They're called lead apron hangers - the OR equivalent of that stair climber or stationary bike that sits in the corner of a room, finding new life as a clothes rack or coat hanger.
We sent an online survey to a panel of our readers; 68 respondents reported 79 so-called lead apron hangers (respondents were allowed to pick more than one piece of equipment).
More than one-fourth (28 percent) of the equipment collecting dust is surgical lasers. Other poorly planned purchases going unused include harmonic scalpels, hydraulic chairs, stereotactic systems, vein and other specialty ablation systems, and specialty tables. Robotic surgery equipment and voice activation aren't realizing their potential in three facilities each, according to the survey.
That's the big question. Overwhelmingly, the root of the problem is your surgeons. They wanted the equipment, talked you into buying it - and now they don't use it. Nearly 84 percent of our panel said surgeons were one of the reasons they'd bought the now-unused equipment.
One-third said they'd thought it to be the wave of the future. A smooth-talking sales rep was at least partly responsible for the purchase in 7.4 percent of facilities. And just one facility had bought equipment - a stereotactic brain box system - because staff had pushed for it.
This could be either good news or bad news: You'll know fairly quickly whether your big capital equipment purchase has gone awry. Within six months, 58 percent of respondents found the equipment had fallen out of favor with staff. Nearly one-fourth knew they had made a bad buy by the end of just one month. One-fifth saw the equipment go by the wayside between six months and a year after purchase; it took longer than a year for the other one-fifth.
Respondents' most popular reasons for discontinued use of items include surgeons' leaving, lack of support from staff, lack of procedure demand and surgeons' changing their minds after using the equipment. A sampling:
- "One-time-use needles for transurethral needle ablation (TUNA) went from $725 to $1,295 after another company bought the manufacturer. Medicare won't reimburse in the [ASC] setting, and insurance companies did not increase [reimbursement] as costs went up; [it remained at] $1,500."
- "The technology was poor, and we could get better results with older methods at immensely lower costs." - about a laser for skin peels.
- "The physicians decided it wasn't that spectacular after all. More cumbersome with the same results of conventional equipment." - about an ophthalmic knife that uses electromagnetic energy as a plasma blade to cut living tissue.
- "The procedure is not reimbursed by Medicare, and private payers never materialized." - about a uni-knee system.
- "It is a robotic arm used for laparoscopic surgery...by one surgeon only when he does lap choles and if a PA is not available to assist him. It is still not used 10 percent of the time in that case, because not all of the OR staff know how to put it on properly. The worst part of all is that we own two of these units."
A couple solutions
Did any of those sound like you? There's help.
Lorraine Melancon, RN, the quality management coordinator for HealthEast Outpatient Surgery Centers, says there's little chance equipment will go unused once a physician orders it. "Our health system has a defined process in place regarding ordering of new substantial instrumentation/equipment," she says.
The system is common sense, but thorough. If a physician requests a purchase, he must fill out a requisition form that is sent to a specialty committee - such as GYN or orthopedics - for approval. Even if the committee finds that the equipment request is reasonable, says Ms. Melancon, "the materials management department may do a search for a comparable product." Feedback from this evaluation is sent to the committee for a final verdict on whether the purchase should be made.
"This process allows for more surgeon accountability," says Ms. Melancon. "I spoke with our facilities purchasing manager, and she does not recall a single item in the last six months that was purchased after going through this thorough process that just sits on the shelf unused."
If it's too late for the prevention route, one respondent suggested cutting your losses and taking what you can get for the equipment.
"Equipment companies will pay cash for any - and I mean any - old or unused equipment," she says. "Kind of like a tag sale. I have used the money [we got as a result] for staff incentives, and that way the staff not only helped me identify what needed to go but benefited from the work."
A new, digital electrosurgical generator
DRE Medical's new ASG-120 electrosurgical generator features Bovie FDFS (Fast Digital Feedback System), which greatly reduces the need to change the power setting to obtain the desired surgical effect, says the company. Bovie FDFS works like this: Because it is digitally controlled, the ESU measures tissue impedances in real time - about 5,000 times per second. As the impedance varies, the power also adjusts, resulting in potentially more consistent cutting and less electrode sticking. You also use less power overall, lessening the potential damage to tissue. The unit features monopolar and bipolar (bipolar footswitch required at an extra cost) functions, 10 blend settings, plus cut. All functions can be performed with 120 watts maximum power output for the most demanding procedures, such as Transurethral resection of the prostate, the company says. The unit lists for $2,495. Call (800) 462-8409, visit www.dremed.com, or Circle 166 on your Reader Service Card for more information.
Carbon fiber for headrests, platforms
A new spinal imaging platform is said to be more radiolucent, and a new headrest top gives you more positioning options, says Oakworks, the manufacturer. Carbon fiber makes the Oakworks Spinal Imaging Platform stronger and more suited for spinal applications that involve imaging and radiology, such as pain management, because it is radiolucent. Features on the 13-pound platform include a double articulating face rest that gives the physician better patient access; adjuster pads to maximize patient comfort and provide incremental support for varying body types; and lateral bolsters to add width and support, according to the company. The new headrest top comes with three face pads: two for supine and the crescent for prone positioning. The company did not provide prices. Call (800) 916-4612, visit www.oakworksmed.com, or Circle 167 on your Reader Service Card for more information.