Automation in the Sterile Processing Department

Exploring the landscape of SPD automation

Last year, when I asked SP professionals on LinkedIn what topics were most important to them in 2025, SPD automation was first voiced as a topic of interest by Densley Coke, MBA, BSTM, CST, CHL, CRCST, CER, SME, SPD Manager of Northside Hospital and Adjunct Instructor at Gwinnett Technical College. 

“The future of sterile processing department automation in 2025 and beyond is poised for transformative advancements,” said Coke. 

When reaching out to the broader SP community on the topic of automation, I encountered an enthusiastic response, with several experts offering up their insights for this article. 

“Automation has taken a foothold in all our lives and the sterile processing departments within various healthcare facilities is no exception; in fact it’s a welcome addition,” said Nancy Kane, senior product manager, infection prevention and control, HuFriedy Group.

“SPD automation has and will continue to find ways to increase labor efficiency and make things easier for employees to focus on quality outcomes and improve compliance,” said John Kimsey, VP, Processing Optimization and Customer Success, STERIS.

“The power of automation lies in its ability to drive proactive solutions, tackling persistent challenges in the industry,” said Brian Reed, co-founder & CEO, Ascendco Health. “It gives departments a bird’s-eye view of operations while helping staff streamline daily tasks, making it easier to identify patterns and trends effectively.

“Overall, automation will continue to support both administration and technicians in the years to come, and automated equipment will continue to change the landscape of sterile processing departments,” said Hannah Schroeder, clinical education specialist, Pure Processing.

Coke, Kane, Kimsey, Reed, and Schroeder shared examples of where SPD teams are leveraging automation in their processes today.

Data and analytics

“The biggest use of automation in 2025 will be in the data collection, workflow documentation, and decision-making areas,” said Kimsey. “Data automation to augment SPD decision making includes calculating real time priority processing needs, labor needs and productivity results, operational metrics, and even ‘stopping the line’ when an out of process step is attempted. Automation of data collection and compiling that data into real-time actionable reports and events is key to ensuring SPDs are efficient and compliant.”

Schroeder noted how she is seeing more SPD teams utilize data to improve their processes and achieve their goals, stating:

“This can include creative scheduling plans, or change to daily/weekly assignment objectives, even including new roles added to the department. We are already seeing positions such as instrument coordinators who are responsible for maintaining tracking systems, or the added responsibility of daily maintenance for the technician.”

Coke noted how SPD teams are using predictive analytics to “foresee potential equipment failures or workflow inefficiencies, reducing downtime.” 

Kane spoke to “equipment innovations with features such as predictive maintenance and cycle detection.” She cited the example of “modern tabletop sterilizers that provide automated mechanical monitoring and automated cycle recordkeeping.”

Instrument cleaning and sterilization

“While many people may envision robots, cobots or automated guided vehicles as automation, SPD has seen valuable efficiencies through simple automation of tasks such as automated dosing systems at the sink and cleaning of robotic arms with automated sonic and instrument washer cycles,” said Kimsey. 

“Automated washers and sterilizers allow simultaneous batch processing, significantly reducing delays,” Coke commented. “High-capacity, automated sterilizers with integrated monitoring systems improve consistency in sterilization cycles.”

“Biological monitoring products with features like enzyme-based detection can provide results of sterilizer function in minutes rather than hours and automatically provide results, with no interpretation or recordkeeping required,” said Kane. 

“It’s these meaningful but simple areas that have provided benefits to SPDs and will continue to do so,” said Kimsey. “2025 will see continued automation of physical tasks, such as cleaning of robotic arms through robotic assisted cycles in instrument washers.”

Tray assembly

Coke spoke to automation advancements in surgical tray assembly, stating:

“Robots designed to assemble surgical trays with precision are gaining traction, especially in large hospitals. These robots use imaging and AI to detect missing or damaged instruments. Robotic tray assembly not only speeds up the process but also reduces repetitive strain injuries among staff.”

Instrument tracking

In exploring the use of automation in the SPD, Coke pointed to the use of RFID tagging for real time instrument location tracking, explaining how this ensures each item is traced throughout its lifecycle. He described the benefits of this automated technology deployment, stating:

“It enhances compliance with regulatory standards like ANSI/AAMI ST79, enables centralized monitoring through software dashboards, and minimizes errors in instrument handling, resulting in higher patient safety.”

According to Kimsey, instrument tracking systems are poised to harness the most benefits in terms of data analytics, as they “harness large amounts of data while interfacing with front line staff. Automating data collection and then automatically compiling the data to augment human decision-making is already underway.”

Inventory management

“Inventory management, a traditionally manual and time-consuming process, will become more proactive through digitized procurement platforms,” said Reed. “These systems will automate cross-referencing and trigger supplier selection, reducing errors and optimizing spending.”

“Automated inventory replenishment will save time, improve resource use, and enhance decision-making,” Reed continued. “These changes won’t happen overnight, but as industry professionals, we can implement them gradually, ensuring they are both purposeful and sustainable for long-term success.”

IFU adherence, risk management

According to Schroeder, while most think “automation means faster,” the benefits go beyond task efficiency to improved compliance and consistency. 

“Automation as a supporting tool aids in consistently meeting required steps in your sterile processing procedures and manufacturer instructions for use (IFU),” said Schroeder. “With the implementation of automated devices, such as conveyor systems or flushing aids, rather than a ‘faster’ approach we are opening opportunity for time reallocation, to put the manpower behind processes that require more human interaction, like visual inspection or equipment maintenance.”

Reed commented on the use of automated data capture and analytics on SPD risk management, explaining how this approach will “reshape workflows by providing real-time alerts to prevent inconsistency, ensuring adherence to best practice IFUs.”

“On a larger scale, these systems calculate departmental risks and performance metrics, offering full transparency for leadership to manage factors affecting regulatory compliance, surgical schedules, and patient outcomes,” he added.

“Having easily accessible information, like manufacturer instructions for use (MIFU) or instrument/product sterilization parameters via something like product embedded QR codes can also save time and effort,” said Kane.

Impact on SPD teams

Coke stressed how the automation of previously manual processes in the SPD requires change management and new skill sets, stating:

“Automation reshapes job roles; manual tasks decrease, but technical oversight and problem-solving responsibilities grow. Lack of proper training is the primary cause of staff resistance to automation.”

“Department personnel will need to be trained to know and perform processes without the support of automation for when those situations do arise,” said Schroeder. “Technicians’ and leaders’ knowledge bases will continue to expand and develop as they now learn not only standards and processes but also understand their equipment and how it supports compliance in completing process cycles.”

“Automation should be viewed as a reallocation of resources versus an elimination,” said Kimsey. “With current labor shortages, we need to leverage our human talent by the most effective means to add value and allow automation to handle task completion where possible.”

Reed commented on how SPD staffing models will benefit from automation, stating:

“Advanced management systems will enable SPDs to align staffing needs with instrument volume, modeling requirements based on surgical demand. This will improve resource allocation, budgeting, and operational efficiency, ensuring departments are properly staffed to meet fluctuating needs.”

Technical considerations and maintenance

Coke acknowledged how there are always challenges with new technology, including compatibility challenges between new automated systems and existing equipment or infrastructure. Lengthy downtime during system upgrades or repairs can disrupt workflows.

“These require collaboration with IT departments for cybersecurity and network stability,” he explained. 

Schroeder spoke to the “large lift” of maintenance, replacement, and sometimes unexpected downtime that comes with the integration of automated technologies, stating:

“Just like any other mechanical equipment in your departments, your automation will require routine maintenance and inspection.”

She offered this example:

“Dosing and flushing systems often require daily disinfection and calibration to ensure they are performing as they should. It’s important to have a determined cadence for maintenance and follow it so that you can negate preventable downtime.”

Automation investments

When considering where and how much to invest in automation, Kimsey offered this advice to SPD teams:

“You need to review alternatives that make sense for the situation both clinically and financially. Trade shows have displayed automated tray wrapping machines or robots that are fun to watch but financially and operationally are not realistic for current day SPDs.”

The promise and potential pitfalls of automated tray assembly

While researching the topic of SPD automation, I came across a study published in the April 2024 edition of BMC Surgical on the link between errors in surgical trays and lost chargeable operating room (OR) minutes.¹ 

The study, conducted across seven pediatric ORs on an academic healthcare campus, found nearly 87% of all tray errors resulted from failures in visualization (instrument inspection, identification, and function). Researchers estimated the annual lost charges for surgical instrument associated delays in chargeable minutes to be between $6.7M and $9.4M. 

They commented on how the reporting of surgical instrument errors historically relies on cumbersome, non-automated, and human-dependent data entry into a computer database that is not integrated into the electronic medical record (EMR), and called for technological advances in instrument identification, inspection, and assembly. 

I spoke with lead researcher Peter F. Nichol, MD, Ph.D., Medical Director of Surgical Services, American Family Children's Hospital, and Associate Professor of Surgery, University of Wisconsin - Madison, School of Medicine and Public Health, on this study and additional research he is conducting on SPD and OR optimization.

Nichol is a fervent champion of OR and SPD optimization. He and his team work collaboratively with technology providers focused on collecting perioperative data, specifically data related to instrument inventory, usage, and quality issues. With his own data scientist, Nichol has been analyzing this data to uncover the root causes and consequences of failures, including tray errors and their impact on surgical revenue. 

The promise: Efficient and accurate tray assembly supports surgical revenue growth

If 87% of all tray errors in Nichol’s study resulted from failures in humans inspecting instruments, identifying instruments, or evaluating their functionality, why not leverage technology to automate these processes? 

Hospital executives want their surgical teams to perform more cases so they can generate greater revenue. Nichol spoke to technology companies that are leveraging AI to optimize OR utilization, identifying wasted time in scheduling to squeeze in more cases. He pointed to one academic medical center that has pushed its OR utilization from 80% up to 90% by using this data-driven intelligence. 

Surgical teams need their SPD teams to deliver instrument trays faster to support rapid OR turnover and the ability to accommodate more cases in the surgical schedule. 

Therefore, automating surgical tray assembly would reduce the risk for human error and speed the delivery of accurate, complete, functional, and safe instruments to the OR. This supports the OR team in performing more surgical cases, maximizing OR chargeable minutes, and, in turn, generating more revenue. 

On the surface, leveraging automation in tray assembly sounds like a remedy to costly perioperative problems and a driver of greater surgical revenue. But looking deeper, there are critical factors that must be addressed before widespread automation can be implemented. 

Pitfall: Tackling the physician preference card conundrum

The so-called “recipe” for surgical procedures, physician preference cards are notoriously inaccurate, with SPD teams on the front-end assembling trays and carts filled with instruments and disposables that go unused – and on the back end reprocessing these items regardless of whether they were used or not. 

“It is a well-known fact that the biggest bottleneck and stressor for anybody working in SPD is decontamination because the OR throws everything into a pile and sends that jumbled mess of instruments for reprocessing,” said Nichol. “The decontamination technician can’t differentiate between what was used in case and what went unused to focus their efforts of removing bioburden from used instruments because everything is mixed together with bioburden everywhere.”

Nichol acknowledged how automated technology for decontamination is far from reality, leaving the dangerous and undesirable task of manual cleaning to humans. He stated:

“It’s probably hard to come up with an AI technology that can read through a pile of completely disorganized, contaminated, and discombobulated instruments to identify what has and hasn’t been used.”

So, if decontamination is already a bottleneck in instrument reprocessing, with technicians overwhelmed by case cart disasters filled with heaps of used and unused instruments, pushing for increased OR utilization without first addressing physician preference cards bloated with unnecessary instruments will only make matters worse. 

And if the SPD can’t reprocess instruments needed for surgical procedures efficiently and effectively, the OR team won’t have what it needs to perform those cases. 

One case study found preference card optimization could eliminate an estimated 10,000+ hours of personnel labor across multiple departments, most notably in the SPD, by preventing unnecessary item picking, packing, returning to inventory (for unused single-use items), and reprocessing (for reusable items).²

Nichol urges healthcare organizations to invest time in understanding instrument utilization so they can cleanse preference cards of unnecessary items. He described his own work in this area:

“We examined instrument utilization for a handful of procedures in our orthopedic hospital. When we looked at a single surgeon and the instruments they use for total hip procedures, there were three or four different patterns of trays with a 5-10% variation in instruments per tray. We determined that if we could establish a single tray that factored in these slight variations, we could eliminate 67% of instruments on that surgeon’s current trays. Downstream, that means far fewer instruments coming into decontam for reprocessing.”

Pitfall: Lack of quality issue reporting

Even with accurate physician preference cards and streamlined instrument trays, quality issues can still occur. While most OR or SPD teams acknowledge they have some level of tray errors, Gregory Agoston B.S., M.B.A., CRCST, LSS, VP Client Services, SpecialtyCare, said few truly understand the extent of the problem. 

“The reality is that most hospitals don’t understand the quality of their surgical instrument trays because they lack an efficient and effective way to track quality from the standpoint of the end user, which is the OR team,” Agoston explained. 

Based on data captured and analyzed by SpecialtyCare, fewer than 20% of SPD related quality issues are reported in hospitals. Agoston described the typical series of events in hospitals today:

“A tray with some kind of instrument issue arrives in the OR forcing the surgical team to fix the problem. Maybe they request a new tray or get what they need from a peel pack. Their priority is to do whatever they can to move forward with the case, perform it effectively and safely and not disrupt that day’s surgery schedule. Often, they don’t have or don’t want to take the time needed to manually report the issue.”

It is a chicken and egg scenario – perioperative teams need automated technologies that make it easy and efficient to document quality issues and identify and address root causes (e.g., a specific tray that is troublesome, a specific SPD technician who needs retraining), but they don’t have the data-driven evidence to convince hospital executives of the extent and cost associated with the errors. If hospital administrators understood the true cost of SPD related errors, they would be more willing to invest in enabling technologies. 

The team at SpecialtyCare is shedding light on these issues and driving the adoption of automation in this area through its research and collaboration with perioperative teams throughout the U.S. 

“Once we implement an automated tracking system for quality issues, a hospital’s reported error rate will generally double, and in some cases triple or quadruple,” said Agoston. “We worked with an SPD manager responsible for two large community hospitals where the OR teams reported about 10 quality issues per month. We implemented the tracking technology and in two weeks’ time, one hospital OR team alone reported 84 tray issues. That prompted a call to us from the healthcare organization’s CFO requesting help to fix the problems.” 

The crisis compelling hospitals to act on SPD automation

When asked how to secure buy-in from hospital executives to invest in SPD process optimization, including automation, Nichol said, “the Boomers are going to drive all this.”

“The Baby Boomers are the largest population, they are not in great health, and they will want orthopedic, heart, and cancer procedures in the midst of the collapsing labor market,” he stated. “As they age, the Boomers are switching over to Medicare Plus, which has terrible reimbursement. When you start adding up the math, if hospitals don’t find a way to be more efficient, they aren’t going to survive.”

Nichol estimates healthcare organizations lose about $50B a year in their SPDs, not including the cost to replace lost instruments. He stated:

“I believe the most successful non-profit healthcare organization made $560M in revenue last year. That is dwarfed by $50B in SPD losses, correct? If we could stem those losses across the board, hospitals would start running much closer to the black.”

So how do we go about driving change now? 

“We start talking about it,” Nichol explained. “Using social media and other platforms to talk about the billions of dollars hospitals are leaving on the table today.”

Follow Nichol on LinkedIn to watch his video series, “The Imminent Collapse of Healthcare.”