Choosing the Right Surgical Patient Positioning Solution Under a Value Based Model

When you think about it, choosing the right surgical patient positioning product really comes down to just a few core value propositions:

1. Efficacy
2. Safety
3. Performance
4. Price

While many could subjectively put those in any order they wish, and there are many sub-genres to consider to each, I’d argue that the industry currently places only one of those at the top, simply because it is the first question out of just about everyone’s mouth these days.

“How much is it?” or worse, “Are you on a GPO contract?”

So, we would like to dissect the real meaning of value based and evidence based approaches to both care and purchasing.

The Value-Based method

Value is a highly subjective term. It can mean cost, performance, safety, or efficacy. Often times many personal opinions, and even blind brand loyalty are thrown into the mix, overshadowing the intent of the transaction at hand. The overriding theme of the industry is to focus on cost first, everything else is second. I’ll be happy to debate that statement all day long if anyone cares to counter argue.

To determine real value, one must be willing to perform a cost benefit of the product or solution being considered, considering all the metrics above, especially the core basics: performance, efficacy, and safety. Highly reliable processes are key to reinforcing these fundamentals.

The Evidence-Based Approach

I would argue there is no such thing as a pure and untainted evidence-based care or practive model. The human conditions of technology, education, infrastructure, services, processes, and science, just to name a few, are always changing. Don’t believe me, well let’s take a look at just a few examples:

• We used to perform frontal lobe ice pick lobotomies as standard of treatment
• We used to blow tobacco smoke up people rear ends for medical treatment
• We used to drill holes in the head (trepanning) to treat multiple ailments, conditions not related to decreasing intracranial pressure during trauma or ICH.
• In fact, a great deal of the stuff I was taught in both nursing and nurse anesthesia school is no longer considered clinically valid.
• Simply put, care and science are always evolving.

The High Reliability Approach

The best we can do for this industry and our patients is to develop a highly reliable and reproducible culture of care, one that remains open to the idea that we are in a constant state of flux. But rest assured, under this model you can still use a scientific method to deduct value.

Assuming all things are equal, especially when it comes to performing a care process, it’s important to look and evaluate the metrics listed above through the eyes of high reliability, as it seeks to reinforce and validate the core values of safety, performance, and efficacy.

Surgical Positioning Is Really Governed by Physics, Physiology, Proccesses, and yes, PERFORMANCE!

Most of today’s Trendelenburg solutions rely on either gel, foam, or beanbag positioning systems. When providers and institutions source products based on the idea of pricing alone, this assumes that all things are equal in both performance and utility, and that each product is undifferentiated from the other, and that price is king. This rightly represents a free market place, assuming again, that all products are essentially the same in their utility of use and expectations. A free market system does not need third party purchasing oligarchies or monopsonies.

Now when a new product comes along, one that evolves the very idea of how positioning processes are facilitated, is it fair to commoditize that product and hold it to the same price point, even when improvements are readily demonstrated over current commoditized solutions? That’s the hard question? 

As I've written before, shoes are shoes, and they range from flip flops to high dollar running shoes, one is used for casual walking, the other for performance and endurance activities. They are not the same and are not purchased for the same reasons. Yet in the eyes of today's healthcare value and purchasing model, they are the same. This is a problem.

Is performance and reliability worth an investment, especially when it improves care processes and reduces liabilities related to variance? But what if new the product or service also focuses on provider safety? Is that worth the investment?

Here are some of the true scenarios that exist under current market conditions. These are not meant to be disparaging to existing products, they only point to the clinical realities providers have to work with. It's all about physics and processes!

• All three of these systems are static and immobile, meaning they each tether to a single point on the surgical table, forcing providers to physically and bodily lift their patients to lithotomy by either hand or sheet. The average provider moves their patient 7-14 inches when lithotomy is required. Surgical table designs affect this process greatly. Check out our #oildrumchallenge to see how antiquated and unsafe this process is.
• If providers choose to position their patients in a lithotomy ready position, they have risked optimized airway access needed for safe laryngoscopy and line placement, putting their safety and exposure to MSD injuries over the safety of their patients
• If providers choose to do the right thing and optimize airway access for safe laryngoscopy, they are then forced to again, bodily lift their heavy patients into positions!
• Each of these systems still rely on antiquated arm adduction methodologies that require bed sheets, and back up fortifications using foam, gel, tape, towels, sleds, and countless other products to help secure and stabilize the patient's arms, ESPECIALLY in obese patients, as surgical tables are ONLY 20 INCHES wide.
• The use of a draw sheet impedes the skin to pad surface contact needed for maximized traction by 30% - 80%, this is governed not by opinions, but by the law of physics. You want maximum traction in 30-40 degrees of steep Trendelenburg.
• While there are some winged foam pad systems on the market, these wings must be tucked back under the patient, this is similar to the sheet tucking method. This process impedes safe and rapid access needed for anesthesia management of IV lines, invasive & non-invasive blood pressure monitoring, and pulse oximetry. They still require high utilization of staff to roll and turn their patients to facilitate this process.

Average time 5-30 minutes across all BMI spectrums (20 to 55-60)*

(*these were preliminary metrics gained from surgical EHR, and observations from one of our customers before the use of of our products, more on this later)

The Power of Opinions and Their Effect on Care

Each of us were born with an innate sense of providing opinions, and as a company we value all constructive and objective opinions any given day, but when all things are considered equal, opinions without practical solutions mean very little, especially when faced with the obvious. Opinions can be a force for innovation and change, but they also impede them. There is no perfect product, just as there is no perfect person, process, care, airline, car, etc. and the list goes on for infinity.

As a caregiver, it is the science of medicine and education that guides care processes, and of course the virtues of humility and selfless actions to serve others. There are standards and processes of care for a reason. Our beliefs are challenged daily, as we learn better ways to care for our patients through the advent of innovation and education.

Again, if we use the scientific principle of all things being equal, is what you are seeing when you evaluate a new surgical positioning product better than what you are currently doing? Does the design improve and optimize all conditions needed to meet the criteria for improved performance, safety, or efficacy?

You see, like surgical care, medicine, or even cancer treatment, there is no such thing as 100% efficacy. There are always going to be conditions and outliers in any scientific, medical, or clinical situation. The goal is to serve the greater good with highly reliable principles that meet the need of 97% of the population, with the goal of 100%. Placing obstacles or devaluing a product over the 3% variance or potential variance states that the greater good is not your concern, or important in your overall value proposition to providing care. This is one of the biggest obstacles second to the cost conundrum we deal with. It’s the rabbit hole we try to steer our customers away from, to again refocus on the greater good, while listening to their concerns for validation.

“We like it but it’s not the right color, the arms are too short, or too long, can it have 9 handles? Can it be thinner, thicker, less soft, more soft?”

Product Design

When products are designed, the best any company can do is to gain feedback from first hand users, and then design a product or solution that best serves the greater good based on statistics, and in our case, human anatomy and clinical conditions. Once those conditions are met, we must account for another and important little applied value proposition, human factors. 

Our products were designed to meet the needs of the overriding surgical population based on measurements and BMI statistics, as well as the evolving needs of providers to keep their patient’s safe under changing conditions commodities can’t account for. Furthermore, our products were also designed to optimize all variances typical of other systems on the market, especially foam based positioning systems.

We also incorporated a provider safety utility in our products to not only help them position their patients with high reliability, but to also reduce the physical effort of patient handling and ergonomic processes, those that have a high potential for provider MSD injuries.

So in closing, we would implore surgical providers to seriously compare the value propositions, of not just our surgical positioning systems, but those other products that serve to drive the performance and safety factor, even if they are not on your GPO contract. And while those are buzz tactics all companies tout in their literature and 5 second pitches, providers should readily see the value demonstrated in real time, especially when it comes to patient handling and positioning processes.  

Our Genesis Bi-Wing AAP? greatly improves all of the clinical scenarios listed above, and is readily demonstrated in real time. There are no such things as a soft cost in healthcare. Metrics can and should also be gained via the electronic health record (EHR) when evaluating new positioning products, paying close attention to anesthesia induction or anesthesia hand-off to skin incision.

In fact, early metrics only place us at 3-7 minutes of positioning time across a wide BMI spectrum (20 to 55- 60), over the metrics previously mentioned (5-30 minutes) with standard tethered systems. We hope to finish our independent validation for publishing by late Spring/early summer.

The Genesis is the only modular positioning system on the market designed for intraoperative repositioning and evolved arm adduction. And while some may use hover type devices to move patients in lateral to lateral level movements, they should never ever be left in place or used under foam or gel Trendelenburg positioners, as they impede the pad to table contact needed for traction in acute angles of positioning. It actually violates the instructions for use (IFUs) for all major foam-based Trendelenburg solutions and puts patients at risk. They may be competitors, but when it comes to patient safety, we ae all in the business to keep patients safe!

With all things being equal, it is time to consider a product that is not like the others.

iMT is a sole sourced Veteran owned medical device manufacturer and small business. We can pass on better cost options than your GPO can, and by law, you can source off contract to get the solutions you need. We are also considered a diversity supplier.

Championing the right care for your patients demands more than just sticking to a GPO contract, especially when all things are not equal.

If you are looking for a patient positioning solution, please contact us today! Come see why clinical experience and listening matters when if comes to developing well rounded patient positioning solutions!

infinitusmedical.com

Can your current Trendelenburg solution do this? This is just our Hadron FPLS system, our Genesis does this, plus arm adduction!