A framework for evaluating clinical solutions in resource-constrained environments
More than 50% of all procedures are now performed outside traditional hospital settings1, with ambulatory surgery center (ASC) volumes projected to grow 21% over the next decade 2. This migration from hospital to outpatient settings brings a fundamental challenge: delivering hospital-quality outcomes without hospital-level backup resources.
Nowhere is this tension more acute than in airway management. ASC anesthesiologists operate in what clinicians describe as “island environments”—requiring the same clinical rigor as hospital procedures, but without immediate access to backup teams or rescue resources.
Based on insights from ASC medical directors who’ve successfully implemented new airway protocols, here are five questions that should guide your evaluation process.
1. What does the peer-reviewed evidence show for first-pass success rates?
In hospital settings, a failed first intubation attempt triggers a well-rehearsed protocol: call for backup, escalate to more experienced practitioners, and bring in additional equipment.
ASCs don’t have that luxury. Your first attempt needs to succeed—not just for patient safety, but for operational efficiency. A failed attempt may mean additional medications, delayed surgical starts, and cascading schedule impacts.
Research demonstrates that video laryngoscopy improves first-pass success rates compared to direct laryngoscopy3, even among less experienced practitioners. Studies including the EMMA trial have documented these improvements across diverse patient populations.
Ask yourself: Look beyond marketing materials to peer-reviewed clinical studies. What success rates are documented in real-world ASC environments?
2. What’s the total cost of ownership—not just the equipment price?
The sticker price tells only part of the story. A comprehensive financial analysis should include:
Direct costs: Equipment purchase/lease, disposable components per case, maintenance agreements, staff training time
Indirect costs and savings: Sterilization workflows, medications for repeat attempts, OR time efficiency, complication prevention
Some ASCs conducting internal cost analyses have found that certain video laryngoscopy systems cost less per case than disposable direct laryngoscopy blades when accounting for the complete cost structure.4 In one case, a facility reported their disposable traditional blades remained unused after implementing video laryngoscopy as standard practice—the anticipated “cost-saving” approach cost more.
Failed intubation attempts create additional expenses beyond the immediate procedure.4 One documented case at a teaching hospital escalated from a difficult intubation to a surgical airway, resulting in a costly ICU admission.4
Ask yourself: Build a comprehensive cost model that includes workflow impacts and complication prevention, not just acquisition costs.
3. How does this technology integrate with your existing protocols?
Some ASCs approach video laryngoscopy as a “rescue device”— something you escalate to when direct laryngoscopy fails. But this creates a paradox: you’re using your best visualization on airways3 already traumatized from failed attempts.
Leading centers have inverted this model, making video laryngoscopy the first-line approach for all intubations.3 This prevents complications from initial failures.3
Ask yourself: Will this technology streamline your current approach or add steps? Can it become the standard rather than the exception?
4. What training and support comes with implementation?
The gap between purchasing equipment and achieving consistent clinical adoption is where many technology investments fail. Effective implementation requires comprehensive initial training, ongoing competency assessment, clinical champions, clear protocols, and metrics to track adoption.
A 30-minute product demonstration differs significantly from a comprehensive certification program. Some manufacturers include extensive training modules with implementation—an investment that dramatically impacts adoption success.
Ask yourself: What happens after the equipment arrives? Who provides training, and what ongoing support is available?
5. Would you want this approach used on yourself or your family?
This question cuts through assumptions about what’s “necessary” versus what’s merely “traditional.”
Consider this scenario: When VIP patients come through a facility—board members, physicians’ families, local officials—clinical teams sometimes quietly adjust their approach. They choose video laryngoscopy over direct laryngoscopy. The reasoning? “Better odds of first-pass success.”3
If video laryngoscopy offers better outcomes3 for high-profile patients, the logical question emerges: Why isn’t it the standard for everyone?
This isn’t about guilt—it’s about recognizing gaps between the care we’re capable of providing and the care we’ve normalized. Current video laryngoscopy technology has reached price points that make “gold standard for all” approaches economically viable.
Ask yourself: Are you making different technology choices based on patient profile rather than clinical need? If so, what’s driving that decision?
Building your evaluation framework
These five questions provide a starting point for structured technology evaluation. The most successful implementations share common characteristics:
- Data-driven decisions based on peer-reviewed evidence and total cost analysis
- Clinical champion engagement from medical directors and lead anesthesiologists
- Realistic timelines with phased rollouts and adequate training
- Clear success metrics tracked from day one
- Stakeholder communication ensuring surgeons, PACU staff, and administration understand the rationale
The path forward
As procedures continue migrating to ASCs, equipment and protocols must evolve accordingly. The most forward-thinking ASCs recognize that limitations in backup resources require higher standards for frontline technology, not lower.
This shift isn’t about spending more—it’s about spending strategically on technology that prevents expensive complications and inefficiencies that erode margins and compromise outcomes.
Adam Thaler, Summit Health ASC’s medical director, implemented video laryngoscopy as standard practice three years ago. Hear his evaluation process, implementation strategy, and results on the ASC Insights podcast.
These tips were developed via a podcast that you can listen to with Dr. Thaler. Listen to the podcast or download the full case study here.
Share your experience: Are you using innovative approaches and using Medtronic products at your ASC? Help fellow leaders make better-informed decisions.
ASC Insights is a multimedia series featuring conversations with ASC leaders about technology evaluation and operational innovation. Developed in partnership with Medtronic.
References
- Ambulatory Surgery Centers Market Size, Share Report 2030
- United States Ambulatory Surgery Center Market Report 2024 – In 2025, 33% of Cardiac Procedures Will Take Place At Ambulatory Surgery Centers (ASCs), Reshaping the Future of Cardiac Care – ResearchAndMarkets.com
- Kriege M, Noppens RR, Turkstra T, et al; EMMA Trial Investigators Group. A multicentre randomised controlled trial of the McGrath™ Mac video laryngoscope versus conventional laryngoscopy. Anaesthesia. 2023 Jun;78(6):722-729.
- Moucharite MA, et al. Factors and economic outcomes associated with documented difficult intubation in the United States. Clinicoecon Outcomes Res. 2021;13:227–239.
