5 Strategies to Ramp up Elective Surgical Procedures

COVID-19 has had a profound impact on patient volumes at healthcare facilities across the nation and has hit operating rooms (ORs) particularly hard. Many health systems suspended elective surgical procedures, and the fear of contracting COVID-19 led many patients to avoid surgical treatment. This resulted in a near 70% reduction in elective surgical procedures nationwide in the last three months. As the acute risks of overwhelmed critical care capacity begin to ebb, hospitals &#; and patients &#; are eager to resume elective procedures. Managing the rapid ramp-up of surgical volume to regain lost revenue is a challenge, but providers also need to focus even more on how to lower cost per case in order to regain lost margin on surgical services.

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To get a better sense of how hospitals are looking to ramp up their elective surgical procedures and lower costs, we reached out to OR staff across the country to capture how they are planning for the weeks and months ahead.

Key Focus: Maximizing OR Throughput to Handle Surging Surgical Volumes

Hospitals expect elective surgeries to increase to 80% of pre-COVID-19 levels by the end of . How quickly surgical volume rebounds is still unknown, but even if patients return en masse for elective surgical cases in the months ahead, hospitals will face the challenge of rapidly mobilizing the resources, staff and space needed to meet this potential surge in case volumes. Surgical equipment availability &#; including surgical lasers and the technologists needed to operate them safely &#; will play a large part in this.

Surgical lasers are some of the highest-value tools in the hospital, delivering high-revenue treatments. But the complexities of scheduling, operating and meeting increasingly stringent compliance requirements for surgical lasers can lead to breakdowns and inefficiencies &#; creating the bottlenecks that operating rooms are trying to avoid.

To that end, here are five strategies to help optimize OR throughput by focusing on the availability and utilization of surgical lasers and other critical surgical equipment:

1. Stack cases based on specialized surgical equipment: OR managers know that case stacking is the most efficient means to mobilize all of the factors that play a role in a surgical procedure and can get patients through the operating room faster. Taking an equipment-focused approach to case stacking can yield greater efficiencies:
   • Grouping together cases that require lasers and other specialized surgical equipment minimizes the need to set up and tear down different lasers and equipment for different patients. This can save hours of valuable time.
   • This approach also yields efficiencies with physician and technician time. We all know that different physicians and laser technicians have different credentials and skills. This equipment-focused approach to case stacking reduces the need to adjust the room or patient schedule based on the available physician or laser technician.

2. Don&#;t buy more &#; rent to meet variable case demands: Surgical lasers are high-value tools &#; but they&#;re also expensive to purchase and maintain. ORs know they need to have flexible and reliable access to a broad range of laser technologies in order to handle the ebbs and flows of surgical volume in the coming months. But rather than buying additional lasers to handle peak case load, savvy hospitals are turning to trusted rental providers as a smarter, more cost-effective option:
   • Local surgical laser rental providers can deliver both the equipment and technologists needed to quickly scale services without having to buy more resources.
   • Even if facility-owned equipment can handle surging caseloads, many hospitals do not have enough certified laser operators to meet the expected uptick in case volumes. Leading rental providers offer technician-only services to offer a flexible labor option to cover any temporary staffing gaps to operate your owned surgical lasers.

3. Cut costs on your surgical equipment maintenance and repair: Surgical lasers are just one type of specialized surgical equipment that can become a bottleneck as surgical caseloads ramp up. Ensuring that other types of surgical equipment and instruments &#; such as endoscopes, ophthalmic, endo/lap, etc. &#; are maintained and repaired quickly to meet a surge of cases will be critical. Keep in mind:
   • Surgical equipment maintenance and repair is no small budget line item. While having the original equipment manufacturer (OEM) provide repair and maintenance service is one option, independent service organizations (ISOs) can provide the same quality while offering meaningful costs savings.
   • Many of these ISOs provide mobile repair options &#; arriving onsite at your facility to service and/or repair instruments to make sure your OR doesn&#;t experience any delays. Typically, this includes providing any necessary loaners while equipment is being refurbished.

4. Keep nurses focused on providing patient care: Many hospitals rely on nurses to stand in as laser technicians for surgical cases. This presents a number of problems &#; which are only intensified by the challenges of the COVID-19 pandemic:
   • Laser operators are required to be trained and certified on every procedure type by surgical laser technology. Often, nurses don&#;t meet the required credentialing to operate lasers for surgical cases. This is not only a major compliance risk;
   • More hospitals are leveraging on-demand support from certified and highly experienced third-party technicians to pull nurses out of laser tech responsibility. This also relieves nurses of the time-consuming burdens of case support, including set-up, tear down and laser log documentation. This approach can give nurses approximately 1.5 hours per case, on average, of time back &#; which can be spent providing patient care.

5. Go to the patients &#; mobilize lasers across multiple sites: Laser utilization is highly variable even during a normal course of business. Surgical lasers can sit unused for extended periods of time in a given facility if there are no planned cases. At the same time, a member site may have a backlog of procedures because they do not have that technology available &#; or do not have the certified technicians to support the case. Addressing these supply/demand misalignments can prove difficult for health systems to manage on their own &#; both because of the complexities of schedule optimization and the complexities of location-specific budgeting and billing.

Leading providers of surgical laser rental and support can help hospitals mobilize surgical lasers and technicians across adjacent locations &#; or to regional facilities &#; delivering a cost-effective solution to meet variable case demands. Health systems and IDNs are increasingly adopting this approach and successfully increasing utilization of these high-value, high-revenue tools.

Looking Forward: Adapting to a &#;New Normal&#; in the OR

The COVID-19 crisis continues to challenge our national healthcare system in new ways. As the acute risks and restrictions from the pandemic subside, hospitals and clinics will face an even larger and more complex challenge: dealing with rapidly rising patient volumes &#; while seeking to reduce their cost per case while not compromising infection control and protections for patients and staff.

Agiliti is proud to partner with hospitals around the country in tackling this challenge head-on. To help meet the increase in elective surgical procedures, we&#;re strategically positioned to provide:

• Surgical

  laser rentals

  and on-demand certified laser technicians across the U.S.
• Surgical instruments and endoscopic equipment

  repair and maintenance

  through our Mobile Instruments Service and Repair business
• Repair and maintenance of common surgical equipment, including anesthesia devices, ultrasound, surgical tables, lights and more.

Agiliti also provides hospitals a comprehensive range of rental, clinical engineering support and onsite medical equipment management to help ensure clinical teams have the right equipment when and where it&#;s needed most.

Learn more by contacting an Agiliti equipment expert today.

Does investing time and money into endoscopic and laparoscopic surgery add up to a win for small veterinary practices? (Shutterstock.com)Why they did it

Client demand for endoscopic and laparoscopic surgery is on the rise-especially for routine procedures like an ovariectomy (OVE) and a prophylactic gastropexy-thanks to their relative safety and their reduced pain, length of recovery and incidence of surgical site infections.

But there's a catch: The learning curve and costs associated with training and equipping a clinic to provide endoscopic and laparoscopic surgery are steep, which may be why they aren't widely used in practice. We veterinarians need to be convinced it's worth the investment.

This study sought to evaluate the economic and clinical feasibility of using rigid endoscopy and laparoscopy in small animal general practice by comparing investment costs with revenue generated during the first 12 months of use in a single small animal practice.

What they did

Over the course of one year, researchers followed the veterinarians in a two-veterinarian (one practice owner, one associate) small animal practice as they trained in rigid endoscopic and laparoscopic procedures and subsequently performed 78 endoscopic procedures. The researchers collected information about the animals from the owners, and the cost of training and equipment was evaluated in light of revenue, complications and client satisfaction. 

Study definitions:

Revenue: &#;The gross fees generated from the initial appointment and examination, the procedure (including anesthesia), hospitalization, analgesia, and related medications.&#;

Major intraoperative complications: &#;Complications necessitating conversion to an open procedure, blood transfusion, or reoperation.&#;

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Minor intraoperative complications: &#;Any complications that did not require conversion or notable intervention such as blood transfusion.&#;

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Postoperative complications: &#;Inflammation, incisional infection, seroma formation, herniation, or documented presence of an ovarian remnant after laparoscopic OVE.&#;

Neither veterinarian had any previous experience or training in endoscopy or laparoscopy. The practice-owning veterinarian completed two days of one-on-one, in-house training with a board-certified surgeon and was assisted by the surgeon in performing four laparoscopic procedures. The practice's associate veterinarian participated in two days of continuing education training at a separate training site and was assisted by the practice owner during her first five procedures.

All patients that underwent laparoscopic and endoscopic procedures during the year following the two veterinarians' training, including OVE, cryptorchidectomy, gastropexy, visceral biopsy, otoscopy, rhinoscopy, vaginoscopy and preputial exploration, were included in the study. All patient information-including history, signalment, surgery time and complications-were recorded, and intraoperative complications were categorized as major or minor.

What they found

Seventy-eight laparoscopic and endoscopic procedures were performed on 73 animals by the two veterinarians during the study period.

Surgery time: Forty-four laparoscopy OVE procedures were performed with a mean surgery time of 64 minutes (± 20 minutes). Thirty-four of these were performed by the practice owner with a mean time of 59 minutes (± 16.5 minutes). The veterinarians performed five laparoscopic OVE with prophylactic gastropexy procedures with a mean surgery time of 73 minutes (± 34 minutes) and 19 video-otoscopic procedures with a mean surgery time of 42 minutes (± 24 minutes).

Client satisfaction: Client follow-up, which was conducted at the time of the follow-up examination or by , revealed that 49 of the 73 clients were satisfied with their pets' recovery. The other 24 clients were unable to be contacted. 

Costs: Primary equipment costs were just over $10,675 per year and were financed via a five-year lease. Other disposable items cost $995 for the year, and training required another $3,140. Total costs came to $14,810.

Revenue: The total amount of revenue generated from endoscopic and laparoscopic procedures during the year-long study period was $50,424.

Complications: The 54 laparoscopic surgical procedures resulted in 12 minor intraoperative complications. No major or postoperative complications were recorded.

More costs to consider:

Equipment sterilization and reprocessing has the potential to add substantial expense and is an important consideration when weighing the pros and cons of laparoscopy and endoscopy. In this study, single-use items were processed by a nearby hospital free of charge until a sterilizer (ethylene oxide) was purchased after the study for $6,000.

Take-home message

Results suggest that laparoscopic and endoscopic procedures were clinically and economically feasible in this small animal practice. Surgery times and complications were considered acceptable, and client satisfaction was high. Though the surgery times for laparoscopic OVE in this study were two to three times longer than the mean surgery time reported for board-certified surgeons performing the same procedure, this was attributed to the newly trained veterinarians' lack of experience. And although upfront costs and training are required, the procedures generated three times the direct costs associated with equipment and training.

According to this study, economic feasibility is dependent on four things: effective marketing, good client communication, appropriate pricing and frequent equipment use. If equipment is not used regularly, revenue can't be generated and skills can't improve. And because laparoscopic surgeries are more expensive, the researchers stressed the importance of good client communication and marketing to explain why minimally invasive procedures are superior to traditional open surgeries.

If you are considering using rigid endoscopy and laparoscopy in your practice, prudence is warranted. It requires thorough initial and ongoing training, and patient safety is of utmost importance. Complications associated with lack of training, inadequate equipment or inexperience aren't acceptable. When recommending procedures, fully inform clients of the potential risks versus benefits.

Jones K, Case JB, Evans B, et al. Evaluation of the economic and clinical feasibility of introducing rigid endoscopy and laparoscopy to a small animal general practice. J Am Vet Med Assoc ;250(7):795-800.

Link to abstract: https://www.ncbi.nlm.nih.gov/pubmed/

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