Upgrade to Power Tools That Surgeons Love

How to select drills, saws and reamers that your orthopedic surgeons will look forward to using every day. 

Maintaining a fleet of drills, saws and reamers that keeps an entire practice of orthopedic surgeons happy is as much an art as a science. Many of these critical tools are generally agreed upon by all staff based on very objective criteria. At the same time, some surgeons have special tools for certain cases and insist they need a very particular model to perform a hip replacement in the way they know to be best.

Balancing standardization with preference 

Administrators must try their best to assemble a fleet that is mostly standardized while also agreeing to all the special requests. At the end of the day, you want all your surgeons to be happy using the power tools they love. That’s certainly what the patient would want, so the preference factor must be weighed heavily. 

But surgeons’ favorite tools of the trade aren’t simply matters of specific makes and models. These preferences begin when surgeons are medical students and are first exposed to what they see in the OR. They see what their mentors used and develop a plan to use what they see and what most appeals to them. Then, as their careers advance, they have a say in what gets purchased, and are faced with multiple choices in an ever-evolving field of innovation. 

Here are two very different perspectives on how to make these crucial selections: one from a busy surgeon and one from a periop services director handling a significant expansion of their center. 

A surgeon’s view

The OR team at Knoxville Orthopaedic Clinic lets out a collective groan when one saw in the fleet emerges from the blue wrap at the start of a case performed by Philip G. McDowell, Jr., MD. It rattles more than the other saws of the same make and model, and Dr. McDowell simply doesn’t like it. Fortunately, there’s always a sterilized replacement on hand that can be quickly substituted in its place. Dr. McDowell knows what he likes in his tools, and it comes down to:

• Fit and simplicity. Most surgeons are interested in tools that fit their hands and are easy to use, says Dr. McDowell. While surgeon ergonomics is vital, it’s equally important for the surgical technologists and nurses in the OR all the time to easily understand how the tools work. In other words, while the ability to do the job is undeniably important, so too is an uncomplicated design. Dr. McDowell is tall and prefers the longest versions of the tools that are offered so he doesn’t need to crouch when he’s working. “Tools that are too heavy, imbalanced or awkward to use either won’t be used well or won’t be used at all,” says Dr. McDowell, who performs as many as five shoulder replacements a day. “If I had a tool that put a strain on my wrist or was just awkward in my hand, my muscles would be sore and my performance would decline, as the tools are nothing more than an extension of my hands.”

• Noise and sturdiness. With the exception of the aforementioned saw that shouldn’t have a rattle but does, Dr. McDowell doesn’t place too much value on whether a tool is noisy or not. Other surgeons, however, place a premium on working in the quietest OR possible. All, however, can agree that whatever you choose needs to be sturdy. “These tools need to be sterilized all the time, so they have to be designed for use and abuse, including the batteries,” he says. “We can’t be in the middle of a joint replacement and have a battery quit on us in the middle of a precise cut, which is why surgeons insist on dependability and durability.” 

All surgeons should be active and engaged in the product-trialing process, says Dr. McDowell. Four or five different companies attended one of OrthoTennessee’s recent power tools fairs. To test them, surgeons performed cuts on artificial bone from the University of Tennessee anatomy lab, which gave the physicians the ability to not only know how the tools felt in their hands, but also how they would perform in the OR. 

“These sorts of in-person presentations are always a good idea to know what your options are,” says Dr. McDowell. “You just might find something that’s less expensive, more efficient and feels better in your hand than your favorite tool that you had considered irreplaceable.”

Juggling multiple factors

GROUP CONSCIENCE Surgical technicians and nurses should have a working knowledge of all power tools used by surgeons in complex orthopedic cases.  |  OSM file photo

Buffalo (N.Y.) Surgery Center is currently in the process of purchasing replacement power tools for its high-volume orthopedic clinic that are nearing the end of their lifespans or are soon to be obsolete. The facility is also in the midst of an expansion, so additional saws and drills are needed to meet higher workloads. Dealing with that combination of factors at once while upgrading its power tool fleet is a challenging project.

Buying power tools is a huge capital investment, so part of an administrator’s due diligence is making sure all stakeholders who will be using the drills and saws sign off on them before they’re purchased, says Kathy Regan, RN, Buffalo Surgery’s director of perioperative services. Getting two surgeon champions on board, one for large-bone tools and one for small-bone tools, is an excellent start. 
While coordinating a proper trial of the power tools is an administrative task, invested surgeon champions should make sure that all their peers attend to try the new devices and be engaged in the process. Once a decision has been made about which power tools to buy, these champions are also important voices at the board of directors meeting when administrators are making the case for the new purchase. 

Power tools need to be comfortable in your hand, designed for simplicity, use and abuse, and above all, able to do the job.
Philip G. McDowell, Jr., MD

Before that meeting, administrators should educate the surgeon champions about why the new equipment is needed, and translate the rationale by breaking down, component by component, how many new products will be purchased, how much they will cost and what the additional tools will allow the center to achieve. Surgeons are often focused on clinical issues and are appreciative of being told how much new expenses will cost and why they’re important. 

“Don’t show up to the board meeting without a budget,” adds Ms. Regan. “Talk about the versatility of the equipment as well and why having as much standardization as possible is important from an efficiency and workflow perspective.” It helps to have a full inventory list and what your repair bills are at that meeting. Buffalo Surgery is assessing its current inventory levels. The next step will be to align the inventory with the facility’s current volume and evaluate their efficiencies. After that, administrators will make their projections about future case volume brought on by the expansion. Once they determine how many additional power tools will be needed, they’ll contact the vendor to ask for price quotes. 

The center decided to limit its trial process to the main company that provides its current power tools. Buffalo Surgery’s fleet is currently composed of aging tools that its vendor will soon phase out completely, along refurbished tools from its current offering. That company is offering a brand-new version of those tools, so the decision will be whether to purchased refurbished tools from the current version that is offered, the brand-new model or a combination of both. 

“We’ll be looking at individual sets to analyze how frequently they’re down and how frequently we’re sending tools out for repair,” says Ms. Regan. “We’ll take all that into consideration before we decide exactly what to buy as part of a capital investment that will be best for us in the long run.” Buffalo Surgery’s leaders will also include its sterile processing department (SPD) in the discussions to see if more disinfecting-sterilization equipment and employees will be needed to handle the additional inventory — and to make sure enough new power tools will be purchased to keep up with the higher future volume so cases won’t be delayed. The goal is to maintain or gain efficiencies, not lose them. 

Ms. Regan emphasizes that your surgeons must be a part of the actual trial, so they can get their hands on that company’s new line of products even if it seems like a foregone conclusion you’re sticking with the same manufacturer. She suggests holding a two-to-three-day trial so all surgeons and SPD staff can attend. “Administrators need to gather all the intelligence and orchestrate conversations between all stakeholders so you’re confident you’re making a sound decision when you’re writing that check,” says Ms. Regan. 

Power-tool upgrades should never be a surprise expense for facility owners, so Ms. Regan suggests forecasting your needs for next year, when the purchase will be made. In terms of how much to buy, focus on the projected needs for next year’s first two quarters, then buy more tools later in the year if needed. “Surgeons want efficiencies, and they want quality outcomes for their patients,” says Ms. Regan. “They depend on us to make major purchasing decisions in concert with them, so it’s essential to get their buy-in.” 

Carpenters of care

Dr. McDowell says surgeons are no different than carpenters and mechanics who have their go-to saw or wrench when they absolutely must get something right. “We form attachments to them and it’s always a sad day when their lifespan ends and it’s time to replace them,” he says. “The good news is that there’s always a new make and model to fall in love with.” OSM