Table 1.

Summary of the changes to the current practice following introduction of the 4S program

Management domain	Current practice	Title and details of the 4S program component
Inventory management	Surgical sets included plates and screws Six different surgical sets were utilized in ORIF surgeries (Small Fragments 1 and 2, Elbow, Ankle, PHILOS™ and Tibia [DePuy Synthes, a Johnson and Johnson company])	Standardized Inventory: One standardized surgical set (DePuy Synthes, a Johnson and Johnson company) to be used in ORIF surgeries was established with the number of instruments reduced to create a streamlined set All implants (screws and plates) were removed from sets
Implant management	A non-sterile surgical set model was utilized in which all implants were non-sterile upon delivery to the hospital and sterilized prior to surgery Unused implants would undergo reprocessing and re-sterilization	Sterile Portfolio: All implants were provided in an individual pre-packaged and sterilized format
Safety management	Traceability of individual implants relied on manual processing at the hospital	Safety Certification: All implants were sterilized by the manufacturer and labeled to allow traceability
Stock management	Stock management involved manual processing of data	Service and Advanced Planning: Digital management of stock control was done by in situ barcode reading and the use of an advanced inventory management system to digitalize processes (eSIMS Advanced Inventory Management Solution)