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Spine Surgeons Waste Millions On Opened, Unused Implant Devices

Joe Cantlupe, for HealthLeaders Media, November 10, 2011

"I led the list for awhile and it was shocking to me," McGuire says. "We are all competitive. No one wants to be an outlier. When it was reviewed that way, it made the problem ugly, and visual."

In particular, the internal review examined the process of "surgeon changed mind," evaluating the reasons behind surgeons' choices, what was accomplished, and the impact on waste flow.

"We are the drivers of the cost, we need to be part of the solution," McGuire says. "Physicians are responsible for ordering a significant amount of material."

A few simple changes amounted to a big impact. Intra-operative waste, which had occurred in 20.2% of procedures prior to the education program, decreased to 10.3% of procedures. Before the awareness program, surgical waste represented 4.2% of the total operative spine budget. Afterward, that percentage decreased to 1.2%.

Overall, the "awareness program was successful in decreasing the cost burden associated with intra-operative waste by 66%," the report states. That was achieved by decreasing the number of implants wasted from 44% to 24% and decreasing the "surgeon changed mind" waste from 42% to 24%. The changes "proved to be and continues to be effective in making surgeons aware of the import of their choices and the costs related to surgical waste," McGuire and his colleagues wrote.

Christopher Kauffman, MD, program co-chair of the NASS annual meeting and orthopedic surgeon at the University Medical Center in Tennessee, said in a statement that the McGuire report should be a "wake-up call" for physicians, particularly spine surgeons.

Looking back, McGuire says it's important that physician leadership, in particular, prompt change. "There has to be an internal champion for medical equipment conservation." he says. "One of the physicians [must] believe that this is the right thing to do."


Joe Cantlupe is a senior editor with HealthLeaders Media Online.
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1 comments on "Spine Surgeons Waste Millions On Opened, Unused Implant Devices"


Apurv Gupta (11/10/2011 at 5:07 PM)
Really enjoyed reading this article, which reveals a highly successful deployment of a "performance improvement project". A similar "performance improvement" approach can work in improving quality, mitigating risk, and improving patient safety. Just to make the elements clear to all leaders, I'm posting my blog on this topic below. The article identifies the following "performance improvement tactics" that should be integral components of all improvement projects: ** Examined how much they used and spent (review and monitor data) ** Questioned why each device was being being used (ask why five times) ** Studied reasons for wastage (undertake root cause analysis) ** Asked surgeons, operating room personnel, industry representatives, and nurses to help them identify waste (seek multi-disciplinary input) ** Compiled lists of who had been wasting more instruments than others (create profiles) ** Shared lists [of waste generators] with each other (create report cards) ** Awareness campaign (educate) ** Physician leadership prompted change (get support from leadership) The key behavioral drivers that project leader, Dr. Kevin McGuire, Chief of Orthopedic Surgery, identified are "physicians are competitive in nature" and "no one wants to be an outlier". Understanding these drivers is key to understanding some of the performance improvement tools and how to deploy them effectively.