When contemplating equipment for a new facility, many factors come to mind, chief among them cost. What may be a better consideration, however, is cost efficiency. The lowest-priced item may not be the best deal. To gain an edge in the highly competitive ambulatory marketplace, you need to equip for efficiency.

You want to be known as the place where patients get in and out with a minimum amount of hassle. You must consider efficient operations for every aspect of facility operations, from admissions in the front of the house to taking out the trash in the back of the house. Here are a few examples of how the right equipment can make the job easier, quicker and safer.

Surgery center data systems
These are a significant investment, yet many facilities do not take full advantage of their data systems' available horsepower. They spend tens of thousands of dollars for a system, and then use it only for scheduling and physician-preference cards. Most of these systems can do materials management and purchasing functions, process accounts payable, and do payroll, staff scheduling, resource allocation and procedure-cost reporting. If you make the investment in the software, be sure to make the investment in time required to implement and learn it.

Think small
Time savers come in small bites (think patient-minutes) with things like EKG lead wires. Consider conformity with the type of monitors used in the facility so that the patient lead connections are all the same, says Sheffield Kadane III, MD, director of anesthesia for HealthSouth Surgery Center of Dallas. When it is time to move the patient between rooms, unplug and go rather than disconnecting the wires from each electrode on the patient at each stop. The leads and sensors that are attached in pre-op stay on the patient until they are off the monitor in PACU. Dr. Kadane says that this is "critical with high-volume, fast-turnover cases," citing 30 cases per day, multiplied by five minutes per case, equals two-and-one-half hours of nursing time saved.

Single-surface patient handling
Handling patients is no longer confined to the stretcher-to-OR, table-to-stretcher traditional model. With products like tapered head-eye surgery stretchers from Steris and Stryker, the cataract patient starts, has the procedure and recovers on the same surface. Eye surgery stretchers are nothing new, but what is new is Stryker's Trio mobile surgery platform. The Stryker Trio is a hybrid between a stretcher and a surgical table and allows the same single-surface utility for orthopedic and general surgical cases. These single-surface approaches not only save time with transferring patients and parking stretchers. They also greatly increase safety to the patient by reducing transfer-related injuries and falls and safety to the staff by reducing transfer-related back injuries.

Equipment management
You can shave minutes off OR times with new approaches to equipment management. An equipment boom can get endoscopic, video, electrosurgical and orthopedic power equipment off the floor and closer to its point of use. This makes surgery more convenient and shortens room turnover times.

Supply management
The right type of material handling (shelving for you novices, or supply chain infrastructure for you know-it-alls) can get the right stuff at the right place at the right time. Consider in-OR specialty carts for specific, supply-intensive, high volume cases like IOLs, myringotomies and pain management. As much as possible, store the most frequently used, heavy, sterile supplies, like IV and irrigating fluids, at or near their point of use.

Instrument management
The right approach on instrumentation will result in time savings. First, you don't need to wash and wrap a 40-instrument set when the doctors usually only use five of the instruments. Wrap up multiple sets of the five most-used instruments and have the other 35 infrequently used items put up in their own set. They are there if you need them, but if not, it is less to handle. It can also cut the number of instruments you need to buy. Consider the autoclavable cameras and endoscopes that are now available; they can be processed quicker in steam than other methods. Keep spares of mission-critical items like bulbs and bulb carriers for endoscopic light sources.

Waste management
The surgical environment presents unique issues when it comes to taking out the trash. One challenge is dealing with waste fluids from surgical suction. Since it is biohazardous waste, you can't legally pour it down the drain, and that means it goes into the red bag - which costs you by-the-pound for disposal. A new solution is the Stryker Neptune system that consists of mobile rovers in the OR that function as both smoke evacuators and surgical-suction collectors, holding 20 liters of fluid.

The rover is emptied and sanitized automatically when it is attached to a docking station located in a soiled utility closet. The biohazardous fluids are chemically decontaminated and then sent into the sewer, legally. Although the system is a capital investment, payback comes from savings realized on labor (continually emptying suction containers during an irrigated procedure), supplies (single-use suction containers) and biohazardous waste-disposal fees.

Keep efficiency in mind
Take a long view when considering equipment for your new surgery center. Sure, you'll need to consider acquisition cost, but also consider the cost of ownership. The cost of ownership includes all the supplies and labor costs associated with the device. It may be inexpensive to buy, but if it is time-consuming to set up, tear down or clean (when compared to its more costly competitors), it may not be such a good deal. By keeping efficiency in mind when shopping for your new surgical equipment, you'll be better poised to take on the financial and competitive challenges of opening a new facility.