Nine managers and technologists discuss their experiences with Prefilled Syringes in a Roundtable Discussion moderated by David S. Enterline, MD, Duke University Medical Center
Welcome to the
Prefilled Syringe Focus Group. This panel has been assembled with
people who are interested in and have experience with prefilled
syringes. I'd like to thank our host, Applied Radiology, for
allowing us to discuss this issue. My name is Dave Enterline and I
will serve as the Moderator of this discussion. I'm a radiologist
in the Department of Radiology at Duke University Medical Center in
North Carolina. I'm primarily a neuroradiologist, and I also
perform interventional neuroradiology and head our emergency
radiology areas. In our department, we have six spiral CT scanners
at our principal hospital. We do approximately 3,000 CT patient
examinations per month, so it is a fairly high-volume department.
Each of our CT scanners has some variety of injector built in, and
we have products from several different vendors. Currently, we
don't use prefilled syringes at our primary site, although two of
our associated hospitals are using prefilled syringes for CT
scanning. At this point, I'd like to have the rest of the panel
introduce themselves and briefly comment on their use of prefilled
Cynthia Caporuscio, I am the Section Head for CT Scanning at Centre
Community Hospital, in State College, PA. We are a small community
hospital with 200 beds. We do use prefilled syringes. We do a high
volume of CT studies for the amount of beds we have in the
hospital, so it is a necessity to use the prefilled syringes.
Gary Goble, Chief Technologist from Aston Ambulatory Care Center in
Dallas, TX. Aston is an outpatient center, and we do between 1,000
and 1,200 CT exams per month. We've been using prefilled syringes
since I came aboard in March 2000. There were financial
considerations that led to that decision, but also morale issues
with the staff to help keep the technologists happy.
Richard Ligi, Director of Radiology and Imaging Services at St.
Francis Hospital and Health Center, Poughkeepsie, NY. We're a Level
2 trauma center. At the present time, we have a very active
radiology organization, and prefilled syringes are very necessary
in a trauma center, as well as in an interventional setting, where
volume is extremely high. We anticipate our yearly volume at around
14,000 examinations in CT, and 3,000 in interventional
Matt Merical, Department Supervisor at Dickinson County Memorial
Hospital in Spirit Lake, IA. For our hospital and for the regional
imaging centers for some rural areas in Iowa, we switched to
prefilled syringes about 18 months ago when we went from axial
scanning to helical. We made the change for reasons of patient
throughput and ease of use.
Jeff Pulliam, CT/MRI Supervisor of Summit Medical Center in
Nashville, TN. We average about 1,300 to 1,400 CT scans per month,
and we've been using prefilled syringes for about 2 years. The
change was made for financial reasons and for efficiency of the
technologists. We've been extremely happy with the results on both
the financial end and on throughput.
Robbin Roberts, CT Scan Technologist at Howard Community Hospital,
Kokomo, IN. We've been using prefilled syringes for close to 4
years now, ever since we went from axial scanning to helical
scanning. With the increased throughput of patients with prefilled
syringes and helical scanning, it's just much better, more
efficient and faster.
Dawn Ross, X-Ray Supervisor at Modesto Imaging Center in Modesto,
CA. We switched to a helical scanner about 9 months ago. Our
technologists were having to come in half an hour earlier to start
their shifts to get the Medrad syringes filled to do their patients
for the day; and they were complaining about having to do this. At
the same time, our patient load increased by about 10 patients a
day, so it made more sense to get the prefilled syringes. They're
ready to go and you don't have as much set up time, so using
prefilled syringes helped us increase our patient volume.
Lanis Taylor, CT Supervisor at Wellmont Holston Valley Medical
Center, Kingsport, TN. At Holston Valley we average 2,000 CT scans
per month. Switching to prefilled syringes was a throughput issue
for us; we're busting at the seams. Once we changed, we more than
made back the additional cost. We love it; it cuts down on our time
and cuts down on the stress.
Casey Watson, Staff Technologist at Eastern Idaho Regional Medical
Center in Idaho Falls. At our facility we probably do an average of
30 to 45 CT scans a day. I think the decision to use prefilled
syringes was weighted heavily on time efficiency and ease of use of
the product from the technologist's standpoint.
Our principal purpose of this focus group is to discuss CT
contrast utilization and to address some of the advantages and
disadvantages of prefilled syringes at individual institutions.
More specifically, we'd like to hear about the panel members'
experiences. How do you feel about prefilled syringes overall, and
what are their pros and cons?
Figure 1 is a picture of one of our CT rooms, with a light speed
scanner and a Medrad injector system. The conventional equipment we
use for CT injection consists of a syringe vial for drawback of
contrast, a device to draw back the contrast, and a connection to
the patient (Figure 2). The prefilled syringe in essence is a
single device, except for the actual connection to the patient. It
has an interlocking bottom that's mated to a particular injector
(Figure 3). Each of the injectors is optimized for individual
Medrad-compatible prefilled syringes were first introduced in
1997. Prefilled syringe vendors have teamed with one of the
injector companies. The major manufacturers of prefilled syringes
offer various contrast concentrations and volumes optimized for
different scanning protocols. This has really been a growth area
for the contrast companies, reporting growth of 20% to 40%
annually. I think it's an area that will continue to grow.
There are some goals I'd like to present for this focus
1) To discuss the decision process in each of your departments;
how did you get to the point of saying, "that's why I want to use
2) Are you using prefilled syringes all the time, or only in
selected patient populations or situations? If you are using them
selectively, please let us know how (such as for emergency
patients, outpatients, combative patients, or patients on weekends,
3) The initial decision to use prefilled syringes is made based
on perceived benefits. Now that you are using them, please share
your views on the actual advantages and disadvantages.
4) Have you increased patient throughput? Are you able to
schedule additional patients as a result of using prefilled
5) How has the use of prefilled syringes factored into employee
satisfaction? As we're approaching a technologist shortage, does it
make a more pleasant environment for technologists to work in?
6) Are there other benefits? Does the fact that the patient sees
a single syringe that they know you're loading individually become
a benefit to your overall institution?
Transition to prefilled syringes
There are many different considerations in making a transition
to or using prefilled syringes, and I've divided them into
categories (Table 1).
Technologist ease of use:
There is certainly an inherent efficiency and ease of use that
comes with prefilled syringes. A technologist can also minimize
contact with contrast agents, which is especially a concern in
cases of contrast allergy. You can decrease the amount of spillage.
These are issues of interest to all technologists.
The safety issues are related primarily to labeling and
misadministration. When contrast is drawn into syringes from a
bottle, are those syringes labeled? How are you sure what the
patient is getting? Needle sticks and glass breakage are also
safety issues. In drawing contrast up from bottles, the safety
issue is related to removing the cap, and tearing off the actual
We should also discuss medication sterility and contamination.
Recently, JCAHO came out with compliance issues related to all
medications. We know that hospitals are very concerned with JCAHO
compliance. Table 2 lists the regulation pertinent to our
discussion. There are two points associated with this regulation:
1) All medication must be labeled appropriately, safely, and in a
standardized method; and 2) Medications should be dispensed in the
most ready-to-administer form possible, to minimize opportunities
for error. How do these compliance issues figure into your decision
to use prefilled syringes?
Clearly, cost effectiveness is a very complex issue, and is
relevant to the decision to use prefilled syringes. Clearly, the
prefilled syringes cost more than the cost of a bottle of contrast,
since there's more involved in manufacturing the prefilled syringe.
So, which factors influenced your decision to use this product? Is
it really a cost-effective venture? A time effectiveness study and
cost effectiveness study would be valuable in defining if the issue
is simply the cost of the prefilled syringe versus the cost of a
bottle of contrast and the actual injector. Which factors, if any,
offset the overall cost to the institution?
Table 3 lists the
direct and indirect costs
associated with using prefilled syringes. All of these factors must
be accounted for in a cost-effectiveness analysis. Contrast waste
is certainly an indirect cost. Are there situations in which
contrast is loaded into a syringe and not used for a patient? How
many ccs of contrast are wasted in drawing it up into a syringe?
These are all indirect costs relevant to cost effectiveness. In
addition to the cost and space for the additional supplies that
must be purchased and stored, how do you dispose of those
additional items? Is there a cost associated with their disposal?
Finally, if a product helps you increase efficiency, is that
efficiency translated into overall savings? These savings can
account for the ability to scan additional patients, but also the
ability to use a CT scanner more efficiently. Does it save you from
having to order another CT scanner or from having to hire an
additional full-time-equivalent (FTE)? Is the additional cost of
prefilled syringes offset by increased throughput, patient
satisfaction, technologist satisfaction, or any other issue?
Contrast Use and Participant Experience
Let's talk about some of the issues relevant to each of your CT
Departments and your use of contrast in general. How long have you
used prefilled syringes? What is your comfort level with them?
We use prefilled syringes across the board. As far as our
examination mix, it ranges from CT head, abdomen, pelvis, and
chest, for the most part, with some extremity scans. So, they are
not all contrast-enhanced exams. But 75% to 80% of each day's exam
mix uses contrast. It becomes a morale issue with the staff when
the schedule changes. Throughout the day we have a set schedule
written on a dry-erase board, with exams scheduled in 30-minute
slots. Once we start getting add-on exams between the 30-minute
slots, it ends up stomping on the technologists' mental well being.
When they arrive in the morning and they look at that schedule,
they say, "Well, at least I don't have to work every single second
all day, I'll be able to go to lunch." That evaporates by about
10:30 with the add-ons. But everyone in an American hospital or
clinic system knows that, to a great extent, we're handcuffed with
what we can do with raises, incentives, or bonuses. So I considered
that switching to prefilled syringes would be one of the perks for
the staff. It did have to be fought for, because there is a premium
attached to using prefilled syringes. But, that premium really
shrinks once you start going through the practical applications and
its impact on the staff and patients. Then, the premium shrinks to
almost an insignificant level.
Rich, how do you use contrast in your department and what is your
scan mix? Do you use all prefilled syringes?
At St. Francis, the majority of our contrast media is delivered
through prefilled syringes, specifically because we're a Level 2
Trauma center. We have one CT scanner at the moment, and the time
schedule is very limited. Our situation is similar to what Gary
described, you have a half-hour slot, you're trying to get a
procedure accomplished, and you don't have the advantage of having
additional time slots. We're basically under the gun when it comes
to time. In the course of our day with scheduling outpatients and
doing inpatients, when a multiple trauma comes in it just throws a
wrench into the entire day. When prefilled syringes came into play,
and into interventional radiology and CT scanning, I found it to be
a benefit, almost like the remote control on a TV. It did an awful
lot to the system, and this is important where I am. We deliver
Isovue 300 at St. Francis, mostly for our chest and abdomen scans.
We usually use 150 mL. But prefilled syringes are a necessity in
Jeff, how do you use contrast at your institution?
Probably 95% of our CT studies are contrast injected, we do very
few nonenhanced studies. It's almost all Isovue 300, the 150 mL
syringe. For the head studies, we use the 370. But, in terms of the
change to prefilled syringes, it came down to efficiency and time
management for the technologists. One tech would come in first
thing in the morning before we got the prefilled syringes and spend
30 to 40 minutes loading syringes, having to initial the syringes,
label what was in the syringes, what type of contrast it is, and
date it. It got very time consuming. You had to guess how busy you
were going to be, but you filled 5 or 10 more syringes than you
knew you needed from the schedule. Now, if something happened
during the day and you got busier than that, you had to take time
in the room to fill the syringes. Then, that room stopped, you
couldn't scan patients in that room and fill syringes at the same
How long does it take to fill the syringe itself?
For each syringe, including the time to label it in indelible
marker, probably 3 to 5 minutes. Then you've got all the bottles
and all the syringes that you've opened up laying across the
counter. If two techs can do it, it could be a team effort. But,
some people don't have that luxury. Then at the end of the day, if
you didn't use all that contrast, you just had to toss it, and that
is a cost issue. I'd say at the end of the day we would throw away
anywhere from 4 to 6 filled syringes, or 600 to 900 ccs of
contrast. So, it was a win-win situation all the way around to
switch to prefilled syringes. The techs love it; it doesn't matter
how busy you are now, you've got plenty on hand. You can reach into
the contrast warmer or wherever the syringes are stored, pop it on,
and off you go. If you do 50 scans a day, or 75, or just 15 a day,
the speed is always there. My techs love it and I love it.
Robbin, you've recently moved to a helical scanner and have a very
efficient operation. Can you tell us a little bit about that?
Before we started using prefilled syringes, we were just doing
axial scanning, and we were only doing 8 or 9 patients a day. It
took a little bit of time first thing in the morning just to get
all of the supplies lined up and ready. That's time that you don't
have patients in the room and you're not scanning. When you're only
scanning 8 or 9 patients a day, any time that you could have
somebody in there makes a big difference. Now, we're scanning from
25 to 30 or 35 exams a day, and I just can not imagine doing this
without the prefilled syringes. Because when you're getting a
patient up off of the table, your finger is on the button, and
you're rolling the injector down and getting ready for that next
prefilled syringe. If you had to take time and draw that contrast
up every morning or you have 10 syringes drawn up already, and then
you get 3 more add-ons...that's just time wasted and taken away
from patients. We use Isovue 300 on all of our studies, and 95% of
our studies are contrast-injected studies. For a chest, abdomen,
and pelvis combination, we use 150 mL; for a standard scan, like a
chest or a head, we use 100 mL.
We've been using the prefilled syringes for about 4 months. Before
that we were using the Tri-Paks. We got our injector about 3 or 4
years ago. The technologists had to come in, take the contrast out
of the bottle, open the Tri-Pak, and put it in a Medrad syringe. So
the chance of contamination was higher by doing that. With filling
them up first thing in the morning according to the number of
patients you had scheduled, when we had a no show (cancellation),
we'd have to throw that syringe away. We'd have 2 or 3 patients a
day that didn't show up. Or even if an add-on patient took their
place, it might not be a contrast study. So we were wasting
contrast on a daily basis. From my viewpoint, since I do the
purchasing, it's easier for me to just order that one prefilled
syringe instead of having to order the contrast bottles and
Tri-Paks. Plus, we had to have a place to store all that, and we're
busting at the seams for space. So just having the prefilled
syringes and the transfer set made it a lot easier for me in
purchasing all our supplies. So I enjoyed the change to prefilled
syringes myself, and it also makes the technologists very
How do you staff your CT scanners, and has it changed since your
transition to prefilled syringes?
Our chief technologist scheduled herself to do the CT patient load
everyday and she had to come in early and fill the syringes. For
about 4 months, she asked me to "please find some prefilled
syringes." When I did, she was very happy, and if you make your
chief technologist happy, it works better for me too.
Lanis, in your department, how have the issues of contrast and CT
injectors panned out?
We've been injecting contrast for years. We had to go through the
cumbersome process of filling the syringes, which means risking
possible contamination and storing two products instead of one on
the shelf. This time is money. When we started using prefilled
syringes it was instant gratification, and a big morale boost for
everyone. We have improved patient throughput. It gives an employee
a little time to give back to the patients, which is a very
important in building a network with those patients. Not only have
we decreased the use of our FTEs by not having an additional person
come in early in the morning to fill the syringes, but the
turnaround time, or prep time, in the room has been cut
dramatically. Instead of 4 or 5 minutes loading up the syringe, you
can re-prep the table, and get ready to go.
We run three machines practically all the time. We run two
machines 16 hours a day, and we have one in the ER open 24 hours a
day and we've also had to off-load ambulatory patients onto that
We exclusively use the 300 concentration. For brain scans, we
use 100 ccs and we still spike a bottle. We're not heavy into
arterial scanning right now, but we expect to be soon. We are doing
a lot of scanning for PEs.
Yes, I think it's a growth area that everyone has seen. Casey, how
do you use contrast and your injectors in your department?
Currently, we do three-quarters of our studies using contrast and
we've been using prefilled syringes for about 2 years now. We have
just the 150 mL Isovue 300 available to us, and that's used for all
of our routine studies, with the exception of head scans. We use 75
mL of the 370 for head scans. I think the most dramatic thing that
I can think of with regard to using prefilled syringes is, as
Richard mentioned, that an outpatient schedule doesn't account for
multiple traumas. We're the major trauma center for the region. So
any time that we're able to save helps us from keeping outpatients
waiting, and I think that is a great benefit for them. In the past,
we've had a number of patients walk away because of the wait. So,
in terms of the number of patients you can scan, it's a great
benefit for the technologist and the patient waiting to get in.
In addition to cutting down patient waiting time, we've also
been able to cut down on the technologists' time to turn around a
room. As everyone has mentioned, that does wonders for the
technologists' morale as well. You don't feel quite as rushed, and
you can get an adequate history.
Advantages of prefilled syringes
If you had to choose, which are the primary advantages to using
We use prefilled syringes exclusively, and we're extremely happy.
We've been using them from the beginning, I think since the very
first day they came out. For our injector, we used to have empty
syringes that we filled, and now with the prefilled it's simple,
it's easy. Also, I've noticed less reaction to the contrast.
I've also noticed a big difference in patient throughput. Every
month the head of my department has congratulated us for hitting a
new total. This is in a 200-bed hospital, and for the last 4 months
we've gone from 934 patients to 956, to 1,051, to 1,081 patients
per month. That floors us, we don't know how we are doing it; it's
just move, move, move. We schedule 35 to 40 patients a day, in
15-minute time slots. That means that abdominal and pelvis exams
are 30 minutes each, and head scans are 15 minutes.
With the prefilled syringes, we have more time to actually sit
down and talk with the patients while we're injecting them. It also
seems that the patient isn't aware as much of that part of the
That makes a big difference to the patients. They're often very
anxious, and obviously the more time you can talk with them, it
really makes an impact.
Oh, yes. Some of them are really apprehensive and it makes a big
difference and puts them at ease, if you can talk with them. You
have to remember that this scan is your daily routine, it's just
another person to you. But to them this might be the only time in
their life they go through this, and they tend to remember the
I'm really happy that Cynthia brought up the issue of patient
apprehension, because that's something I really think about. Going
back, a radiologist would walk in the room with two 50-cc syringes
with needles. For patients, that was quite scary. Now with this
system, it makes it a lot easier. I think that's a big plus that
hasn't really been considered.
I think it is reassuring to the patients if the tech can stay with
them. Everyone who comes in for a CT scan is always sure they've
got cancer. It doesn't matter what they're there for; they "know"
they're going to find cancer. But if you're in there with the
patient when the contrast is going in, I think it has a calming
effect. The patient is nervous. You've told them that they're going
to feel hot or get a funny taste in their mouth, but if you're able
to stand there beside the scanner, they can see you and hear you.
It makes the test go that much easier for them.
It also eases the patient's mind to see the tech just walk over
to a contrast warmer, grab that syringe, and walk back to pop it on
the injector head. For the patient to see you ready to go like
that, is so much better than if they see you making what seems to
be a witch's brew while you're drawing up the syringe, running back
and forth to get the supplies. I think it gives the patient peace
of mind, and makes the techs a little more friendly to the
Disadvantages of prefilled syringes
We've talked a lot about the benefits, and we'll talk about
cost-effectiveness. But have you found any disadvantages of the
Quite frankly, I can't think of any disadvantages of the prefilled
syringe. If we carried a wider range of volumes, we'd use them even
I can't think of any disadvantages, either.
No. At our institution, we have yet to have a prefilled syringe
fail. That's pretty remarkable, given the numbers that we've done
I can't think of any disadvantages. As far as the way the syringe
is itself, no. But as far as the day-to-day usage, I haven't seen
any problems. I think it's as close as you can get to having a safe
and effective system.
That's a very important point. How many people are aware of any
misadministration, either at your own institution or have heard of
any at other? I know it happened in our area. This can be
aspiration or any other form of misadministration.
We've been lucky in our hospital; that hasn't happened to us.
In my facility, a technologist drew an empty syringe back in the
injector, and just failed to take it off the injector head. The
next technologist came in with a trauma patient, thought the
syringe was loaded up, and injected air into the patient. Luckily
the patient was okay, but the technologist was traumatized, when he
realized how close he came to killing a patient. In avoiding
misadministration, these prefilled syringes are actually
I think most of the people here would agree that, more than any
other modality, CT techs are probably the hardest hit individuals
for taking call. If you have someone who does their 8-to-10 shift,
non stop, with one patient right after the other, and then they're
on call until the next morning when they start their next shift,
you have someone who is a zombie at times. This is especially a
problem when you have a trauma situation. Matt told me that their
volume doubles and triples during tourist season in the Spirit Lake
area. If the CT tech is called in at night, they still have to
perform the next day. When you have someone almost nodding off at
the console, you're setting yourself up for problems. You want as
error-free a situation as possible.
The procedures can be so monotonous for the tech; you're doing the
same thing 30 times a day, and you lock into your routine. It's
very easy to make mistakes in that situation.
This is especially a problem with the traditional syringe, if you
were loading them through the injector, sometimes the technologist
can get distracted, and then he's loaded partial contrast and a big
bubble of air in there. So, he's got to take the time to stop and
push the air back out. It seems to me that if you sucked room air
into those syringes, you've contaminated the syringe and the
contrast, to a point. It was an uncomfortable feeling. But, at the
same time, you were under such stress to get patients in and get
them out, to go so hard and so fast. But, you can't afford to make
Approximately 60% of the panel are aware of misadministration. I
think they're very isolated situations, but they are significant.
The consideration is, of course, how many problems like that are
tolerable? I think everyone would agree that in safety issues, zero
tolerance is certainly the goal. What about the sterility issue;
have people had any problems with that? Jeff, you've mentioned
drawing back air, and one of the things that all prefilled syringes
have is a little bit of air right at the top. To a certain degree,
when you tilt the injector down you can see that air bubble move,
and that tells you that you're truly loaded.
Yes. All of my technologists are concerned enough to make sure even
that air bubble at the top is gone before they turn the injector
head. I've seen some facilities where you see the injector at just
a slight angle. At my facility, I preach to them to make sure that
injector head is turned completely pointing up and down, to make
sure there are no air bubbles whatsoever. It's as close to 100% as
you're going to get that way and you can eliminate the technologist
making a mistake.
The small bubbles we see all the time in IVs coming from the
patient floor are inconsequential. But what we're talking about are
really the dramatic or the multiple cc injections that are
extremely detrimental, particularly in precarious patients, or in
patients that have right-to-left shunts in the heart. Those are the
patients that really get into trouble.
Our facility is small enough that we don't have the luxury of being
able to staff a dedicated CT tech, so all of our techs have to take
call and cover CT. It can be really stressful for a tech to be in
OR one week and CT the next. Just concentrating on the patient,
getting the scan right for the radiologist, and doing the MIPs and
the MPRs is hard enough, let alone having to worry about
contaminating the contrast. So from my standpoint, making the
process as easy and foolproof as possible was important just in
relieving their stress.
Using the prefilleds has also allowed us to standardize patient
contrast dosage. We got the radiologists to agree on dosages and
concentrations. We use both 300 and 370 at our facility, and we
power inject and use the prefilled syringes for all of our contrast
cases. It does ease the techs' anxiety, because they're anxious
about being in CT a little bit, especially those that are new to
the modality. So, we can relieve a little bit of anxiety in
providing the prefilled syringes, and that makes it easier for
them. Also, there's only one technologist in that department. When
we went from axial scanning to helical, our volume went up about
28%. So, since we are still staffing one technologist, we have to
make the workflow as efficient as possible and the prefilled
syringes help us do that. From a cost standpoint, using prefilled
syringes is a little more expensive, but throughput has increased.
If you use the Medrad syringe or power injector, you need to use
the Tri-Paks to load your own contrast. The Tri-Paks are not
inexpensive, and if you couple that with the cost of a vial of
contrast, it's not that much less expensive than buying the
Have any of you changed your staffing? Either scheduling or the
total number of technologists, since you've made the transition
from syringes that you load yourself to the prefilled syringes?
It hasn't really changed our staffing. However, it has allowed us
to be able to increase our patient volume and still staff just one
At St. Francis it was the same. It doesn't reduce the staff, but it
increases your volume and just one technologist is pretty much the
We eliminated coming in 30 minutes early before a shift to set up
the room. The bulk of prep time was setting up syringes and filling
them, and then you had to take the trash out, because you just
filled the container with the residue from the set-up. So, in that
way, it just trimmed 30 minutes off. But it's a significant 30
minutes, because the techs had to come in before their shift really
My radiologists didn't like the fact after we filled the syringes,
they would lay on the counter until they were used. The
radiologists didn't like the fact that the patients could see them,
or that they might think they could be tampered with, or somebody
had actually touched them and contaminated them. So, it eliminated
a lot of that concern, also.
So, now that you've gone to the prefilled syringes, how do the
radiologists feel about that?
I've had no complaints. You just snap it off and throw it away, and
you put a fresh one on. The patient can see you pulling the sterile
top off and getting ready for the next patient, and they know
everything is contained and sterile.
With us, our shift starts at 7 am. When we had to draw up our own
syringes and fill them in the morning, it took the first 30 to 45
minutes. So, it just took away patient time. Now we get patients in
starting at 7:15. By 7:30, we're doing our first patient. As Jeff
said, it's an opportunity to get inpatients down that were added on
and start your day earlier.
We still have one technologist. But it's cut down on the overtime
we had to pay when she had to clock-in early. We're now back to an
8-to-5 schedule for our CT scanner. Even 5 minutes in the medical
field is golden, any way that you can cut your time is good. If we
can just save 5 minutes here or there, by doing something
differently, that might allow you to get up and go to the bathroom
or go get a cup of coffee or something.
We have changed the way we staff. We used to have a tech come in at
6 am, and that was to prep the rooms, warm up the scanner, and draw
up all the syringes. So, now we've cut out the time to draw the
Casey, as a technologist, what are your perceptions as far as room
prep, set-up time, etc.?
I have a really high appreciation for the product because I work a
night shift, and I'm there by myself for the majority of my shift.
That means I have to take time for transporting patients and
getting reports ready. So, with prefilled syringes, I have just one
less thing that I have to worry about for the day. So, it's
How Prefilled Syringes Are Used
Is anyone selectively using prefilled syringes? Is there a mixture
of patients in whom you use prefilled syringes and nonprefilled? I
know some of you are at or close to 100% prefilled usage now.
I'm pretty close to 100% usage. I would just say pediatric patients
would be the only patients that we don't regularly use them for
since we need less volume.
Yes. We use 100% prefilled.
How quickly was the curve between getting a couple samples, going
to selective use, and then going to 100%?
We started off with just the Tri-Paks. We were getting our contrast
from another vendor, and thought we would just use the Tri-Paks.
But, they were cumbersome, and the Tri-Paks are not inexpensive.
So, we tried the prefilled syringes. We probably used the Tri-Paks
for 4 or 5 months. Then we switched to prefilleds and never went
back. Now I don't think the technologist would let us go back.
Also, I think the technologists know that prefilleds are a
little bit more expensive, and they appreciate the fact that we're
willing to invest that to make their job a little bit easier.
As an administrator, you have to remember that you need to give
your technologist the necessary tools to perform a procedure. By
giving them a prefilled syringe, I feel a lot more confident than I
used to, because I don't have to worry about all the intangibles
and risks involved with measuring volumes by hand. I think
prefilled syringes are a much better tool to provide your
We're 100% prefilled syringes, other than pediatrics. In children,
we just draw a syringe from a bottle; we still keep a couple of
those on hand, to get the smaller volumes.
From a department manager's standpoint, is there an advantage in
the transition to prefilled syringes? How do you go about making
I think if the techs are used to using the Tri-Paks and filling
their own syringes, the transition is relatively easy. It doesn't
take much training to learn how to snap a syringe on and flush the
air. So, I think it's a fairly easy transition.
Does anyone want to comment on the overall scheme of contrast
utilization in the department and how they use prefilled syringes
versus bottled syringes?
By doing away with the bottles and having to fill syringes, we've
gone down almost 100% in needle sticks. It just stops the whole
department if someone gets a needle stick. You have to fill out the
paper work and send them to the emergency room. Then, you're on
your own for a while, and all kind of things can happen while
they're getting the needle stick checked. It's done away with that
almost 100 percent.
Also, in most medical facilities now, there are two trash cans: the
regular trash and the red-bag medical wastetrash. The red-bag trash
is expensive to dispose of, because it goes by weight. If someone
is filling syringes from bottles and throws the glass bottles in
the red-bag trash, even though they shouldn't, that gets very
expensive. But not too many people are going to harangue a tech
about the trash. He's already sweating bullets trying to keep up
with the patient load, not getting lunch, and barely getting a
restroom break. So, that's one of those little things you don't
really think about, unless you're actually observing the operation
of the CT tech. All these intangible things add up to be pretty
significant, and that affects your bottom line.
I totally agree. You also don't have multiple bottles anymore. We
used to pop the tops all the time and put them into an injector
warmer. That also created a problem; it wasn't very safe. Many
technologists would get their fingers caught on the rims of those
metal bottle tops. Having something that you know is safe to
handle, especially with the fears of cross-contamination today, is
With prefilled syringes, you've eliminated a lot of the
possibilities of an accident to your technologist and to your
Rationale for the Use of Prefilled Syringes: Presentation
by Gary Goble
There were several factors involved in the decision-making
process to go to prefilled syringes rather than the multi-component
system, as I call it. Primarily, I initiated the decision process
in response to several issues. At our clinic we had one CT
technologist performing 16 to 24, up to 30 exams per day. This
includes a lot of add-on exams, which created a problem, not the
least of which was an unsatisfied CT technologist.
I drew up a list of the possible ways to address this problem.
1) Hire an additional technologist. That would be difficult, as
well as expensive. 2) Hire a tech assistant, which of course that
is still another addition to the staff. 3) Turn down clinicians'
requests for add-ons, which is simply not possible in today's
environment. 4) Find a way to increase productivity.
I knew our goal had to be to increase productivity to solve this
problem. I found that the prefilled syringes have many advantages
associated with them, and they don't impact just one aspect of our
scanning department (Table 4).
Decreased inventory and storage:
One of the biggest impacts was a direct benefit to me personally,
because there's decreased inventory. There is just one unit versus
three to four units in a multi-component system. So, I spent less
time conducting inventory. It's also a lot easier to manage space.
With the prefilled syringes, the room inventory is reduced as well.
So, you have that storage space allocation that gets freed up for
Decreased ordering time:
There is also the issue of the time spent ordering the
multi-component systems. When I came to Aston in March, we had a
three-part system. If you notice, the syringes come in a 50-piece
unit, the tubing is an 100-piece unit, and the contrast is 10- to
12-piece unit. It's like buying hot dogs, there are 8 hot dogs to a
pack, but 12 buns in a pack. That's an exact corollary to the
multi-component system, because these people were either very, very
smart about how they're packaging their product or they don't have
a clue about the practical use of their product. There's no
match-up in amounts.
Of course, the technologist's time has been the prime consideration
throughout this discussion. The bulk of the time that can be cut is
the daily room prep time. The consensus seems to be that it's a
30-minute allocation to load up the multi-component systems for the
day. Granted, that's the techs' quiet part of their day. But that's
still a half-hour that could represent one or two more exams.
Cindy mentioned scheduling 15-minute slots. My hat's off to you!
I don't think we could accommodate that and deal with add-on exams.
As sure as the sun rises in the East, if we went to a full
15-minute slot schedule, we would still be doing add-on exams.
Another issue mentioned was orienting staff. Matt rotates his staff
through the departments. So, you have someone in CT one week, and
in other departments for the next few weeks. So, when they come
back to CT, they should be able to come back into an environment
where they don't have to remember where the pieces are and how to
do each step. With the prefilleds, they just go over, open a pack,
and load it up on the injector. It's simpler for the techs to learn
We're all being asked to manage our time more efficiently. As
managers, we have to manage our staff's time as well as our own
time. This can be difficult, to say the least. Using prefilled
syringes, we spend less time ordering the multi-component systems
and we save time by fewer compliance problems. I personally get
informed when the CT technologist gets behind schedule. These
delays are usually related to starting an IV or a patient who
needed reassurance. It's a human-interaction issue.
With the helical scanners today, the amount of time that the
patient's in the room may only be 15 to 18 minutes. So, you have a
very narrow window of interaction between the technologist and the
patient. Lanis brought up an important point about a lot of the
patients' perceptions. They come in to get a CT scan, and almost no
matter what the scan is for, they're thinking: cancer. The patient
is coming in for what they may consider the most important exam of
their life. It's nice to know that the technologist may be able to
spend 3 to 4 minutes actually talking to and touching the patient,
rather than having their back to them while they hook little
plastic pieces to mount into this other strange-looking machine.
So, I think that personal touch is very, very important.
It's clear that today a predominant factor is money. Yes, there is
a premium associated with using prefilled syringes. But, that
premium is offset by the other benefits.
I didn't begin with the assumption that we would move to prefilled
syringes. That wasn't my decision-making process at all. Rather, I
considered: what is the problem and how are we going to solve it?
The big factors were inventory, the time associated with managing
and stocking that inventory, and training. As never before, we're
in an environment in which it's very rare to find a radiology
department that has been staffed by the same people for the last 10
to 15 years. Many of the longest-term staff is in the 5- to 7-year
range. So, when you have that type of revolving staffing, you need
to streamline almost everything: your paperwork, your scan
protocols, and, especially, your room prep for patient
Of course, I had to submit my decision to the people with the
sharp pencils, and I had to do a little bit of convincing.
Basically, I told them we would increase expenses a little bit. But
that it could be offset by increased patient throughput, kicking in
another two add-ons without that increasing the technologist's
overtime. There's always a tradeoff in everything we do nowadays.
The decision to switch to prefilled syringes was a positive one,
and we have not regretted that decision to this date.
Thank you very much, Gary, for the insights into your decision
process in converting to prefilled syringes. I'd like to hear some
of the factors involved in others' decision process to switch to
prefilled syringes. Who was involved in the decision process? What
were some of the perceptions you faced from business standpoint?
Which factors were involved in the final decision?
The technologists and the chief technologist began the decision
process in our hospital. First, we looked at the cost factor. But
the ultimate decision finally came down to the technologist and the
At our facility, once I collected the information and set up my
argument for making the change, I submitted that to my director.
Then, I wrote out the criteria I used to make that decision with
offsetting points on both sides, and that went to a budget analyst.
The increase in expenses had to be approved, not so much with what
we would be getting out of this, although that was included in my
proposal. Purposely on my part, I did not want to paint us into a
corner by saying, "If we switch to this system, you'll see 18 more
exam units done per month," because the technologist has no control
over what the patient volume is. If you notice, through our entire
conversation about prefilled syringes, the consistent theme has
been keeping your people happy and keeping them employed at your
facility. There's surely direct cost related to losing
I have to agree with Gary, the points that he touched upon were
exactly the points that determined our move to prefilled syringes.
Going back to the technologists, I think the greatest consideration
is giving them the necessary tools to perform a service that will
benefit not only the institution, but also the patient. To me, it's
just another state-of-the-art excellence that is necessary to
deliver the system to the patient.
How did you bring the decision to your boss, to the department,
and, finally to the hospital administration, for approval?
Looking at it from an administrative standpoint, they want to see
the pros and the cons, to see exactly what the benefits are.
Basically, I put all the positives in one category and the
negatives in another and looked at the negative that would impact
the institution, which was finance, of course. But after someone
sees all these positives, I think the financial end of it becomes
very trivial and doesn't have much impact.
When we went from axial to spiral scanning about 18 months ago, we
looked at injectors. The first thing we looked at was injector ease
of use and dependability, and we selected the Medrad injector. So,
then we had to make a decision about contrast. Obviously, Bracco
makes prefilled syringes for the Medrad. We started off with the
Tri-Paks and then switched to the prefilled syringes. I agree that
the cost is secondary to ease of use. Luckily, we're an independent
hospital, so we can look at all the different contrast vendors and
products available. Of course, you have to look at department
revenue versus the little bit extra that you're going to spend for
the prefilled syringes. I weighed all those things and then went to
my director and presented the case and he agreed. I think the issue
that finally made the decision was ease of use. We have one
technologist, and it's important to make the process as simple as
possible, eliminating as many chances for error as possible.
Our process actually started when my chief technologist happened to
come in the room when we were stopped between cases and trying to
load syringes. Patients were backed up, sitting outside the door
waiting, and we were wasting valuable room time. If the table goes
cold, you're not making money. But our chief tech mentioned that
Bracco had these prefilleds, and would I be interested in them? I
said, "Sure." So, the Bracco rep showed up, and after one day of
just trying it, I was sold. We were willing to take the hit of
however much it added to our costs at that time, because we could
bring in more patients. It might be two, four, or six more
patients; everybody can give different numbers on their throughput
improvement. But it still boils down to ease of use. The
technologist was comfortable with it, and it was very safe. It was
almost a no-brainer decision to go to that point.
Our radiologists were not involved in the decision-making
whatsoever, and, in fact, they didn't even realize that we had
changed. We did it strictly for technologists' ease of use and the
technologist throughput. It was strictly between the chief tech and
myself, deciding it. She was aggressive enough to take it to
administration and, even for them, it made perfect sense.
Did you have to do a lot of financial analysis?
Not very much. They asked about what we thought we could do, how it
would improve throughput. It took me maybe an hour to jot down some
numbers to show what I thought we could do. The decision-making
process for our hospital probably took less than 2 or 3 days. It's
a minor hit to your bottom line, and, even with managed care, you
can make up that difference with one or two patients. That's why
our hospital looked at it.
Our process to move to prefilleds was actually started by the sales
rep. One day, he and my director came in while I was in the process
of filling syringes to get ready for the rest of the afternoon. My
director said, "Do you have a patient waiting?" I said, "Yes, but
I've got to get this done. I've got to get a couple more syringes
drawn up." He said, "I think I have something that you're going to
be interested in." That's when he and the rep told me they had the
prefilled syringes and he arranged to get a box to try them out. As
Jeff said, it was just a matter of 2 or 3 days, and we
automatically switched over. The radiologists were not involved in
the decision at all. As soon as we started using them, we knew we
wanted to switch
I think it's easy to convince the technologists. It's harder to
sell the departmental administrators. How did you bring it to
Something that worked to our benefit was that we had just switched
from the axial scanner to a helical scanner. So, they knew they
were going to be making more money because of our increased patient
throughput. We could slip in this extra contrast that we wanted
because of eliminating technician time to get that ready. It just
made it all a nice transition.
I evaluated our CT scanner's throughput, averaged that out for a
week, and then extrapolated that out for a whole year. So, I
determined a year's average volume and the revenue generated. Then
I took the same figures for the costs to start an IV, and the whole
three-part system. Once I had those numbers together, I figured the
contrast costs, which was a whole separate column. I ended up with
separate columns totaling the cost for us to operate on a yearly
basis. I reserved our FTE, because even more than contrast, that's
your biggest expense for running the department. Once I looked at
those figures, I took a prefilled syringe scenario and figured what
the variance would be. I didn't offset that variance with the
things that I observed, such as throwing the bottles in the red-bag
trash, because that's such a tenuous argument. While I presented
those issues informally, they weren't numbers on a sheet for the
accounting person to analyze. But it was a close enough variance
that once I presented the figures, I addressed the intangibles,
such as the tech's time. I said, "I'll let you figure out what it
costs me to pay this tech for 30 minutes of straight time or 30 to
45 minutes of overtime to do the add-ons." So, I didn't just
present it as "we want to do this; what do you say?" and then it
just passed through. There were some hard numbers associated with
it, and in a large facility, you're talking huge amounts of
I got really close on the dollar margin for the variants and
said, "Here's what we're looking at." I even broke it down to
dollar per patient, and said, "This is how much more it costs per
patient to do it this way." Then, I offset that dollar amount with
the advantages and let them figure it in their head. I did not even
mention misadministration costs. If you have one misadministration,
you potentially blew your whole contrast budget for 3 years.
What sometimes gets left out of consideration is the technologist.
You can give them the latest helical scanner and all the latest
equipment. But they can still be pushed to the limit. It's
important to remember the benefit of eliminating one more stress
that they're facing. It's one more thing they don't have to take
the time to do. Sometimes that gets lost in all the discussion
about money and the bean counters just want three more patients, or
ten more. But if you can even give the perception to the people
that work for you that you're trying to make their job easier,
they're going to be more willing to push to do two or three more
Even those considerations, though, are convertible into financial
terms. We're talking retention. If the administration says it costs
you $3,000 just to run an ad for a technologist...you're avoiding
that by keeping a happy camper here. The techs are getting the
message that they are important to us. But, at the same time, we
know we'll be able to put some more patients through here. But, the
techs are not even seeing that aspect of it. They're just seeing
the fact that we shaved some hassle out of the day.
Yes! I don't have to stop if I'm out of syringes, especially if
I've got a bad trauma that's came in, with blood everywhere. In
that case you really don't want to have to spend 2, 3, or 5 minutes
loading the syringe, you can always argue that. That takes that
stress off the technologist, they're under the gun to begin
Probably the worst time to draw up a syringe is when you're half
awake at 3 o'clock in the morning. It's much easier to use the
This eliminates so much, and it makes the technologists happier.
Then they're going to be willing to do a little more in the
department, maybe, to keep the radiologist happy. The films come
through quicker; everything goes just a little bit quicker. You've
eliminated some time.
Dawn, you're in charge of purchasing and medical supplies. What was
the decision process that was important in your case in going
through those justifications?
Actually, I was pretty lucky because our chief technologist is a
working technologist who is scheduled just the way the other
technologists are. We put in our new helical scanner about 9 months
ago, and she was the first one trained on it. Since we were short
on technical staff, she had to do the scanning every day for months
until the other techs were trained. Since she's the chief
technologist, she wanted to find a way to make the process faster.
She asked me about buying prefilled syringes. All we had to do was
prove to the medical director that the image quality was going to
be the same if we switched to the prefilled syringes, which it was.
There were no additional reactions because we switched; it was the
same as before.
From my standpoint, the ordering is easier. We don't have a
computer system that I use to order, and I don't have anything
written down, it's all in my head. I order for the whole facility,
the film, the contrast, the needles, everything; and that's for the
CT, MRI, mammography, ultrasound, and X-Ray departments. So, it
makes a big difference to take one thing off my list that I have to
order. I don't have a set time for ordering, I have to supervise
the X-ray department all day long. I just have to get away, look at
the supplies, write it down, order it, and send out the purchase
order (PO). So, if there's one thing that I can take off of that
list, it helps me get back to the X-Ray Department quicker and do
That's my point about trusting the people that you have in power in
the hospital. I think you have to be accountable for the decision
and be ready to account for the increase in the budget.
I was ready to account for it, but I was never asked to. It's been
there for us, and there were never any questions asked because we
never had any problems since we switched.
Great. Lanis, what input do you have as far as the decision process
and how it came to pass?
Well, it was an idea that all of the techs had batted around. We
crunched the numbers for the system director who is the director of
the four hospitals, and we're very lucky to have him on board in
our hospital. We knew there was a price difference. Our ultimate
goal was to keep the backlog of scheduled patients to 2 days, who
otherwise may not get in for 3 to 4 days. With that, even though
using prefilleds was going to cost a little more, we felt from the
standpoint of our image to the community, it was worth it. Our
throughput was worth a few dollars, and that's how we presented
So, you sold it on reducing the backlog?
Yes, we did. I always said, "You can have the biggest cannon on the
battlefield. But if you don't have enough people to get the cannon
balls up there, you might as well have a pop-gun." That's the same
as the IV contrast issue. You can have the biggest machine. But if
you have to fumble around for 5 minutes, and it takes you as long
to load the contrast as it does to do a scan, then you have really,
Have you had to cost-justify that time? Have they been happy with
Yes. They questioned us up front, and we have showed them the
numbers about every month.
Great. One of the issues that's been raised is JCAHO compliance.
Was that a factor in anyone's decision for this?
We're a JCAHO-accredited facility, and I think being in compliance
is important. It didn't play into our decision-making process,
however, because there were so many positives.
Now, what about those who don't have a contract with a specific
contrast manufacturer? Does it make the transition to a prefilled
syringe any easier or more difficult?
We're out of the system. We do have a contract, but it isn't with
the company that we presently use for contrast. Everyone likes the
contrast that we're presently using, so we went outside the system.
We're allowed a certain percentage of the total purchase of that
product outside the system.
Our purchasing group doesn't have an exclusive agreement with
Bracco. We have arrangements with several different vendors. So,
even though our purchasing group had that alliance, we went with
the product after looking at different products.
Our facility does not have a purchasing group that has a contract
with Bracco. But it wasn't hard to get the approval to get the
So, it's a factor, but probably not an overwhelming factor at this
As we go down the list of indirect costs, especially those that
revolve around the technologists; we've talked about the factors
involving efficiency. But I think the actual decision is easier,
because I think the benefits of prefilled syringes already outweigh
the negatives, including the cost.
Prefilled syringes easily deliver a product, and it's a safe
product, number one. With all the fears everyone has with the
so-called epidemics of transmittable diseases, I think this is very
important. Many times patients do ask about it; they look around
and see the equipment that you're using. So, when you come in with
a filled syringe, just place it on the injector, and then they're
injected, it is easier for them to know that what they're getting
has not been given to someone else. You're getting something
I agree. In these days of competitive health care, patients are
much more aware of the medications that they're being given.
They're less likely to be completely trusting of any healthcare
facility. So, you have to be certain you're doing a good service.
But patients do question things more than they used to. I think
that's good; it's good to be educated.
With regard to approaching administration with a rationale for
prefilled syringes, it's clear there's a direct and indirect
increase in patient care and benefit to the patient. I'm sure that
everyone's facility has a mission statement and the first sentence
talks about wanting to bring a higher standard of care to their
Absolutely, that's universal now. Have HMO contracts, or other
contracts, gotten in the way of this decision process in any
No, not at all. I have noticed that patients are much more educated
and knowledgeable, especially in my area, which is a college town.
They want to know what's going on, what you're doing step by step.
They don't want to just be the patient anymore. They want to be
part of it.
What advice would you give to people that are about to make this
decision process to move from filling syringes for their contrast
injector to using prefilled syringes?
I would say it's a no-brainer. When you sit down and study what is
really important, technologist safety and the patient benefits, and
you realize the exam numbers will go up...even with the extra cost,
you almost have to do it. You have no other choice.
I think the process should include the technologists, so you are
empowering them and allowing their decision to play a part. In my
particular circumstance, one of the CT technologists did not think
it was necessary. But, within a month of implementation, if I'd
told him we were switching back to a multi-component system, I
think he might start crying!
I think that someone who does not use prefilled syringes would just
have to take time to think about all the positives, and they're too
overwhelming. I think they will definitely dominate any thinking of
an administrator or CEO. Maybe not a CFO but, I'm sure, for anyone
directly looking at patient care, it shouldn't be a problem.
You can't really associate a dollar amount with the fact that your
technologist is going to be happier. So, the variance that I dealt
with was specifically related to a lot of the things that the
administrator would not even be aware of. They're not going to be
thinking of things like misadministration, and you could almost
quantify that factor...allocate 20¢ or so to that for that little
bit of piece of mind.
But, you can try to account for cost of heavy glass bottles
contrast comes in ending up in the medical waste. Every place that
I've worked, I've observed those in the red-bag trash. Especially
in a hospital setting with multiple scanners set up, all that
additional weight is very expensive, since the hospital is charged
by weight. So, that certainly needs to be minimized, and there is a
penny percentage that you could associate with that. Once I came in
within less than a dollar of the cost variance associated with
prefilled syringes, then the intangibles that are hard to quantify
kicked it over.
It wasn't a decision solely based on keeping that technologist
happy and efficient, even though that's been a preponderance of our
discussion. To me, there was a direct trade-off in the dollar
But if you had just one misadministration or error, the
administrators would have to open up the checkbook and that
patient's family would own part of that hospital.
But, that's hard to quantify when you're doing your analysis.
Exactly, but all it takes is one problem, and you've got a black
eye that you're never going to recover from, because that family is
going to tell its circle of friends, and those friends are going to
make the story even worse.
But, the CFO would not know that. So, you have to say it bluntly.
"Do you realize that we have an individual that performs exams,
works their 8- to 9-hour day, frequently without lunch, and then is
on call with the potential for having the 16 hours that belong to
them interrupted at 2-hour intervals? Do you realize that person
has to come back in the next day and is responsible for starting an
IV and administering contrasts into a patient's bloodstream?" Then
a light bulb goes on, that we're not just an assembly line putting
people in a machine, pushing the button and saying, "Hold your
breath," then bringing in the next one. It's a reminder that there
is the possibility of human error that wouldn't be quantified
Have you found switching to prefilleds is budget-neutral or an
actual cost savings?
We have such a competitive atmosphere and we're a clinic. I know
others here are on a 24- or 16-hour schedule in a hospital. We are
pretty much limited to 7.5- to 9-hour scanning schedule. Part of
that is because you can't inject if you don't have support staff on
hand in case of an adverse reaction. We have that little niche of
time, and I have not gone back to analyze what we're doing since
the switch to prefilleds, how much we've increased patients. But if
I were asked, it would not be difficult to do. I have been asked
generally "How is that going?" My response has always been, "Well,
we're shaving off room prep time. We're able to accommodate add-ons
almost without thought." So, it would not be difficult to point out
how many exams were directly related to the 20 or 30 minutes of
room prep time that we saved by using prefilled syringes. I don't
even bring up the savings in storage space or time to count the
inventory, because that's my function.
We are owned by such a big corporation, and are one of their
highest facilities in patient load. So, I don't think they mind
giving us the little extra that we need to keep up our productivity
and increase in financial standings for them. Because we are their
biggest facility, they give us what we need to keep going, to keep
bringing in the patients. So, we haven't had any problem justifying
That's our situation, too. As the department administrator looking
at prefilled syringes, the first and foremost thing you have to
think about is: "Will this benefit our patients?" That's what we're
there for, not just "How much money can we make?" Then, you have to
look at: "Is the department profitable? Will it continue to be
profitable if we use prefilled syringes?" If the answers to both
those questions are yes, then you need to try this product. Then
you can see if it will benefit your patients, reduce your risk of
litigation, and be good for the technologist. We have to keep
patient care in mind first.
I'd like to thank you all for coming and sharing your experiences,
opinions, and insights into the use of prefilled syringes. I think
this product will certainly be a wave of the future.
should also be recognized for hosting this panel discussion and
recognizing the impact that this product will make in each of our
individual practices. Thank you all.