INSIDE THE CURRENT ISSUE
Economic pressures forge differing instrument
by Kara Nadeau Della Vecchia
As economic pressures grow and reimbursements decline, healthcare facilities face tough decisions regarding their instrument maintenance programs. As a significant line item in most sterile processing department (SPD) budgets, some facilities are cutting preventive maintenance programs in an effort to reduce that area of spend in the short term. Others, taking a more strategic approach, are adopting preventive maintenance programs or increasing their current investments in this area, recognizing that properly maintained instruments can reduce costs in the long-term by minimizing costly repairs and enabling SPDs to better serve operating rooms, which are the revenue-generating centers of most facilities.
"Ironically, the trend we are seeing is that
hospitals are approaching instrument maintenance in opposite directions,"
said Greg Bright, Vice President of Operations and Business Development for
Prezio Health. "Financially constrained, one group of hospitals is
restricting the amount of instrument maintenance they are performing, thus
reducing that particular spend category. On the other hand, we have seen
healthcare providers recognizing the need and role these instruments play,
taking a much more proactive approach to maintaining them, thus reducing
spend over the life of the instrument. In both cases, healthcare providers’
behaviors are being driven by the reduced reimbursement revenue expected in
The preventive path
Those facilities taking a proactive approach to
preventive maintenance of surgical assets reap a broad range of rewards —
from fewer repairs, longer instrument life, lower replacement costs, reduced
down time of instrument sets, happier surgeons, and safer patients.
"Spectrum has demonstrated that over time
healthcare facilities experience reduced repair costs with instruments
lasting longer when they are properly maintained," said Derek Lashua,
Marketing Director for
Spectrum Surgical Instruments Corp., a subsidiary of
STERIS Corporation. "As hospitals gain an understanding of the financial
aspects of a successful maintenance program, they are also able to more
effectively address budgeting issues. Couple preventive maintenance with
education and you further fortify the program resulting in increased patient
safety, more satisfied surgeons and the reduced likelihood of readmissions
due to hospital-acquired infections. It’s a win/win, with the additional
benefit of a more knowledgeable and educated Sterile Processing and Surgery
The clearest benefit of preventive maintenance is
a facility’s ability to regularly monitor instrument performance and
intervene to address minor issues before major repairs are needed. This not
only saves money on repairs in the short-term, but can also save a facility
considerably in the long-run by enabling it to keep current inventory versus
having to purchase new instruments to replace those that are beyond repair.
"A properly designed and implemented preventive
maintenance program reduces the total cost of ownership for equipment, which
includes both replacement and repair spend," said David Anbari, Vice
President, National Operations,
Mobile Instrument Service. "Well maintained
equipment will last longer thus deferring replacement spend. In the
break-fix approach where only broken items are sent for repair, many broken
items are past being repairable and could have been saved had proper
maintenance been performed."
In an environment where reimbursements are more
clearly tied to patient safety and care, the impact of preventive
maintenance on clinical outcomes is an obvious driver to the adoption of
these programs. Virtually everyone in a healthcare facility these days is
acutely aware of the need to reduce the risk of adverse events, such as
healthcare-acquired infections (HAIs). Starting in the SPD with properly
functioning, intact instruments that can be thoroughly cleaned and
sterilized is critical to this effort.
"Through the proper identification of problem
areas, such as trapped bioburden, surgical instruments that are
hard-to-clean (such as Kerrison rongeurs and laparoscopic instruments) can
be identified by hospital staff and communicated to the instrument repair
vendor where issues can be properly addressed," said Lashua. "Additional
areas of testing and inspection such as sharpness testing and laparoscopic
insulation testing can further reduce potential risks to the patient."
By taking a preventive approach to instrument
maintenance, healthcare facilities can also boost both the operational and
financial performance of their ORs by assisting SPD staff in their efforts
to deliver properly functioning instruments when needed for cases.
"Sterile processing departments provide critical
support to one of hospital’s highest revenue-generating areas, the
department of surgery," said Bright. "These two departments working together
to establish a long-term plan to optimize the return on investment
associated with their instrument inventory will pay the greatest dividends
Roadblocks to preventive maintenance
For those SPDs that have been unable to secure
support/funding for preventive maintenance programs, or whose spend in this
area has been slashed, financial pressures are just one hurdle many must
overcome to get on the preventive path.
Industry experts point out that in many
facilities, administrators and other senior-level staff do not understand
the importance of preventive maintenance in extending the life of valuable
surgical instruments, supporting SPDs in the servicing of the ORs and
enabling clinicians and surgeons to properly care for patients.
"As most decision-makers understand, surgical
devices are costly items that need to be maintained — much the same way that
commercial aircraft need to be maintained," explains Jack Hower, President,
Surgical Devices, IMS. "Routine maintenance on a plane is critical to ensure
safety, efficient scheduling, and, ultimately, revenues. The same is true
for surgical equipment."
Others indicate that a lack of financial and/or
staff resources is often cited as a reason for failure to adopt preventive
maintenance. Some facilities feel they do not have the means to adopt a
program and keep it successfully implemented over time.
"Failure to implement a proactive maintenance
program is usually a misguided allocation of resources," said Ralph Basile,
Vice President for HealthMark Industries Inc. "Preventive maintenance is an
upfront cost. When in a budget crunch, administration often looks at this as
an area that can be cut. This is short term thinking, as failure to properly
maintain equipment will cost more in the long-run — and often the long-run
cost comes a lot sooner than expected."
Preventive maintenance options available
For those facilities that have chosen to implement
a preventive maintenance program, there is a broad range of options
available to meet their specific needs, from in-house repair facilities
staffed by dedicated technicians, to mobile labs where instrument
maintenance can be performed on-site, which increases efficiency and reduces
set down time compared with shipping instruments out to a remote location.
Industry experts agree that the majority of
preventive instrument maintenance and repair today is performed on-site via
mobile labs. This can be an ideal option for those facilities that either do
not have the need for an in-house facility or the resources to establish
"On-site mobile repair services have been
growing," said Jim Tobin, Group Product Director,
Services. "For those facilities with more modest needs and/or without the
space for an in-house repair center, the on-site mobile repair services
provide them with same-day turnaround of sets and the ability to have an
instrument expert available to the clinical staff for questions and
While mobile labs can meet the needs of the
majority of healthcare facilities today, larger facilities with high
procedure volume and/or those looking for more extensive technical support
can bring preventive maintenance in-house by dedicating existing space or
building a new in-facility maintenance and repair center.
"The majority of preventive maintenance and on
demand repair services continues to take place via mobile labs. However,
where synergy and scale are present, certain integrated delivery networks
have elected to bring these core competencies in-house," said Bright. "This
is generally done in concert with a proven industry leader and a committed,
defined vendor-client relationship."
Tobin notes that Aesculap has seen a particularly
strong growth in the implementation of in-facility repair centers. He points
out that a key benefit of this approach is it offers clinical staff direct
access to technicians with extensive knowledge of and experience with
instruments and other devices.
"It a great opportunity to educate clinical staff
on the proper use and care of various surgical assets," said Tobin. "The
clinical staff loves the ability to speak to an in-house expert on the
manufacturing and maintenance of surgical instruments, and we can provide
unique insights on the care and handling of surgical assets as they make
their way through the hospital."
Anbari concurs that mobile labs are the most
widely used option for on-site instrument maintenance today but indicates a
growing trend toward building repair centers into facilities. He notes that
this can be a "good option if you have space and the demand for service on a
regular basis," but cautions facilities:
"Of late, too much time gets invested on where the
facility is located and not enough on ensuring the service provider is
delivering the right overall program in terms of cost, quality and service."
While sending out instruments to remote facilities
for maintenance and repair is not an ideal solution, it is sometimes
necessary for specialty instruments or complex devices that cannot be
serviced via mobile lab or in-house due to the need for advanced repairs
and/or hard to find parts. Tobin adds that some facilities simply have very
modest needs when it comes to instrument maintenance that can be fulfilled
via remote servicing.
"There is a sizable minority of facilities that
choose to have their surgical assets serviced remotely like at our National
Repair Center," said Tobin. "For these facilities, their needs may be very
modest where on-site services may not make sense for them and/or they
require more advanced services beyond the capabilities offered on-site. For
most specialty devices, servicing of these products are handled in this
Considerations when choosing a program
With a variety of preventive maintenance options
available, an SPD leader must first conduct a self-evaluation to determine
what its facility needs in terms of maintenance and repair services, and
then evaluate vendors based on this criteria to choose the program that best
meets their requirements.
According to Lashua, a successful preventive
maintenance program starts with education. He states:
"This cannot be emphasized enough. Begin by
sitting down with a representative from your instrument repair vendor and
find out what they offer in the way of CE-approved educational programs.
These programs should be offered at no charge to your hospital and will
serve to educate your staff on how to proactively identify potential problem
areas before the instruments reach the operating room. Tour your vendor’s
on-location repair vehicle, and if possible, schedule a tour of your repair
vendor’s facility. Education coupled with preventive maintenance is key to
reducing overall spend and improving patient safety."
Anbari recommends SPDs ask the following questions
when evaluating preventive maintenance solutions providers:
Will service be provided when optimal for the
facility or service provider?
Will the service provider provide service
level guarantees for turn-time, percent of repairs completed on
location, and percent of instruments requiring replacement?
What is the experience level of the
What is the proposed preventive maintenance
schedule and what method was used to create the schedule?
Does the provider offer a comprehensive
approach to equipment management and repair reduction or are they
content to fix broken instruments?
Tips to SPDs for securing buy-in
For those SPDs that see the value in adopting a
preventive maintenance approach, but face challenges in securing the
necessary resources to implement a program, the industry experts offer up
"We find the most impactful message is that preventive maintenance reduces
total cost of ownership and improves patient outcomes. You must show a
business case for preventive maintenance and what long-term spend for
repairs, replacement, and maintenance look like with and without a
preventive maintenance program."
"Often times the instrument repair budgets are the largest item in a
department’s operating budget. By demonstrating the ability to reduce
expenditures in this area by taking relatively inexpensive and modest
preventive maintenance steps is key to getting administration buy-in."
"One important point is Surgeon Satisfaction. No clinician wants a piece of
equipment to fail during a procedure. Imagine driving on a vacation with
your family and having the car break down on the side of the road because
you failed to have routine maintenance such as oil changes, performed on
your vehicle. As a reminder, according to regulatory standards, endoscopes
should be included on the medical equipment inventory to ensure that proper
management of them is occurring."
has been working through this ‘learning curve’ with facilities to
demonstrate that not only can they make the move to a robust preventive
maintenance program but the return on investment is significant enough to
make the decision right away."