Today, surgical departments face increasing pressure to say compliant with instrument processing standards set forth by major accreditation agencies. Often, facilities need to buy more instruments to meet these standards, yet are challenged by budget constraints, lack of support from their surgical instrument providers and increasingly complex instruments. Here, Rob Edelstein, President of Millenium Surgical, offers 20 tips for surgical facilities to make the most of the surgical instrument purchasing process.

1. Maintain accurate expectations of instrument utilization. If you hear of new surgeons or new procedures coming to your facility, ensure you will be getting a strong ROI before filling an instrument “wish list.”
2. Selectively invest in quality. Certain instruments, such as Needle Holders and Scissors, are more likely to breed surgeon contention than others if quality or maintenance is sub par.  Purchase the highest grade of these and similar instruments, and your surgeon and staff satisfaction will rise.
3. Old habits die-hard with surgeons, and they’ll often ask for a specific instrument solely by brand name. It’s important to determine if the requested item must come from a specific vendor. If the vendor name or part number was for reference only, then you have an opportunity to compare cost. By making just OneCALL™ to Millennium Surgical, you’ll be able to compare cost and have the support of our trained, experienced, and accessible team.
4. Most of the surgical instrument suppliers in the United States do not manufacture the instruments they sell, outsourcing to a number of companies.  This results in an identical instrument being multi-branded, and thus sold at varying costs, creating an opportunity to save on purchases if you compare costs between different companies. Your surgical instrument source should have relationships with many quality manufacturers to ensure you get the quality instrument your operation requires.
5. As the ASC industry grows, so does the number of qualified surgical instrument suppliers required to support these centers. This translates into more options for you, driving down cost while promoting quality manufacturing. Make sure you work with a company who specializes in providing surgical instruments to ASCs.  
6. Always have a backup plan and try to identify at least two (2) suppliers for each item on your list. If your supplier can’t find your specific instrument, ask them to recommend another supplier. If they can’t, or won’t, consider another supplier.  
7. Knowing where to trim and where to spend comes from experience and paying careful attention to results. Intelligent purchasing promotes overall satisfaction.
8. Intelligent cost-cutting. Cutting cost on the purchase of Handheld Retractors, Sponge Forceps, Towel Clips, Dressing, Tissue Forceps and Basic Hemostats will not directly affect surgeon satisfaction.  Identify target areas to help your center’s bottom line.
9. Streamlined purchasing. By focusing only on the instruments you need, you’ll save thousands of dollars. Sets are often designed by instrument companies and include unnecessary parts. For example, when buying a Bookwalter-type ring, target only the necessary components and avoid complete sets.
10. Verify discounts when placing contracted instrument orders, as many times vendors sell products at list price and mix them in with your contracted order, without making it clear on your quote which items are discounted and which are not.  If you’re not sure, give your vendor a call with questions. 
11. Your contracts must be current and in effect, with proper discount grading levels, before proceeding with surgical instrument purchases. All paper work must be completed by you and filed by your vendor before purchasing.  Even once paperwork has been filed, pricing must still be loaded against your account.  All of the above must occur to ensure savings, or you may be paying too much for your instruments.
12. Compare the invoice with the PO on every order you place, to ensure accuracy and minimize risk.  As companies have grown, systems have become more complex, creating increased possibility for error.
13. Instrument returns is often a process that does not receive adequate attention or follow-up.  Process and track returned items directly through the vendor, instead of your sales rep, within 30 – 60 days of purchase.  Follow up on credits that have not been posted to your account within 15 days of the return.
14. Many times companies “discontinue” items each year as a cost-cutting measure. These items are still available via special order, but at a significant premium. Research other vendors, as they may work with the same instrument manufacturer, offering a duplicate item without the premium.  
15. With highly specialized instruments and sets comes significant handling responsibility. Only necessary, highly qualified personnel should handle these types of instruments to ensure proper use and maintenance.
16. “Non-repairable” instruments can often be fixed by third party services at a significant savings compared to working with the original vendor.  Investigate your options before resorting to a new purchase.  
17.  Building smart trays from the start helps avoid the need to flash sterilize instruments.  By keeping the selection and quantity to a minimum, you can use the base tray as a test to determine what needs to be added and what can be removed.  Maintain instrument stock at a volume that anticipates days with high amounts of cases.
18. Market the benefits of high-level sterilization to surgeons and patients as a means of competitively differentiating your center from others.
19. Rightsizing your existing trays allows for fast processing time, less work and lower cost.  Carefully list all items in a tray, and have a Scrub Tech track use for each item, creating new set lists when appropriate.  Surgeons should review all updated trays, and unused items should be removed.  Only add to a tray when you are sure the instrument will be utilized in the majority of cases.
20. Create and maintain a detailed list of instruments in an electronic format such as Excel. Include a complete instrument inventory, including specifics such as tray details and peel pack items.

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