hORh JOUR1IAL FEBRUARY 1992, VOL 55, NO 2

President S Message

Technology assessment is stronger with nursing’s expertise

ecently. a prominent AORN member, who is Re mployed as a director of perioperative nurs- ing services in a large medical center, lamented her frustration at the impasse she had faced in negotiations with several burgeons to standardize the laparoscopic cholecystectomy instrumentation in the department. She had spent days costing out the different systems and identifying the advan- tages and limitations of each brand. In the end. none of the surgeons would budge. The OR direc- tor spent a large portion of her surgical budget satisfying the whims of five different surgeons because she feared they would take their business down the street. Inventory, in-service education. and maintenance needs were complicated by the variety of instrumentation. Is this an isolated occurrence’? I don’t think so. Is this the tip of the iceberg of technological torments faced by peri- operative managers‘? You be the judge.

How do perioperative nurses evaluate new and emerging technologies’? Are traditional decision- making methods sufficient for the “high- techhigh-cost” items that compete for precious OR dollars? When a new. expensive technology is considered for purchase at Mount Carmel Health. Columbus. Ohio. Kay Ball. RN, MSA, CNOR. AORN President-elect, conducts a “justi- fication study“ to ascertain the percent of proce- dures that will use this potential purchase. How many physicians will use it, and will it enhance revenue’? Can it be used by more than one service and with more than one procedure? She also evaluates any studies that have been done using this technology and compares the technology with similar devices. A cost-benefit analysis is

built into the decision-malung process. The pro- cess that Ball uses is a variation on a method known as “technology assessment.”

Technology assessment is a form of policy research that looks at the short-term and long- term results of using a particular technology. In health care, this assessment focuses on the safety, effectiveness or efficacy, risks, associated costs, and other issues. Other increasingly important issues have societal, legal, and ethical implica- tions. New technology assessment also considers not only the effectiveness of interventions and technologies, but patient preferences and quali- ty-of-life issues as well.’

Society is paying a financial and ethical price for technological successes in health care when technologies are introduced without considera- tion of the ethical implications of their intended and unintended outcomes. The annual cost of health care in our country now exceeds 12.2% of the gross national product (estimated at more than $22 billion a year); a good part of that is attributed to the cost of medical technology.’ One author estimates that in 1989, one third of hospital costs were spent on inappropriate use of technology.i As more providers and payers of health care are faced with the economic con- straints of health care and the complex clinical and policy decisions associated with today’s “high-tech” medicine, new strategies to make fiscally sound decisions are being developed.

How can budgetary decisions also consider the safety and effectiveness of new instrumentation, equipment, and supplies used in surgical patient care? Johns Hopkins Medical Institutions,

4ORN JOURNAL FEBRUARY 1992, VOL 55. NO 2

Baltimore. established a program for medical tech- nology and practice assessment in 1986 to grapple with multiple and complex issues facing their health care institutions. patients. manufacturers. and payers.’ The Kaiser Permanente Health System has a new technologies committee to eval- uate new technologie~.~ Some hospital groups such as the Mercy-affiliated institutions have clini- cal product evaluation committees that use analy- sis. evaluation. and cost-benefit decision making to reach consensus about group purchasing of patient care products.-

The input, clinical expertise. and experience that nursing can bring to these programs is invaluable. Nurses have developed new nursing in t e r v e n t i on s , have modified e v a1 u a t i on approaches. and have constantly adjusted their practices in response to new technologies. Nursing practice is directly affected by almost every new technology introduced into the health care setting. Nowhere is this more appar- ent than in the surgical environment.

Nursing must be involved in interdisciplinary efforts to conduct technology assessment when ( 1 ) decisions about technologies made by one discipline affect the work and personnel in other disciplines; (2 ) activities and responsibili- ties are realigned among disciplines; and (3) a technology is most effectively introduced with a team approach.s Do these situations sound like they apply to perioperative nurses‘? 1 believe they do, and I also believe that the never-ending development of new technologies in surgical care make i t more important than ever for perioperative nurses to be involved in technology assessment. Regardless of the size. geographic location, or diversity of services your surgical department offers, consider the contributions you can make to product evalua- tion. in-service education on new devices and equipment. and discussions on the ethical issues associated with technologies used in sur- Zical intervention.

As the closing speaker at AORN Congress in 1988. former Colorado Governor Richard Lamm told us that medicine has outpaced America’s ability to pay for its inventions. More recently. he has raised the question of whether we are obligat-

ed to provide “Cadillac care” to everyone. A provocative thought, to be sure, and one with no easy answer. Yet, perioperative nurses can con- tribute to decisions made about technologies used in health care. We are the experts in nursing care; we see the benefits, and sometimes miracles, that technology can provide to our patients. At the same time. we should offer our knowledge and experience to help make decisions about priori- ties in surgical technology.

As the face of surgery continues to change, the role of the nurse in surgery also will change. Participating in technology assessment is one more way that perioperative nurses will continue to help with decisions made about patients.

JEAN M. REEDER, RN, PHD, CNOR LIEUTENANT COLONEL, ARMY NURSE CORPS

PRESIDENT

The opiiiiori.~ or assertions coritairied in this article cire the priinte views of the ciuthor and are not to be corwtnced as oficial or as reflecting the views of the US A t m y Medical Department o r the Department of Defeiise.

Notes I . H D Banta, P B Andreasen, “The political

dimension in health care technology assessment pro- grams.” Interriatioiial J o ~ i r i i ~ l of Technology A.ssessnierit in Health Care 6 no 1 ( 1990) 1 15- 123.

2. V R Fuchs. A M Garber, “The new technolo- gy assessment,’’ The N e w Englcind Journal of Medicine 323 (Sept 6, 1990) 673-677.

3. A Jacox, K M Kerfoot, “Nursing and technol- ogy: Technology assessment in hospitals,” Nursing

4. J V Maloney, Jr, “Technology in health care: The social impact and economic cost,” Medical P t o g w s s it? Teclinolog~ 14 no 3-4 (1988-89) 109- 114.

5. E P Steinbcrg, S Graziano, .‘Integrating tech- nology assessment and medical practice evaluation into hospital operations,” 16 QRB (June 1990) 218- 222.

6. P McGuire. “Kaiser Permanente’s new tech- nologies committee: An approach to assessing tech- nology,” QRB 16 (June 1990) 240-242.

7. P Cotton, “Medical schools receive a mes- sage: Reform yourselves, then take on the health care system,” Journal of the Anierican Medical Association 266 (Nov 27, 1991) 2802-2804.

8. Steinberg, Graziano. “Integrating technology assessment and medical practice evaluation into hos- pital operations,” 21 8-222.

ECOIID/H~C.F 8 (July/AtIgust 1990) 276-279, 290.