Terri Benedict, director of surgical services at St. Lucie, says contracting with IMS brings a dedicated technician into the OR to remove instrument and equipment worries from the nursing staff. "Nurses are inundated with new technology, and this service helps free them up to focus on the patient and increase efficiencies around patient safety," said Benedict. "Minimally invasive and laparoscopic technology can be difficult, with video towers, printers, color balance, etc. It’s a challenge that is well served by an expert in these systems, and it takes one piece of that diversification away from the OR nurse. They don’t have to be electricians and AV experts."

With nurses free to focus on patient care and IMS personnel making sure instruments and equipment are ready for each procedure, surgeon satisfaction has improved significantly. Said Benedict, "I believe our case volumes have grown because surgeons like having that support. I’ve heard surgeons say if they have a choice, they come here. It’s an added value in the surgeon’s mind."

The combination of improved staff efficiency and surgeon satisfaction has led to more minimally invasive cases at St. Lucie. The agreement stipulated that case volume would increase to a minimum of 50 cases per month. In 2006, case volume averaged 54 cases per month, and this upward trend has continued with an average of 63 cases per month for the first 10 months of 2007.

A certified IMS surgical technologist conducts the pre-case set up for a minimally invasive procedure. Surgical technologists are also responsible for on-site intra-operative assistance, post case turnover, technical support, and trouble-shooting for instrumentation and video equipment.

Benedict says the fee-per-procedure structure of the partnership has worked very well for the hospital. "The initial goals were set at realistic improvement levels. This means the hospital isn’t paying for the service on procedures that aren’t done. We looked at our volumes and projected forward, and set the minimum number of cases that we would be charged for at 50 per month. If we are doing more than the minimum, St. Lucie and IMS both succeed." According to Bragg, VanBalen, and Cook, "One additional procedure per day can generate $4 - $7 million of revenue in an average sized facility (i.e., 250 beds) in one year,"1 obviously a significant financial benefit to the hospital.

The IMS program also provides hospitals with savings on capital equipment purchases. Because IMS provides the instrumentation under a lease agreement, the inventory is kept current and sufficient to meet procedure demand. "We have to spend a lot of capital on technology and equipment," said Benedict. "The instruments are provided by IMS and they care for them, so we don’t have to replace instruments and use our capital. IMS brought in extra sets and lenses, and even provided a safe laparascopic cautery device (active electrode monitoring technology) to eliminate arcing, as an added value to the service. We don’t have to worry about instrument replacement and loss."

St. Lucie Medical Center entered into the agreement due to an established track record with IMS. "They had proven to be a good partner and very trustworthy at every level," says Benedict, "but we had to believe that we would achieve greater efficiencies and more throughput in the OR." That proof came through the elements of the program. "Their assistance with pre-case setup and post-case turnover really provides an extra FTE in the room. The technicians are on call 24/7, and that helps our circulator, especially after hours. I don’t hesitate to call in another person for tough weekend cases, but with IMS I don’t have to, and those are hard dollars you can quantify."

Benedict also says it’s important that the integration of outside personnel into the OR go smoothly. "IMS holds its reps to high standards, and they are expected to come in and be assimilated without taking over a room. By assembling equipment before the case, it takes workload off of us. They keep preference cards for physicians and are also helpful in cutting down on use of disposables, such as disposable trocars. Their technicians are integrated to the point of being part of our process improvement plan and are very active in all of our quality indicators for surgery and reporting. They are also active in teaching and providing inservices for staff."