Safety first: higher acuity cases demand more protective surgical gowns

In an age of value-based care, more and more higher acuity cases—such as total joint replacements—are shifting from inpatient to lower-cost outpatient settings. As a result, ambulatory surgical centers (ASCs) and surgical hospitals have a greater need for more protective surgical gowns.

Standardizing gown selection is a proven strategy to better accommodate higher acuity cases by helping to ensure that clinicians select the right level of protection for each case. Gown standardization also yields other important benefits, such as streamlining inventory management and reducing costs.

The Association for the Advancement of Medical Instrumentation (AAMI) establishes guidelines for choosing gowns based on the level of protection required. The foundation of these guidelines is a classification system that denotes barrier effectiveness–measuring resistance to water, efficacy in critical zones and blood penetration. Levels 3 and 4 are most commonly used for surgical gowns.

Choosing the correct surgical gown for each procedure is important, because these products play an important role in helping to ensure clinical safety. They are intended to protect patients from infectious microorganisms carried by clinical staff and other patients, while also safeguarding healthcare providers from infections transmitted through bodily fluids during a procedure. 

The motivation for shifting higher acuity cases to ASCs and surgical hospitals is clear: outpatient surgeries generally cost 40% less than inpatient for the same procedure. As a result, the number of ASCs offering outpatient joint replacements has increased from 25 in 2014 to more than 200 in 2017. The number of hip and knee replacement surgeries is expected to grow 73% by 2026. At that time, an estimated 51% of these surgeries will take place within an outpatient setting.

To help manage these higher acuity cases, ASCs need the added protection of AAMI Level 4 gowns. Some ASCs may be purchasing them for the first time. Not only will this add cost, but also require more shelf space, as ASCs begin to stock a new product. That’s challenging, because ASCs typically have limited shelf space and managing yet another product complicates inventory management.

Standardizing the solution

What can ASCs do to select the right level of gown protection, while helping control costs and streamline inventory management at the same time? The solution is to standardize gown selection based on procedure mix. Use AAMI guidelines to determine the level of gown protection needed for each procedure. This will help reduce costs by avoiding under- and over-protection. Why use a more expensive Level 4 gown if it’s not required for a particular procedure? Conversely, why risk being under-protected if the procedure requires a Level 4 gown and all you have on the shelf is a Level 3?

Next, stock fewer types of products and streamline purchasing to a single distribution vendor, as opposed to maintaining multiple relationships. Doing both will streamline inventory management, from ordering to stocking. Using fewer products in smarter ways generally results in simpler and more cost-effective purchasing decisions.

By standardizing products on the shelf, an ASC will also be standardizing the practice of gown selection by clinicians. For example, there is more than one type of Level 4 gown. By standardizing your gown inventory, clinicians will know which product to take off the shelf based on the procedure to be performed. 

In particular, Level 4 poly reinforced gowns are better for shorter procedures, while breathable SFS gowns are more suited for longer ones. Though more expensive gowns may initially increase costs, properly ventilated attire helps keep clinicians comfortable, which may support better outcomes and could decrease costs in the long run.

Just as important, involve clinical staff in the surgical gown standardization process. In a recent study conducted of OR staff, 45% indicated they were unfamiliar with AAMI levels. By raising awareness of the role of these levels in proper gown selection, you will be in a better position to help lower costs while improving clinical safety.

Above all, remember that gown standardization based on AAMI level is not a one-time exercise. As new procedures are added or eliminated and surgical staff members join and leave the practice, stay focused on your current procedure mix and adjust your gown purchasing accordingly. Keep in touch with clinicians to help support what they are already doing well. Choosing the right surgical gown is imperative in keeping patients and surgical staff safe as they continue to perform more and more higher acuity procedures.


 1Becker’s Hospital Review. 10 things to know about total joint replacement in ASCs for 2019. March 28, 2019. https://www.beckershospitalreview.com/orthopedics/10-things-to-know-about-total-joint-replacement-in-ascs-for-2019.html

2Becker’s ASC Review. The evolution of total joint replacements from the hospital to the surgery center. Feb. 19, 2019. https://www.beckersasc.com/orthopedics-tjr/the-evolution-of-total-joint-replacements-from-the-hospital-to-the-surgery-center.html

3Key Group, AAMI Knowledge Research, June 2017.

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