This article appears in the upcoming March print issue of Surgical Products.

When busy Morristown Medical Center needed to upgrade its cramped and aging central supply area, it pulled out all the stops, investing in high density storage solutions from Lista International. Systematizing the hospital’s surgical instrument storage, preparation, and sterilization area is expected to dramatically improve productivity and accommodate future hospital growth, while maximizing available space and meeting exacting healthcare requirements, regulations, and codes.

Looking To Save Space

Morristown Medical Center, in Morristown, NJ, is a busy and growing hospital with nearly 6,000 employees, including about 1,400 physicians. Part of the Atlantic Health System, Morristown has been undergoing major renovations and upgrades in several areas. One of the largest areas of focus is the central supply (CS) area, which handles equipment and supplies procurement, receiving and storage, as well as surgical equipment sterilization.

According to John Meggs, CS Director at Morristown, central supply serves an essential function in ensuring smooth hospital operations, and is critical for positioning the hospital for the kind of growth it envisions. As Morristown had grown to be the No. 1 area hospital for several specialty services, the central supply area had been somewhat overlooked. Most equipment was 20-25 years old and nearing the end of its useful lifecycle, and hospital administration saw that they could no longer keep up with the total workload. They decided to completely renovate the CS area, and embarked on a $7 million renovation that would bring it up to the highest standards and provide sufficient capacity for future growth. The renovation included Lista high density storage and prep and pack workstations, as well as new sterilizers and new instrument and cart washers.

Meggs explains that he was actually recruited to join Morristown based on his past experience managing four other large CS department renovation projects. Before his arrival, the renovation team had been looking at using standard stainless steel wire carts and wire shelving for storage, but Meggs called upon his past experience to recommend that Morristown focus on increasing productivity and capacity by using high density storage solutions from Lista International.

“I have worked with Lista on several projects over the years,” says Meggs. “It started years ago, when I visited a hospital that had Lista products and fell in love with the concept of using high density storage for saving space, and having shelves built to my specifications so I can further maximize the space I have.”

In addition, Meggs appreciated Lista’s considerable experience in the health care industry, which has a number of requirements, regulations, and codes developed by The Joint Commission that govern such items as the amount of allowable space from the ceiling to top shelf, from the bottom of the floor to products stored, as well as labeling.

Meggs was essentially given carte blanche to come up with the best possible design for central sterile supply. The tricky part was that Meggs was not just planning for today. Rather, he was planning to see if Morristown could add increased capacity as it grows. For example, Morristown currently works on about 100 surgical cases a day, five days a week, and is seriously considering adding two operating rooms, going from 28 to 30 in the next five years.

“We have to look at maximizing space so I can be ready to increase our ability to work on more cases while keeping up with the demand in CS,” he says.

Meggs explains that a lot of hospitals are trying to attract the top surgeons and add specialties, and the system used to pack surgical instruments is dictated by the surgeon and their personal likes and dislikes. The environment changes often, so he needed a storage system that has flexibility, allowing for different tray sizes, as well as the ability to stack containers to maximize use of shelf space.

Maximizing Productivity

To come up with a plan that works best for CS as it is now, while thinking ahead for the future planned OR department expansion, Meggs turned to Scott Wood of Lista and Joe Figueroa of Figueroa Medical & Associates. The Lista team came up with its recommendations after careful review of the workflow, numerous drawings of options, and revisions based on Meggs’ feedback.

The new space includes eight new surgical instrument preparation and packing work stations, where technicians put together sets of instruments that are placed in trays, wrapped and stored, then later placed in the sterilizer.

Technicians begin by taking clean unsterile instruments from the cabinetry, where they are stored in fully adjustable pull-out slotted drawers equipped with labeled dividers and partitions. They select the needed instruments and assemble the case on work stations that are equipped with a stainless steel work surface and an overhead shelving system set up for a flat panel monitor. Supplies are stored under the cabinet. Technicians are also supplied with a magnifier so they can see the instruments to ensure they are completely cleaned, and spot any fragments before instruments are packed and put into sterilization. The work stations also include their own integrated power strips and overhead lighting so technicians can clearly identify and inspect the instruments and supplies.

The technicians then take the instrumentation to the wrapping station, where it is wrapped for sterilization. Unlike the past system, which used individual tables that had wasted space underneath the counter, the Lista system provides storage for all the necessary special wrapping supplies, stored in 84-inch by 57-inch roll-out drawers on two of the four sides. According to Meggs, this system works well because technicians no longer need to walk around looking for supplies, which definitely increases productivity. He says, “The goal is to get everything the technician needs in one place, including tags, arrows, biological indicators, sterilization tape, and filters, so the tray is complete when it’s wrapped and put out for sterilization.”
When the trays come out of the sterilizer, and before they go up to the OR, they are placed in the Lista storage wall system on heavy roll-out trays.  Specialty services are color-coded and CS mimics the color-coding system with its equipment labeling scheme. Container sets are placed in specific locations, using a supermarket aisle type labeling system, so it easy to pick a case for the particular specialty, including all required soft goods.

Meggs had seen this type of system work very well in the other hospitals he has managed. Based on his experience, he knows picking cases will get much easier, faster, and more efficient, once the staff becomes accustomed to the ease of selecting by aisle and bin location. The long term goal is to move towards an instrument tracking system, in which technicians will be able to scan and track an instrument set from start to finish. This will provide the hospital with the ability to quantify efficiency improvements and validate where the set is at all stages of the use cycle.

Meggs also liked that Lista provided a complete turnkey solution, which he says is important in a hospital setting. He explains that Lista was involved with the shipping and brought in people to assemble the products. There was no break in service, as the team came in and assembled the products during the quieter weekend hours. In his view, it is important to know the hospital can delegate a headache for which it does not want to be responsible.

The solution is being implemented in phases. The first phase completed was general storage for the entire central supply area. Phase two was the surgical equipment wrapping cabinetry, including a counter system for storing instruments, counter high cabinets with drawers and stainless steel counters, overhead storage with retractable doors, and a Lista storage wall that provides sterile storage for all sterilized cases. Phase three is the prep and pack work stations.

Meggs figures that the new Lista high density storage system holds about 40 percent more inventory than the same amount of space fitted with wire shelving. The shelving system is also adjustable, so the hospital can mix and match the depths of shelves to respond to the inventory.

“While working with Lista, I was able to refine the design, changing and making additions, including increasing the number of drawers after the first phase,” said Meggs. “It is a work in progress, and never stagnant. I will continue to make changes as we get feedback, and the beauty of working with this type of system is that I can call up Lista and tell them I need this extra shelf, or want to remove something and add something else. They work with you, which is extremely important in a medical setting, where the process is slow, with a great deal of bouncing back and forth. Lista is not just doing things without giving me input – they are open to me showing them what I’d like to do and then giving me options for making it happen.”

What's Next?

The next phase, currently in the early discussion stage, is storage needed to support the two additional ORs. Planning is focusing on how many more trays would be needed to maintain efficiency and ensure that the OR can function 24/7 with no downtime or delays. In addition, Meggs reports that the hospital is evaluating improving storage by adding work tables and shelving at the hospital’s ambulatory central processing department.

While Meggs had to educate hospital management on why it makes long term sense to spend more for the Lista products, everyone is now onboard. They can see the benefits of the high density storage and work stations both in terms of substantial increases in productivity and accommodating future growth. And the fact that they’re painted the beautiful “Morristown blue” just adds to their appeal.

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