial sectors to improve efficiency and quality. The aim of this study is to design a JIT process for the delivery of surgical instruments and to assess the potential risks. The JIT delivery process of surgical instruments was designed for a Dutch hospital working with an external Central Sterile Supply Department (CSSD). Hazards (ie, sources of potential adverse events) were identified according to the Healthcare Failure Mode and Effects Analysis (HFMEA) methodology. The risks of applying JIT principles to the delivery of surgical instruments were compared to the risks involved with the current situation of the hospital at the time of this study (supply-driven delivery). The results showed that the total (high-)risk score of the JIT situation was similar to that of the current situation, although the number of (high-risk) hazards was slightly higher. However, almost half of the hazards were ‘controlled’ (when actions to remove the hazard were taken later in the process), in contrast to the current situation in which only about 10% of the (high-risk) hazards were ‘controlled’. The JIT delivery of surgical instruments is expected to present less risks compared to the current situation. The multiple requirements for information technology support and a higher level of trust between the CSSD and OR department should be taken into account in order to improve the supply chain management of surgical instruments.

  • Delivery
  • Economics
  • Orthopaedics

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