Meet Your Integrated OR’s Capital Equipment Needs

Purchasing pearls from leaders who have seen it all.

Facilities looking to upgrade their capital equipment often find the prices are so high that it derails the budget.

With margins as tight as they are for many of the ambulatory surgery centers out there, overpaying or over-outfitting your OR on capital equipment would be a disaster.

Luckily, financially savvy administrators and executives understand there are proven ways to tackle a capital equipment spend economically without breaking the bank.

Overspending isn’t an option

There are a myriad of booms, monitors, lights and video systems that can provide your clinical staff with a leg up on the competition and you don’t need to overspend to do it — if you do your due diligence and employ some practical negotiating skills.

Take it from Michael Young, MHA, FACHE, president and CEO of Temple University Health System, located in Philadelphia, a man who knows a thing or two about capital equipment purchasing. According to Mr. Young, there are several key areas surgical facility leaders must take in consideration when budgeting for and purchasing capital equipment, and it all starts with ease of operation — how easy it is to use and how much training/how many staff will need to be trained — and headcount of operation associated with the equipment. Mr. Young says it’s important to factor in whether staff can operate the equipment from a single site. For instance, if you have an X-ray machine a technician can operate from a single site, you can save yourself the cost of staffing another X-ray tech.

Of course, there are the acquisition costs of capital equipment, numbers that are understandably pored over by surgical leaders. But Mr. Young urges surgical facility leaders not to overlook the historical experience of downtime. “If you have a C-arm that’s going down all the time, every single minute that it’s not operational, it’s costing you money,” he says.

If you’re purchasing new equipment, there’s the warranty question. “Twelve months is a standard warranty. If you push a little, you can get 18 months, and if you push a little harder you can get 24 months,” says Mr. Young. “Demand the extended warranties.”

That advice is geared toward new equipment, but Mr. Young is also a big believer in used or refurbished capital equipment. “Surgery centers come and go,” he says. “If you’re looking at used, you might be able to get something faster, and you’ll definitely be able to get it cheaper,” adding that the quality is generally extremely solid and dependable.

Mr. Young also offers a sound piece of general purchasing advice that applies regardless of what you’re buying. “Bundle your purchases whenever possible, you’ll do better that way,” he says. “Group the purchases and try to do four ORs at a time or two ORs at a time.”

Last but not least, Mr. Young urges facility leaders to get anesthesiologists’ opinions on equipment like PACs (picture archiving and communication system) and C-arms you are considering. “They are in the room a lot, and you want know if they don’t know how to position or use something,” he says.

Future programs, growth and volume

BIG-TICKET ITEMS C-arms, specialized tables, lights and monitors can break your budget if you don’t haggle like a pro with equipment companies.

When it comes to capital equipment purchasing, Theresa Nolan, RN, BSN, MSN, associate executive director of perioperative services at Cohen Children’s Medical Center in Queens, N.Y., believes in reaching out to your peers. Talking with other facilities to see what has worked for them, as well as using benchmarking and analytics to run projections will go a long way toward making sound decisions, she says.

Cohen Children’s Medical Center also always takes into consideration its needs for future programs, future growth and projected volume when investing in capital equipment.

“Planning and identifying areas for operational growth in advance assisted us in our capital investments,” says Ms. Nolan. “All requests are subject to an internal review and approval process that requires a purchase justification, and each requested item is also assessed for its future-proof capabilities,” adding that all purchases are prioritized because OR investments impact the strategic goals of the entire hospital, not just periop services. “Timely communication is key for the clinical team as they are directly impacted by changes to the workflow and operations of the new equipment,” she says.

Twelve months is a standard warranty. If you push a little, you can get 18 months, and if you push a little harder you can get 24 months. Demand the extended warranties.
Michael Young, MHA, FACHE

Decisionmaking in action

Below are just two examples of Ms. Nolan’s purchasing experiences. In each of these scenarios, Ms. Nolan and her team looked well beyond the upfront investment to determine their needs.

• Microscopes. They trialed several microscopes for their ENT service, reviewing safety, efficiency and imaging. “ENT is historically a busy service line and as we’ve transitioned out of the COVID crisis, we have seen an emergence of other viral infections in children,” says Ms. Nolan.

The end result of the trial? “We purchased two to ensure we could manage two procedures at the same time at a cost of more than $400,000,” she says. “The second microscope serves as a backup but also allows for growth in this specialty service.”

• Portable fluoroscopy units. “We initially purchased two units and managed this resource by moving the procedure times around to ensure there was no conflict,” says Ms. Nolan. “As we’ve become busier, we purchased a third machine for more than $200,000 to eliminate the need to move cases which can pose a risk to surgeon satisfaction, patient delays and other concerns.”

Armed and ready

Capital equipment is the lifeblood of every efficient surgical facility.

Subpar devices and technology lead to subpar outcomes and performance. It’s critical for surgical leaders to enter those purchasing discussions with prospective vendors ready to ask tough and relevant questions and negotiate like the future of the facility is on the line because, in many ways, it very much is. OSM