Part I: The Business Case for Standardization and Why All Surgical Patient Positioning Products Are Not Created Equal!

When it comes to choosing Trendelenburg patient positioning solutions, it is important to understand that not all products are created equal!

Most of today’s Trendelenburg positioning solutions were developed by those who only focused on the desired end goal of positioning. Their product's task was to minimize sliding and provide stability for their patients on the table during gravity dependent procedures, those requiring 5-40 degrees of omni-directional surgical table rotation. While they were valid in their innovative thinking, they did not focus on the patient handling processes inherent to their use. They also did not consider the impact of advanced procedural care, obesity, or variable infrastructures like surgical tables. The processes they depended on also reduced the efficacy of their products because they still relied on lift sheets to move patients and to tuck their arms. If you wanted to create the skin to surface friction needed to reduce sliding, why would you cover up 40-80% of the surface area you needed to accomplish that goal with a sheet?

From there, other commodity disposable companies mimicked this approach. 

The Achilles Heel

All foam, gel, or bean bag positioning solutions currently on the market share one common flaw, each were created to commoditize a processes to achieve one desired end goal, regardless of how it affected those who actually positioned the patient. These products historically relied on a culturally diverse piecemeal approach that still demanded additional fortifications and the creative use of tape, plastic sleds, towels, sheets, diapers, more tape, and countless other consumables that served to help secure their patients, especially their obese patients. It is important to note that creativity is not a standard of care.

As a company, when we think we have seen it all, we are reminded of the creativity and the resourcefulness of staff who must work with what they have, instead of what they need. This is not to disparage any facility or care culture, it is to bring to light the countless issues we face when positioning surgical patients without a highly reliable approach to care.

To Commoditize or not to Commoditize?

It would be easy for us to offer another foam based positioning solution and then try to gain your business by focusing on the only thing that seems important in today’s healthcare, price, but we wouldn’t be evolving your standards of care if we did that, and we most certainly wouldn’t be offering you an improved solution that took surgical provider safety into consideration. Our goal is to keep improving products and processes inherent to surgical care. All of our margins go into continued R&D.

As we have said before, assuming all commoditized goods are equal in performance, price is, and should be the king. This is what a free market is. But keep in mind, this assumes that there is no room for improvement and that a foam commodity is the best it will ever be. But what if a new product came along, one that offered optimized performance, safety, and greater efficacy of surgical positioning care, is it fair to expect the same price? We do not think it is, so we offer the business case you see before you. 

You see, most of today’s Trendelenburg solutions are nothing more than simple foam pads, standard eggcrate or some degree of viscoelastic foam substrate, where non-woven cloth strips are sewn into a very flimsy and flexible material. Foam has no real support if it is not reinforced, and the effect of shear, especially on foam that is only one to two inches thick, will rip during surgery just about every time. Let's put it this way, you wouldn't want to hang off a cliff with this being your only lifeline from falling. Why should it be any different when your head is hanging down towards the floor at 40 degrees?

Furthermore, these pads are meant to be in constant contact with the mattress, as they also require friction between surfaces to keep the pad and the patient on the table. But, here's the reality, there are many products that are placed between the pad and the mattress, and this changes the very foundation of efficacy for these pads. These compounded devices also causes the patient's center of gravity to become unstable. They also increase the risk for skin integrity issues due to the different material characteristics of each device or product placed between the patient and the surgical mattress top. And if you place a lateral transfer device, something like a Hover type product, the results can be catastrophic, especially when acute angles of the surgical table are required. Think Lasagna!

There are plenty of promises of pressure reduction properties with certain pad companies out there, but this assumes the pad is in direct contact with the mattress (think marshmallow on marshmallow), which is of course, another piece of foam. One inch memory foam pads easily compress and bottom out, and if something with different material properties is placed underneath the pad, there is very little pressure reduction (think S'more layers of marshmallow, chocolate, and graham crackers). Please don't believe the hype. The good news is that our products have two types of complimenting foam components built in and upon a very solid non woven base, capable of lifting up to 500 pounds, but more on that later. We would hang of a cliff with our product and feel confident in its ability to hold the weight without tearing.

Another thing all foam pads share in common is that they all tether to a single fixed point on the surgical table, and it is here the majority of the problems lie.

The processes that must be endured by surgical staff when preparing patients for positions like lithotomy, or those that require arm adduction, were never considered during product R&D. Again, they only focused on the end result of what they hoped to achieve with their products. In short, they relied on surgical provider resourcefulness and piecemeal approaches to make them work. They did not guide care highly reliable processes improvements, ergonomics, optimized efficacy, or performance driven efficiencies that actually created ROI for their customer. More on this in the Cost of Safety section below.

The Business Case

The problem in today's healthcare industry is that it tries to whittle everything down to cost. They formulate a failed logic that believes cutting the cost of goods used for surgery, and then subtracting this cost from the reimbursement, along with the overhead of staff, electricity, health benefits, follow up care, etc., were going to net them some estimated profit per procedure. The problem is when you apply this approach, you are missing out on true cost benefit and performance. 

Today’s surgical procedures are rapidly moving to bundled reimbursements (BPCIs). These reimbursements are also tied to safety, outcomes, performance and efficiency. In short you are getting paid X, whether that procedure takes you 5 minutes or 500 hours. What difference does it make if you saved $5-20 dollars on a foam positioning pad, if your current processes cost you 5-30 minutes on average to position your patients (thin to obese for surgery?)

Let’s look at an example:

 2018 NATIONAL AVERAGE MEDICARE PAYMENT APCs: Gynecology Procedures (laparoscopic, robotic, or open)

• 5415 Level 5 Gyn Procedures (CPT: 58260, 58262, 58263, 58270, 58291,58294) $4112
• 5416 Level 6 Gynecologic Procedures (CPT: 58290, 58292)  $6,287
• 5361 Level 1 Laparoscopy & Related Services (CPT: 58541, 58545, 58550, 58578)           $4,488 
• 5362 Level 2 Laparoscopy & Related Services (CPT: 58542, 58543, 58544, 58546, 58552, 58553, 58554, 58570, 58571, 58572, 58573)                   $7,595

Average surgical time 2-3 hours equates to: $34.26 - $38.29 minute in the OR

Current processes take 5-30 minutes to move the patient, tuck the arms, and secure. Higher times equate to higher BMI patients. 

 Inefficient processes equate to a loss per procedure:                       $171.30 - $1027.00

Our product's average positioning times are range from 1-7 minutes (1-3 minutes on average) netting a considerable cost benefit. There is no such thing as a soft cost in a volume driven industry. 

Most perceived upfront commoditized cost savings are lost after the first minute of positioning under current condtions.

The Safety Case

Advances in surgical procedural care and their postioning regimens have outpaced real solutions. The resourcefulness staff must maintain to position their patients, isn't just fraught with variance, it places providers at increased risks for injury. While no product is perfect, we offer a better way than lifting patients by sheet and hand. In fact, if you wanted to use a mechanized lift with our product we could provide a sling that would facilitate that process. This does NOT exist with other Trendelenburg positioning processes. Please allow us to demonstrate the realities of what your providers must deal with:

The impact of obesity has tremendous impact on ergonomic processes for staff. Even the AORN is trying pass laws relating to patient handling and lifting.

Per CDC/NIOSH:

Rates of musculoskeletal injuries from overexertion in healthcare occupations are among the highest of all U.S. industries. Data from the Bureau of Labor Statistics (BLS) show that in 2014, the rate of overexertion injuries averaged across all industries was 33 per 10,000 full time workers. By comparison, the overexertion injury rate for hospital workers was twice the average (68 per 10,000), the rate for nursing home workers was over three times the average (107 per 10,000), and the rate for ambulance workers was over five times the average (174 per 10,000).1  The single greatest risk factor for overexertion injuries in healthcare workers is the manual lifting, moving and repositioning of patients, residents or clients, i.e., manual patient handling.

And if those statistics aren't being measured as the unseen liabilities and losses you should consider, then maybe this will put things into perspective (Becker's):

Healthcare workers report some of the highest injury rates in the nation, and those injuries come at a price beyond the workers' wellbeing. In 2011, healthcare worker injuries ended up costing the industry an estimated $13.1 billion and more than two million lost work days, according to Scott Harris, PhD, director of EHS Advisory Services for UL Workplace Health & Safety. The hospital share of that was an estimated $6.2 billion and at least 926,000 lost work days

Broken down to the individual level, each healthcare employee with a lost-time injury costs just over $73,000, Dr. Harris says. Across the healthcare workforce it’s $862 per employee.

Perhaps this will also put some liabilites in perspective, and make that strive to save a few dollars mean less (OSHA):

According to one large national survey drawn from 53 healthcare systems with roughly 1,000 hospitals in all 50 states, patient handling injuries accounted for 25 percent of all workers’ compensation claims for the healthcare industry in 2011.3 On average, a workers’ compensation claim related to patient handling cost $15,600, and wage replacement accounted for the largest share of this cost ($12,000).

In terms of wage replacement, patient handling injuries are among the most expensive type of hospital worker injuries.3,4 In addition to these direct and highly visible costs, there are numerous indirect and less visible costs from patient handling injuries—difficult to measure, but with a very real impact on a hospital’s finances and resources. These include employee turnover, training, overtime, incident investigation time, productivity, and morale. Patient safety, satisfaction, and recovery times may also be affected if workers are injured during patient handling and repositioning. These indirect costs can increase the total cost of patient handling injuries by two to four times.

For example, a number of studies have tried to estimate the cost of replacing a nurse who leaves the profession, factoring in the costs associated with separation, recruiting, hiring, productivity loss, and orientation and training. These studies place those costs in the range of $27,000 to $103,000 per nurse.

And if your employee's wellbeing isn't enough to consider, then maybe your patient's is! Please stay tuned for our explanation on the effect of physics, physiology, and material properties involved with patient positioning in Part 2 of this series.

If you have seen enough to consider evaluating our products, please visit infinitusmedical.com for more information!