Big savings when doctors aware of price of instruments

During brain operations at Toronto Western Hospital, neurosurgeons used to squirt fibrin glue — a special anti-coagulant substance — to quickly stanch routine bleeding.

The cost of that squirt: $364. Now, except in emergencies, doctors apply pressure for five minutes to get similar results. It takes slightly longer, but it’s free.

The switch in techniques is part of a fascinating new costsaving drive being instituted by hospitals across Canada, producing some dramatic results and paying dividends to wait-listed patients.

Single-use or disposable surgical supplies that range from sutures to scalpels and sterile drapes — not to mention pricey blood-clotting glue — can total thousands of dollars per case and add millions to the budgets of acute-care hospitals.

By some accounts, the “massive” expense is second only to salaries.

A new Canadian study, though, suggests that many doctors have no idea what any of these items cost, a situation likened to grocery shopping at a supermarket devoid of price tags.

But now many hospitals are showing surgeons the stickers on their throwaway equipment — and calling out those who rack up unusually high bills for disposables. Physicians have been getting frugal in response, choosing products that can be hundreds of dollars less than an alternative.

In just four months, neuro- surgeons at Toronto Western — part of the city’s University Health Network — cut their disposables costs about 30 per cent, or some $750,000, moving from a department deficit to surplus.

“All you needed to do is give the surgeons, the people on the ground, the information they needed to be helpful, and they jumped at the chance,” said Dr. Michael Tymianski, head of the network’s neurosurgery division. “Doctors would look at their bill and say ‘Holy smokes, they charge $200 for that piece of foam? I don’t need to use that.’ ”

The savings have enabled the division to hire more surgeons and provide 150 additional operations a year. And reducing the cost of those disposable products has not af- fected patient outcomes at all, says Tymianski.

Even so, some doctors are worried the push to use cheaper supplies in operations could put a minority of patients at greater risk, with negligible long-term gain.

Severing an appendix by tightening little loops around it costs $18, for instance, compared with $300 for detaching the little organ with a surgical stapler — a disposable device itself, notes Dr. Chris De Gara, president of the Canadian Association of General Surgeons.

But if the loop method has even a one per cent greater risk of complication, that could lead to some patients spending longer in hospital — and wipe out the cost savings, he warns.

“I tend to adopt a policy … that we use the best product that we believe works for the job and we say ‘Bugger the cost,’ ” said De Gara, “There are others who are driven by cost and will say ‘No, I don’t care what your product is, I want to do it more cheaply.’ ”

Disposables range from relatively inexpensive scalpel blades and sponges to implants that can cost thousands of dollars and stay in the patient’s body. The use of much of it is non-negotiable, but not all.

If there are options, though, surgeons have been essentially blind to the financial differences.

In a study just published by Western University’s Dr. Leigh Sowerby, fellow ear, nose and throat specialists in London, Ont., and Montreal were asked to estimate the price of a list of 23 common throwaway supplies — from syringes to tracheotomy tubes and “bone wax.”

More than 70 per cent were unable to estimate accurately the cost even to within 50 per cent of the real figure.

Sowerby’s St. Joseph’s Health Care in London has been on a mission to boost knowledge, giving surgeons lists of supplies with prices attached, and comparing costs between different doctors.

“There are so few places in our lives where we are not aware of our costs,” said Sowerby. “If you’re shopping for groceries, if you’re shopping for clothes, you’re constantly aware of what things cost.”

Providing that information to surgeons is already having an impact. Sowerby cites the case of a “triangle knife,” that scrub nurses produced before every ears, nose and throat (ENT) operation, its sterile packaging ripped open for rapid access.

Whether a surgeon employed the single-use scalpel or — as often happened — left it untouched, the $110 instrument was tossed in the garbage afterward.

That kind of practice has led to a shockingly simple change at St. Joseph’s and some other hospitals. Unless a surgeon is sure he or she will use a product during an operation, it is kept wrapped up so it can be returned to storage if not employed.

Similar cost transparency has been introduced at Vancouver Coastal Health facilities, leading to an ongoing dialogue between equipment managers and doctors, says Linda Lemke of Providence Health, part of the region.

Among the results: An ENT surgeon who stopped using a single-use, tissue-sealing device that cost $375 and replaced it with a $35 model. He felt the 10 minutes saved by the pricier one could not be justified, says Lemke.

At Toronto Western, a neurosurgeon who specializes in minimally invasive endoscopic operations had a similar revelation after discovering a disposable scalpel he used to make a single, small incision at the base of the brain cost $200.

“When he found out … he said ‘ Are you kidding? I can do that with a 65-cent scalpel blade,’ ” recalls Tymianski.