What it takes to succeed in the new millennium

Conference targets disposables, redesign

The two pairs of laparoscopic scissors have the same steel blades, but the "disposable" one has plastic handles, and the "reusable" one has steel handles. If you could sterilize the disposable scissors for half the price of buying a new pair, would you do it? Is it safe and ethical?

Those questions lie at the heart of the controversy over reprocessing disposable items. To ensure their programs’ survival well into the next century, same-day surgery managers want to save money while maintaining the safety and quality of patient care. Some vendors, meanwhile, cry foul over the practice. That issue will be among those debated at an upcoming conference, Balancing Cost and Quality: The Secrets of Successful Ambulatory Surgery Programs. Sponsored by Same-Day Surgery newsletter, the conference will be held March 14-16 in Atlanta. (For more on the conference, see source box, p. 142.)

"Out of reimbursement and cost issues, a new industry has been formed that is possibly cutting into the profits of some of the bigger [medical supply] companies," says Vern Feltner, president of Alliance Medical Corp., a reprocessing firm with offices in Asheville, NC.

In this cost-conscious era, bucking the status quo can be the key to survival. The SDS conference will prepare you for the next millennium as managers share their paths to greater efficiency.

You may think there’s no way to squeeze more money out of your costs. But conference speakers such as Feltner may make you think again. Reprocessing a single-use item costs about half as much as purchasing a new replacement, he says. For example, a surgical saw blade may cost $40 new; a reprocessor would charge $20 to sterilize, sharpen, refurbish, and inspect a used one.

"Every device is 100% inspected for cleaning, functionality, and sterility," he says. "It’s guaranteed, and the facilities are indemnified against liability," Feltner says. "Each facility gets its own instruments back."

The reprocessing industry is regulated by the U.S. Food and Drug Administration. "There has never been a patient injury. There has never been a lawsuit [related to reprocessing disposables]," he says. "It’s not surprising that’s true, because we’re not talking about reprocessing pacemakers. We’re talking about reprocessing very simple instruments that have been reprocessed for years."

In fact, Feltner asserts that disposables were created by the generous cost-plus reimbursement of the 50s and 60s, in which hospitals fared better with new supplies than by attempting to recoup reprocessing costs. "Many of these products they were buying that were labeled single-use were the very same products that they were buying as reusable," he says.

Getting a handle on Y2K concerns

Jim Keller, MS, director of the health devices group at ECRI technology assessment firm in Plymouth Meeting, PA, will demystify the year 2000 (Y2K) bug. SDS managers can avoid unnecessary costs as they review equipment for Y2K problems, Keller says. "A lot of hospitals will use the Y2K problem as an excuse to buy a new piece of equipment when it’s not really that much of a problem. There are going to be some legitimate times when a device needs to be replaced or upgraded. But there will be other times when there’s an easy work-around."

You may think the Y2K bug won’t bite you. But anything that has a computer chip and a date could be affected when the millennium arrives. That means everything from scheduling and billing software to devices such as pulse oximeters, infusion pumps, and imaging equipment. Same-day surgery managers need to identify equipment that uses a date and verify, through vendors, that the product is not susceptible to the Y2K problem, he says.

In some cases, a monitoring device such as an ECG recorder may print the wrong date, recognizing "00" as 1900. A nurse could scratch out the incorrect date and initial the change. In other cases, equipment may use the incorrect date to calculate a patient’s age and come up with a negative number; that could cause the program to lock up.

"You can’t ignore it," Keller says of the Y2K problem. He acknowledges that the biggest barrier for same-day surgery managers may be finding time to contact vendors for each of their items. But if you ignore this veritable time bomb, your other efforts to create efficiencies will be for naught.

Fast-track’ patients move past phase 1

Other cost-saving ideas may not be as dramatic as the reuse issue. But by examining your processes, you may improve patient care, satisfaction, and efficiency. At Forrest General Hospital in Hattiesburg, MS, clinical nurse specialist Jan Odom, MS, RN, CPAN, FAAN, has "fast-tracked" some patients through recovery, allowing them to bypass phase one. The use of shorter-acting anesthetic agents, conscious sedation with local anesthesia, and less-invasive surgical techniques enables patients to spend less time in recovery.

But simple changes also can have an impact, Odom says. For example, making sure prescriptions and physician orders are available at the time of discharge enables patients to leave when ready. Pre-op education can prepare patients for the recovery room. "You’re trying to make your processes more cost-efficient," she says.

By moving patients more efficiently through your center, you may free time in your OR schedule and increase your caseload, she says.