Orthopedic volume is growing at such a rapid rate that some researchers predict that the number of patients requiring joint replacements will outpace the number of physicians able to perform these procedures within the next decade. To help you keep pace with the strong demand for orthopedic surgery, we've compiled 6 assets that can help attract busy surgeons to your facility.

1. Quality instrumentation, without delays
The instrumentation and supplies needed for orthopedic surgery can be very expensive, but failing to have enough instrumentation to keep cases humming can cost you in efficiency and surgeon satisfaction. Administrators of high-volume orthopedic facilities recommend 2 strategies to keep your facility well-equipped to handle a heavy ortho caseload: a good relationship with your vendors and a dedicated instrument tech.

When it comes to dealing with vendors, remember that everything is negotiable. Greg DeConciliis, PA-C, CASC, administrator of Boston Out-Patient Surgical Suites in Waltham, Mass., recommends that you ask if discounts are available on demo equipment, try to get major pieces of equipment for free in exchange for purchasing the vendor's disposables and try to consign items that only 1 or 2 surgeons request instead of keeping them on the shelves to rarely be used. For example, when a new surgeon started bringing hip arthroscopy cases to her ASC, Kecia Rardin, RN, CNOR, CASC, administrator of the Northwest Ambulatory Surgery Center in Portland, Ore., got one of her vendors to bring in loaner instrumentation sets for high-volume days until the facility could find room in its budget to purchase an additional hip set. "Have prospective surgeons visit your facility, bring their preference cards and be as specific as possible," says Mr. DeConciliis, whose facility does 60% to 70% orthopedic cases. See if they'll be willing to work with what you already have, and if not, take their preferences to the vendors and try to work out deals to get the equipment your surgeons want without breaking the bank.

Finally, don't rely on your surgical techs to handle the cleaning and sterilization of instrument sets in addition to assisting with surgeries and turning over rooms. A dedicated reprocessing tech can help prevent the bottlenecks in central sterile that are so often the cause of delays in instrument-heavy orthopedic cases. Ms. Rardin also believes hiring a dedicated surgical tech with special training in instrument reprocessing helped her facility achieve a 0% infection rate in 2010.

2. HD arthroscopy towers
We all know that properly outfitting your facility is one of the keys to attracting orthopedic surgeons. The Charlotte Surgery Center in North Carolina purchased 7 new high-definition towers right before it brought a new, large orthopedic group on board in 2008. "That was key to letting them know that we were investing in making this work," says Administrator Les O'Connor, MHA, FACHE. Do you absolutely need to go high-def to bring new orthopods into your center? Not necessarily, says Mr. DeConciliis. "You need to have as good a tower, the most current version of a tower and the actual arthroscopic equipment, as you can afford. If that means HD, that's great." But as more of your competitors — both hospitals and ASCs — upgrade to high-def equipment and surgeons become more accustomed to the sharper images, the greater the pressure will be for you to follow suit. Ms. Rardin says her facility is gearing up to purchase 3 HD arthroscopy towers in 2011 to stay competitive in recruiting new orthopods.

3. Regional anesthesia program
Advocates say perioperative nerve blocks help smooth and speed patient recovery times in PACU by reducing post-operative nausea and vomiting, the need for narcotics and the high pain scores that can keep patients in your facility longer than necessary. Overall, the back-end time-saving benefits of regional anesthesia will probably not free you up to do more orthopedic cases in a day, says Mr. DeConciliis, but they can prevent bottlenecks and improve patient satisfaction, which in turn could help entice surgeons to bring more cases to your facility. Continuous nerve blocks for more long-term post-op pain management are also a boon if handled correctly, says Ms. Rardin, whose facility uses continuous blocks in nearly all large orthopedic cases. "The anesthesiologist calls the patient every night to make sure they're doing well," she notes. "It's good PR because patients wake up comfortable and it decreases your recovery times." Both Mr. DeConciliis and Ms. Rardin recommend investing in an ultrasound machine to facilitate nerve block placement.

4. Skilled anesthesia and support staff
Orthopedic cases can be long and messy, and the instrumentation, implants and equipment used are always changing. That's why, whenever possible, it's important to hire clinical staff who are experienced with orthopedics to assist your surgeons with a high level of skill and professionalism. "The biggest factor would be the surgical tech that works with [the surgeons]. They must be very familiar with the implants and instruments that are used in these cases," says Mr. O'Connor. "If you have a good tech, it can make or break your facility," agrees Mr. DeConciliis, who recommends that you specify you're looking for someone with orthopedic experience when hiring and try asking your surgeons and vendor reps if they can recommend techs they've worked with at other facilities. Once you've assembled a highly skilled surgical staff, you'll want to retain them, which is why Mr. DeConciliis advocates paying your surgical techs well.

"The other piece," says Mr. O'Connor, "is a good working relationship with your anesthesia group. We have a dedicated 3-man anesthesia group here, and I think that has served us well in the fact that they know every doctor, it's always the same 3 guys here, and because of that continuity they are familiar with exactly how the physician would like the anesthesia in their cases to go." Again, because of the complexity of many orthopedic cases and the need for sophisticated post-op pain control, a skilled and reliable team of anesthesia providers can be a big selling point with prospective surgeons.

5. An accommodating schedule
The biggest selling point Ms. Rardin stresses to orthopedic surgeons she's trying to recruit is the improved quality of life they can expect when they bring their cases to the ASC. "We try to convince them that they're going to have more personal time," she explains. The key is creative scheduling, whether it's letting a surgeon flip between 2 rooms to keep a steady pace of cases going, consolidating the schedule to let a surgeon finish sooner if possible or scheduling like cases (all right knees; all left shoulders) in a row to reduce room turnover times. "We've done a lot of block time reassignment," adds Mr. O'Connor, who recommends that you closely monitor your block schedule and consolidate rooms for efficiencies as needed.

6. Surgeon salesmen
"Your existing orthopedic surgeons are your best bet for getting additional ones in," says Ms. Rardin. She speaks to her facility's orthopedic surgeon-owners at least once a quarter about their role in recruitment efforts, encouraging them to offer names of prospective surgeons and coaching them on how to answer questions about the center and sell it to their colleagues. Ms. Rardin says you should also be creative in your marketing efforts and keep your eyes and ears open to changes in the community; you never know when the opportunity to recruit new orthopedic surgeons will arise.