Factors affecting perfusionists' decisions on equipment utilization: results of a United States survey

The decision to utilize extracorporeal equipment is influenced by a number of factors, including clinical efficacy, cost effectiveness, and personal judgment. The purpose of this study was to report the results of a national survey that examined factors affecting perfusionists' decisions on equipment utilization. An 80-question survey was mailed to chief perfusionists at 1030 U.S. hospitals performing open-heart surgery. 524 completed surveys were returned, which represented 797 hospitals (78.8%) and 671,290 procedures over a 2-year period (July 1996-June 1998). Within the survey, 36 questions pertained to equipment utilization and served as the basis for this report. The perfusion equipment that had seen the greatest reduction in use were; heparin-coated circuits (HCC) (12.0%), in-line blood gas monitors (9.7%), soft-shell venous reservoirs (SSVR) (7.2%), and in-line arterial hemoglobin monitors (6.3%). Cost was the major determinant affecting the decision for the following devices: in-line blood gas monitors (82.4%), cardioplegia in-line delivery filters (75.0%), in-line arterial hemoglobin monitors (69.7%), HCC (55.6%), and SSVR (43.2). Ineffectiveness was the major reason reported for discontinuation of arterial-line bubble traps (64.7%), venous reservoir level detectors (50.0%), and arterial-line pressure manometers with pump shutdown (50.0%). 438 respondents discontinued use of one or more of 29 different devices during the past 2 years. Cost was the major reason in 52.7% of the cases, ineffectiveness in 33.1%, and 14.2% were in a category labeled "other." The pressures brought upon by the changing healthcare structure have influenced perfusionists' equipment selection, with cost being a major factor affecting clinical decisions for certain device utilization.