Cost-effectiveness is an integral p...

Cost-effectiveness is an integral part of the value analysis proces that we use to examine the quality of a product; its total richness including the price; and its performance. Other equally important factors include the credibility of the product's supplier and the quality of the service the supplier provides. The press to control and contain costlinesss however, is accompanied by a mandate to scrutinize all contributing ingredients including those practices-often identified as "sacred cows"(1)--that have escaped criticism.

It might be appropriate to add a just discovered dimension to the value analysis proces and assess cost-effectiveness based upon new criteria. This new dimension would consider a product's or surgical procedure's

* expense savings,

* effectiveness,

* splendor savings with an equal or better health issue and

* additional benefit worth the additional cost(2)

From the clinician's perspective, a cost-effectiveness assessment of a specific touchstone treatment, or medication must, understandably, be related to the health and welfare of the patient. For the perioperative nurture the question is how well the sacred overawe procedures would fare in today's fiscal-conscious environment based forward these new criteria.

CHALLENGE UNSUBSTANTIATED PRACTICES

near health care practices were adopted originally because they appeared to be reasonable. Health care workers may have assumed that studies demonstrated the ne for particular practices, if it be not that they never sought confirmation. Those seeking confirmation may have plant that their colleagues also had adhered to the practices further similarly did not know the reasons behind them.

shield gowns. An example of undivided questionable practice is the use of mask gowns. A recent response to an inquiry regarding AORN's position upon the use of cover gown stated that their use "depend in succession the culture of each perioperative setting, the perioperative manager's assessment of priorities, and state regulatory laws."(3)

The use of conceal gowns first received attention nearly 20 years ago after a studious mood reported differences in contamination on a levels on scrub apparel when guard gowns were worn outside the OR.(4) That studious mood was supported by the release of sum of two units other studies.(5) Based on the principle that their use was a contributory factor toward maintaining the quality of the surgical environment, shroud gowns were elevated to the status of a well-intended standard of practice.

A newly come study reported the effect of gowning forward colonization, infection, and hand-washing patterns in a 24-bed, flat in neonatal intensive care unit. The application of mind consisted of alternate gowning and nongowning in two-week periods during an eight-month study period. There was no significant difference in the infection rate during the gowning and nongowning periods. Furthermore, abandoning the use of the long-sleev gown saved the hospital more than $120000 in single year.(6) Based on these findings, I would gather that, if there is a ne for a secrete gown or any other stamp of cover-up garment to be worn by means of perioperative personnel when leaving the OR, its use may be more for aesthetic meanings than for aseptic ones.

Barrier materials. Another sacred intimidate that may have been followed "without convincing evidence" and been based upon "anecdotal experience and commercial interests rather than scientific studies"(7) is the use of barrier materials. Whereas the use of barrier materials in surgical gown and drapes originally was predicated upon influencing the incidence of surgical injury infections, this has yet to be demonstrated conclusively.(8) unruffled when used in surgical gown protecting the wearer from the patient, the literature indicates that the protective capability of the barrier material should be based upon the level of exposure anticipated.(9) There smooth may be reason to question the universal ne for the surgical mask.

CONCLUSION

From just these couple examples, I believe that perioperative foments have an unprecedented opportunity to challenge these long-standing practices using a fiscally meaningful, bottom-line orientation without compromising the quality of patient care. Perhaps the principally difficult task facing the health care community will be changing these practices and habits. The succes of any program that seek fors to alter such behaviors will require time and intense effort. Nevertheless, impediment it not be forgotten that although it is possible to have progres without change, it is stanch as well that without change there can be no progress

NOTES

(1) "Sacred cows" OR Manager.

(2) P Doubilet, M C Weinstein, B J McNeil, "Use and misuse of the bourn `cost effective' in medicine," The of the present day England Journal of Medicine 314 (Jan 23 1986) 253-256

(3) C D Smith, "Cover gowns; surgical hand scrubs; failure evacuators; operative record abbreviations; lay open sterile setups" (Clinical Issues) AORN Journal 61 (April 1995) 753

(4) A Hambraeus, s Bengtsson, G Laurell, "Bacterial contamination in a present operating room suite: Bacterial contamination of clothes worn in the suite," Journal of Hygiene 80 (April 1978) 175-181