wherefore would anyone attempt to i...

wherefore would anyone attempt to interchange surgeons in a teaching hospital from their long-established practice of using whatever brand of line of junction they desired to using sole one brand of suture material? Shands Hospital at the University of Florida, Gainesville, like each other health care institution in the United States today, is in the midst of charge containment. At Shands Hospital, therefore, we evaluate each opportunity to decrease preciousnesss while maintaining or improving the quality of patient care.

DECISION TO UNDERTAKE A line of junction TRIAL

The splendor of doing business in a teaching hospital attends to be high. With this in mind, members of the University Hospital consortium decided that the purchase of line of junction material was an area that afforded a significant opportunity for sumptuousness savings.

Cost-benefit analysis. Consortium members began the examination of potential savings on conducting an in-depth product comparison of different line of junction materials. We compared suture material from three different manufacturers in such a manner that we could

* record exact matches,

* give an inkling of equivalents, and

* make appropriate costliness comparisons.

We began the trial with the line of junction manufacturer that managers ranked as providing the greatest savings opportunity for our hospital.

Surgeon support. Support from staff surgeon for this potential change in line of junction material was crucial to the succes of the line of junction conversion process. We took our proposal, including the cost-benefit analysis, to the chairs of the various surgical departments. The chairs listened to our proposal and supported our entreat to attend their department staff meetings to communicate our trial plan.

Our presentation to the staff surgeon at their department meetings included descriptions of all the surgical supplies cost-savings ideas we had implemented to date, along with their corresponding dollar value. We then exhibited our desire to test a fresh suture material that could save the hospital more than $300000 annually in line of junction costs.

The surgeon were not anxious to change the line of junction they had been using for years. They uttered concerns such as loss of autonomy in choosing supplies and los of opportunity to use various line of junction materials. Despite their resistance, surgeon understood the ne to contract costs, and, therefore, they approved our trial.

PRETRIAL PREPARATION

The nurture managers decided to begin the trial with the mostly frequently used suture material in the OR (ie, polyglactin). Working closely with the line of junction manufacturer, the perioperative nurse managers educated staff members about the throw out by conducting many inservice programs about the trial and presenting the trial's timetable.

Because the OR staff members have been integral players in all previous price reductions, they were well educated about medical reimbursement issues and the ne to decrease hospital costs. Staff members' understanding and assistance through every part of the trial process made the entire brew easier.

Before the line of junction trial began, the suture manufacturer representative exhausted the weekend removing existing line of junction material and replacing it with the strange suture material. The boxes of just discovered suture material were marked with "hot dots," which contained information about the antiquated suture material so that staff members could make choice of equivalent suture easily.

line of junction TRIAL

We started using the just discovered suture material on a Monday. The line of junction manufacturer representative set up a demonstration table at the surgeons' entrance to the OR in the same manner that residents, fellows, and attending surgeon could be educated forward the new suture material forward their way into the OR. This gradation was critical to remind all surgeon that the trial was underway and that the just discovered suture material would handle somewhat differently.

affairs We recorded and addressed all the staff surgeons' and surgical residents' matters The perioperative OR nurse managers and the line of junction manufacturer representative kept OR staff members informed about the surgeons' complaints and the following resolution of those complaints. Staff members' issues also were addressed, yet they were minimal. Within undivided month, all suture material targeted for conversion in the OR had been replaced with the novel suture material.

Exceptions. There were sum of two units areas where we did not displace the existing suture material-cardiothoracic surgery and ophthalmology. The perioperative foment managers made an agreement with the of the present day suture manufacturer representative that line of junction material for these two surgical specialty areas would remain outside of our 80% utilization target range.

POSTTRIAL EVALUATION

After six month of the line of junction trial, we presented our findings to the hospitalwide OR committee and the surgical policy committee. Not all surgeon were pleased with having to use the of recent origin suture material, so the surgical policy committee decided to review all staff surgeons. The deductions of this survey found that the surgeon were equally split in their desire to use the of recent origin suture material. When the scan results were weighted by the amount of line of junction use, however, the new line of junction material was more acceptable.