A pain-free way to switch instrumentation
A pain-free way to switch instrumentation
Laparoscopic instrument service saves money, time
North Fulton Regional Hospital in Roswell, GA, discovered a painless way to switch from disposable instrumentation to reusables and to increase efficiency in laparoscopic cases at the same time.
The secret: A new service provides laparoscopic equipment and technical expertise in the OR. The equipment and instruments are owned by the firm, which means the hospital or surgery center can cut its capital budget for purchases and repairs, says Linda Boring, RN, CNOR, director of surgical services at North Fulton Regional.
Before each procedure, a company representative helps set up the case with laparoscopic instruments, then remains in case the equipment needs adjusting or the staff needs technical assistance. The rep removes the instruments during room turnover, takes them to central processing, and decontaminates and sterilizes them.
For Boring, that’s like getting an extra staff person. She also appreciates having someone with technical expertise on hand. "When the picture becomes less than perfect, they’re experts in being able to pinpoint whether it’s the CO2, the light source, or the lens being fogged up," she says. "They can correct problems immediately so the doctor doesn’t get frustrated. It causes the case to go very smoothly."
The Surgical Resources of Atlanta currently offers the service in Atlanta and is expanding to Miami, Minneapolis, and Charlotte, NC. A similar program is available from Endoscopy Specialty Inc. (ESI), a division of Pilling Weck, based in Research Triangle Park, NC. The ESI service is available in Missouri, Florida, New York, North Carolina, California, Indiana, and elsewhere in the Midwest and is rapidly expanding. (For contact information, see source box, at right.)
Surgical Resources charges $360 per procedure to provide all laparoscopic instrumentation and the technical person who remains with the equipment. ESI’s per-procedure charge varies depending on the extent of equipment and instrumentation provided to the facility. ESI requires a minimum of 500 cases per year.
While this service sounds like a luxury, representatives from both companies that provide the service say it can result in substantial cost savings.
"I had to justify this to administration when I first asked to use this service," says Boring. Initially, she stressed that it would enhance physician satisfaction. The company learns the preferences of the doctors and sets up the equipment as they like it. The service, including the troubleshooting help, makes cases run more smoothly which means physicians love it, she says.
Although the hospital already had made a partial shift from disposables to reusables, the service enabled a further switch, which reduced capital purchases.
"We were constantly sending our scissors to be sharpened and instruments to be repaired," she says. "[The service] takes care of all of that." Surgical Resources even bought some of the hospital’s laparoscopic equipment. The company guarantees that its equipment will work and is responsible for all repairs.
After six months, Boring was able to demonstrate a cost savings, but she notes that some advantages are hard to quantify. "There’s an extra person in the room who’s helping set up the cases," she says. "That extra person knows the doctor’s preference as to where the doctor wants the camera set up. So there’s some consistency."
Much of the cost advantage of the laparoscopic service involves the shift to reusable products, Boring says. That alone makes the laparoscopic service economical, says Dennis Kogod, vice president of sales and marketing for Pilling Weck.
When hospitals or surgery centers are considering the service, Pilling Weck conducts a cost analysis to compare the cost vs. the savings that can be produced, Kogod says. The overall savings depends on variables such as the number of cases and the amount of disposables that are used. "We want to give hospitals enough information so they can decide whether it’s worthwhile to undertake this project," he says. "Our experience has been that we have been able to significantly reduce the cost per procedure based on hospitals previously using disposable products or a hybrid of disposable and reusable."
Try new procedures without capital risk
Beyond the direct cost savings, the laparoscopic service offers a way for hospitals or surgery centers to try new procedures without making a major capital investment, Kogod says. For example, the introduction of laparoscopic nissenfundoplication required an investment in new equipment. "If [same-day surgery managers] decided at some point it wasn’t a good venture for them, they wouldn’t have bought any instrumentation," he says.
Physicians aren’t required to standardize their instrumentation with the laparoscopic service, but they may need a shift in practice if they are accustomed to using disposables, says Terry Templeton, president of Surgical Resources. Ultimately, physicians are won over by the benefits of the service, he adds.
"We guarantee the doctors that 100% of everything is going to work 100% of the time," he says. "Once the surgeons understand that this program is to their benefit, they’re pretty agreeable to make some changes in what they want [to use]."
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