Offsite Sterilization Allows Lifeline Surgical Partners to Expand Service Lines

A sterile processing technician organizing surgical instruments on a table in a clean room environment.

(Adobe Stock by PondLord 938500017)

Editor's note: Many facilities have considered using an offsite reprocessing center. This example shows how cooperation can benefit all parties involved.

Lifeline Vascular Care, a company that manages nephrology and vascular ambulatory surgery, has rebranded as Lifeline Surgical Partners to better encompass the skills and service lines it supports. Growing and tailoring the portfolio of its centers to meet the needs of physician partners involves finding innovative solutions to operational challenges in ambulatory surgical centers (ASCs), such as sterile processing.

Lifeline’s journey to utilizing an offsite reprocessing center (ORC) naturally evolved from its mission to convert extension of practice (EOP) and office-based lab (OBL) models into full ambulatory surgical centers. Maintaining consistent high-quality care for their vascular and cardiac providers and patients would remain core to their strategy as they pivoted to supporting multiservice line ambulatory centers.

“Our growth mindset and expansion into new markets align with our physician partners looking for improved return on investment opportunities while meeting their patients’ needs,” stated Amanda Iobbi, director of surgical services. “We’ve expanded our pain and spine offerings while adding orthopedics, GI, and podiatry to our ambulatory surgery mix.”

Like many ASCs seeking to expand surgical volumes by adding arthroplasty surgery, the support infrastructure necessary to do so can hinder or halt operations altogether. As Lifeline partnered with neurologists for pain management and spinal stimulation procedures, their sterile processing needs started to change. These procedures require a high volume of reusable equipment and instruments, requiring additional staff and infrastructure to properly clean and sterilize them.

By adding podiatry procedures and then orthopedics, Lifeline is now bringing together providers who normally do not work together but share a common mission to serve their patients with high-quality care, without having to worry about the logistics or support functions, such as sterile processing. Their normal use of tabletop sterilizers would no longer be sufficient or capable of handling the new surgical procedures.

Case Study for Offsite Reprocessing

Lifeline’s joint-venture Pittsburgh North Surgical Center, located 20 miles north of Pittsburgh in Cranberry Township, quickly became the perfect case study for transforming an EOP into an ASC. Local physician partners were excited about the prospect of moving into ambulatory surgery but realized they would quickly need sterilization capabilities to do so.

Building and growing new practices and service lines is an incremental process, whereas establishing a sterile processing department requires a full investment upfront. “We talked with our providers about potential sterilization solutions. Using the local hospital’s sterilization services was not an option,” shares Iobbi. “We were starting fresh in a building that didn’t have the infrastructure that was required, so we needed a timely and cost-effective solution.”

Having already worked with STERIS to purchase sterilization equipment for a center in New Jersey, Lifeline reached out again to discuss its Pittsburgh location. When Adam Friedel, alternate care market director for STERIS, heard about Lifeline’s dilemma, he realized that STERIS’s ORC, located north of Pittsburgh, could be a suitable solution. Offering transportation, decontamination, and sterilization services to local health care providers, STERIS provided services on a per-tray fee basis, which met Lifeline’s initial reprocessing needs.

The ORC allowed Lifeline to scale its sterile processing services to match its surgical volumes. As the center’s volumes grew, they were able to add additional instrument trays to the offsite-reprocessing contract, and STERIS would adjust transportation pick-up and deliveries to accommodate.

“The ability of the offsite center to scale with the needs of the providers is incredibly beneficial,” Iobbi shared. “To know that our instrumentation is being reprocessed at the highest level of quality, and the intangibles of not having to worry about sterile processing equipment maintenance, administrative tasks, staffing and competencies, testing equipment, and regulatory requirements is very comforting.”

ASC Investment Avoided

Most new ASCs or those transitioning from nonsurgical business models to invasive surgery find the first 5 years to be financially fragile. While hospitals and health systems may have the capital to invest in ASC growth strategies, independent physicians wishing to start their own ASC may not have the capital dollars to spend on a sterile processing infrastructure build-out.

The additional infection prevention and compliance requirements for sterile processing, aimed at ensuring positive patient outcomes, also create challenges for smaller physician groups. Lifeline found offsite reprocessing a perfect fit in their turnkey solutions plan for their providers. Tailoring their portfolio of services to their physician partners in a boutique experience, rather than a cookie-cutter model, allowed them to maintain their deep interpersonal cooperation with providers. Providers feel great that they do not have to worry about sterile processing issues that they have faced in larger facilities, while knowing the solution can scale and expand as needed.

Operational Logistics

Lifeline’s Pittsburgh ASC is like other ASCs across the country: busy, all hands-on-deck mentality, and more to do in a day than time permits. Setting up the offsite reprocessing partnership and logistics was simpler than they initially thought.

“We were a little concerned at the start,” shares Iobbi, “with the idea of sending our instruments offsite and hoping they come back sterilized and on time.” Lifeline’s team shares that they are commonly given a round hole for a square problem, but take pride in finding the solution.

Addressing these concerns upfront was critical, especially for the local infection control and quality team. STERIS reviewed the offsite process with the entire Lifeline team, shared positive success stories from offsite reprocessing, and addressed the initial fears that were expected. While initial hurdles were being overcome, the providers were excited to have a solution, especially when they realized the STERIS ORC motto was “100% Complete, Sterilized, and On Time” – exactly what they had been seeking.

As time progressed, the STERIS team integrated into the local Pittsburgh ASC team’s daily operations. Lifeline corporate support eventually decoupled as operational logistics became a standard and predictable daily process.

The ORC and ASC teams collaborated to implement best practices for offsite reprocessing, beginning with the end-of-case point-of-use instrument handling. Staff returned instruments to their correct instrument tray, removed gross bioburden, pretreated instruments with a neutral pH transport gel, and placed them in the provided transportation cart.

By “prepackaging” the tray for transport to the ORC and providing access for the STERIS driver, a hands-free exchange was created that freed up the ASC clinical team to focus on patient care and allowed them to go home on time. With many of Lifeline’s centers operating with only a few clinical staff, allowing them to focus on the clinical aspects of their work improves their work experience and satisfaction, as well as patient outcomes, which is what the providers and Lifeline want.

The Long Run

Lifeline’s experience in Pittsburgh opened the door to viewing sterile processing in a different light. Onsite SPDs are still an option, and for some ASCs, it may make the most sense to invest in onsite equipment and staff. Having offsite reprocessing as an option allows for a different conversation, different financials, and more opportunities.

Lifeline has always intended to build an internal SPD in Pittsburgh, but its appreciation for offsite reprocessing has grown, and Lifeline is now considering it as a possible solution for new centers nationwide. The Lifeline business development team includes offsite sterilization as a solution option when building relationships with providers who want a turnkey solution. Physician owners appreciate solutions that can scale and expand as their business grows, without requiring significant capital investments.

The Lifeline team sees offsite reprocessing as a cost-effective solution not only for short-term needs but also for medium and long-term operations. The low cost of entry, robust chain of custody, and sterilization standards established by STERIS, along with turnaround times tailored to operational needs, are what future ASCs are seeking. ORCs will be a critical link in the chain, as Lifeline continues to find innovative ways to improve the ambulatory surgery experience for both patients and providers.