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Proliferation of programs that recover surplus operating room supplies may effectively address the needs of volunteer overseas surgical efforts. However, these programs tend to garner supplies highly heterogeneous in nature. In order to evaluate the nature and quantity of supplies generated by plastic and reconstructive procedures, we extrapolated the inventory of 71 consecutive cases from our 33,000-case database. Additionally, we examined the recovery of 7 specific supplies from all cases performed at Yale-New Haven Hospital over a 3-year period. Though consistency is unlikely when only plastic and reconstructive surgical cases are examined, operating room-wide recovery may be a reliable source of usable materials.

One of the most difficult challenges a materiel manager can face is designing different programs to support materiel management services for specific clinical and ancillary areas of the hospital. While basic service standards for purchasing and logistic services should exist for all areas, a large part of how effective a materiel management department is depends on customized program development. In other words, fine tuning services to major customers, such as the Operating Room, can mean the difference between simply filling supply orders and aggressive cost control. This article reviews how Baystate Medical Center (Springfield, MA) maintains consistency in standardizing materiel services while adapting to the requirements of individual departments, such as Surgical Services.

The real issue in the debate about reusable versus disposable surgical instruments is the true cost and efficacy of specific instruments. Each device needs to be scrutinized on its own merits and analytically compared to other instruments. The goal of this case study was not to promote one type of instrument over the other but to focus on some of the data elements and complex issues involved in determining true costs, cost-effectiveness, and efficacy of the reusable and disposable instruments.

The rationalization of health care spending has high priority in these times of economic difficulty. Anesthesiologists can contribute to more efficient use of resources and therefore must be well aware of the cost of the products they use. This study aims to evaluate their knowledge of the cost of commonly used products. Seventy-eight anesthesiologists with varying levels of experience and from different levels in the hierarchy were questioned about the cost of 20 products, drugs and disposable items commonly used in their work. The physicians were within 50% of the real price of 4 of the 11 drugs studied and were 100% right about 3 drugs. The respondents were 100% correct about 2 of the disposable items studied but did not give estimates within 50% of real cost for any of the remaining 7 items. Neither position in the hierarchy nor years of experience was related to degree of correctness in pricing the products studied. Awareness of the prices of commonly used products, particularly of disposable material, was low in the population of anesthesiologists studied.

New perioperative technology is developing constantly. To ensure the integration of quality, effectiveness, efficacy, and efficiency in patient care, an overall structure to new technology assessment should be implemented. This program for technology assessment, evaluation, and implementation was created to be a cohesive process using both human and monetary resources and to incorporate a cooperative plan used by all services within the mission of the hospital and under the guidance of administrative services.

A study conducted by Deloitte & Touche examined the use of minimally invasive surgery (MIS)--specifically laparoscopic cholecystectomy, laparoscopically assisted vaginal hysterectomy laparoscopic inguinal hernia repair and thoracoscopic wedge resection--at nine U.S. hospitals. From a total hospital cost perspective, two procedures studied reduce hospital costs, one is a breakeven and one increases hospital costs. In addition, with MIS there is a major shift in resource consumption from nursing care units to the operating room. Best practices, defined as most efficient staffing levels, operative times, lengths of hospital stay and other treatment characteristics practiced at the study hospitals, were also identified. Hospitals can maximize their return on MIS by providing ample training to surgical and processing staff, standardizing on equipment, wisely choosing when to use custom kits, block scheduling for MIS and incorporating MIS into the hospital's strategic plan.

Between June 1990 and February 1993, 26 children underwent laparoscopic cholecystectomy. Their ages ranged from 25 months to 19 years (mean, 12.3 years; median, 13 years). Only six of them had hemolytic diseases associated with gallstones. Five presented with acute cholecystitis. Laparoscopic cholecystectomy was performed on these five, within 5 days of admission; the mean postoperative hospital stay was 2.5 days. The other 21 patients underwent elective cholecystectomy; their mean postoperative stay was 1 day. Several modifications have been made in our technique. Three 5-mm ports and one 10-mm umbilical port are used. In addition, direct incision of the umbilical fascia is performed with insertion of a blunt trocar and cannula rather than using the Veress needle for insufflation. The importance of positioning the epigastric cannula in the left upper quadrant in small children cannot be overemphasized. Cholangiography is now attempted in all patients and is easier with the Kumar cholangioclamp and sclerotherapy needle, under fluoroscopy. The total hospital charges for the patients who underwent elective laparoscopic cholecystectomy are compared retrospectively with those of seven children who had elective open cholecystectomy during the same period. In addition, a comparison is made between the two groups with respect to the costs of operating room equipment and postoperative pain control.

The rising costs of surgical care and decreasing third-party reimbursement mandate conservation of surgical resources and supplies whenever possible. One such resource is autologous blood. Its conservation has the added benefit of protecting the patient from the potential dangers of homologous blood and its products. This article presents conservation techniques found to be feasible in open-heart surgery.

Kaiser Santa Rosa (KSRO), a small facility in the Kaiser Permanente health maintenance organization, was found to have an unfavorably high non-payroll cost per surgical hour as compared with other Kaiser facilities. An Operating Room Cost Awareness Committee was formed to address the problem and has now become a standing committee at KSRO. The committee is composed of surgeons, nurses, materiel management personnel and administrative representatives. Through a spirit of cooperation and the authority to approve and deny all OR supply requests, the committee has been able to bring its OR costs in line with other Kaiser facilities.

The cost of a transurethral resection of the prostate is of considerable concern to the community. More of these procedures are being performed as the number of patients in the aged population increases. The costs of wages and salaries, purchase of equipment and depreciation, stationery, linen, investigations (pathology) and pharmaceuticals are compared with the bed charges (as charged to a private patient), the cost per inpatient day and the cost per inpatient treated, which is calculated from the operating fund budget expenditure of The Bendigo Hospital. The cost per diagnosis related group (DRG) 336 (defined as: transurethral prostatectomy, age greater than 69 and/or complication/co-morbidity; mean length of stay 7.0; relative weight = 0.9869) and DRG 337 (defined as: transurethral prostatectomy, age less than 70 without complication/co-morbidity; mean length of stay 5.8; relative weight = 0.7788) are compared with the figures for a similar procedure in 1987 in a United States hospital and extrapolated, by the use of the Consumer Price Index, to 1992 levels. The findings demonstrate that transurethral resection of the prostate as costed in this hospital compares very favourably with that in a US hospital, and favourably from the point of view of health care costs.

Clearly, the choice between single-use and reusable laparoscopic instruments encompasses a number of complex issues. We found that hospitals in this study could replace existing reusable instruments with disposables--without meaningful impact on total costs. Such change would also have important benefits not quantified in this study. These include reduced risk of postoperative infection and transfer of blood-borne pathogens resulting from improper cleaning and sterilization, improved instrument performance, and reduced risk of employee injury. Given the importance of the single-use versus reusable decision, each hospital needs to analyze its own, specific situation. With input from surgeons, administrators, and OR, infection control and sterile processing staff, each institution can make an informed decision consistent with its cost and patient care objectives.

Autologous blood recovery devices have taken on new importance in the effort to conserve finite resources of blood products in the face of ever-growing demand. By incorporating this technology in the vascular, orthopedics, and cardiovascular arena, substantial savings of blood will be realized. The expanded utilization of autologous blood recovery will enable an already burdened blood supply system to continue to provide an adequate source for our patients. It will also help assuage our patients' fears by limiting their exposure to homologous products and the attendant risk of infection by blood-borne pathogens.

Objective: To provide a mechanism for addressing the need for consistency and projection in overseas donation of surgical supplies, we conducted a case-by-case inventory of unused materials recovered from all surgical procedures in our facility over a 2.5-month period., Design: Unused surgical supplies were recovered in coded bags from individual cases and inventoried., Setting: Inpatient operating rooms at Yale-New Haven Hospital., Main Outcome Measure: The weight and dollar value of recovered materials were tallied for each case type; these were then extrapolated according to the frequency with which each procedure is performed in the United States to provide an estimate of the impact of a nationwide recovery program., Results: The value of supplies recovered ranged from $1 (bone marrow transplant) to greater than $40 (liver and vulva/perineum procedures). By extrapolation to case-specific data from the National Hospital Discharge Survey (1990), we estimate that a nationwide recovery program could yield more than $193 million in charitable material and reduce operating room waste by more than 1.7 million kilograms (1948 tons)., Conclusions: Consistency and organization would contribute greatly to efforts to alleviate existing medical supply needs in the developing world. This case-by-case assessment should enable participating centers to project more effectively the outcome of such collections and allow the coordination of efforts. Though unlikely to be adopted by all operating theaters in the United States, the potential charitable contributions from a nationwide recovery program are significant.