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- The Magazine
Maintenance and Repair Strategies for Endoscopes
By: Joe Paone | Senior Editor
Engaging a trusted service provider on the most favorable terms possible will keep your service lines flowing profitably.
With endoscope repair, cost isn’t the only consideration. Providers require consistent, high-quality availability and prompt turnarounds to avoid risks to performance and throughput. Routine maintenance and repair of these expensive instruments is critical to positive outcomes and patient safety.
More repairs than ever
Endoscopes should be handled delicately, but no matter how careful you are, accidents will happen, and wear and tear is inevitable. Physicians and staff need to be your eyes and ears to spot problems. “It really starts at the frontline,” says Damien Berg, BA, BS, CRCST, AAMIF, vice president of strategic initiatives with the Healthcare Sterile Processing Association, who serves as a per diem sterile processing technician at three hospitals and a surgery center for a Colorado health system. He says it’s the responsibility of clinicians to spot and report issues with function and performance, and of sterile processing techs to closely inspect scopes for damage.
More problems with scopes are being spotted because of updates to the AAMI ST91 endoscope reprocessing standard, which now recommends that techs visually inspect scopes using a borescope. “With this heightened sense of inspection, techs are seeing things they could not have seen before,” says Mr. Berg. “But there’s a caveat: They’re seeing things that they don’t necessarily know what they are. They’re not necessarily the experts in the internal workings of the device. For example, is that little dot part of the manufacturing process or is it debris? In certain manufacturing processes, they use dye in the internal lining as a marker — a blue dot, a red dot, a red line. If a technician is not skilled or properly trained in that visual recognition of knowing how those scopes are made, they might kick it out for repair.”
Result: An increase of scopes unnecessarily going offline for repairs they may not need. “We need to focus on training and visual recognition for sterile processing techs on what is good and what is bad,” says Mr. Berg.
This emerging issue spotlights the importance of forging a solid, cost-effective, reliable service partnership with either the scopes’ original equipment manufacturer (OEM) or a vetted third-party service provider.
Dollars and sense
Eric M. Pauli, MD, FACS, FASGE, David L. Nahrwold Professor of Surgery, chief of the Division of Minimally Invasive and Bariatric Surgery and director of endoscopic surgery at Penn State Milton S. Hershey (Pa.) Medical Center, says his facility maintains a service contract with the OEM. “They guarantee our scopes and will take them back for service and repair,” he says. “If we ask and if they can, they will give us a loaner scope when one of ours goes out. That’s very beneficial, but the downside is you need to pay for that contract and service, which adds a great deal of expense.”
Recently, the FDA clarified that third-party repair services that are certified, trained by the OEM, have the proper parts from the OEMs and can repair scopes back to OEM specs are acceptable servicers as well, says Mr. Berg.
Administrators thus have options, but should tread carefully. Does the third party offer loaners? Will it repair on a per-scope basis, or does it require you to sign a more onerous contract?
Mr. Berg works with both OEMs and third-party servicers. “There will always be compelling arguments on either side,” he says. When considering third parties, Mr. Berg recommends asking numerous questions, like “What are the costs and turnaround times? Are the technicians trained properly? Are they using equal parts and replacement materials? Can they quickly provide loaned scopes or substitutes? Are the techs maintaining their training to work on a variety of manufacturers’ scopes?”
That last question is crucial for centers that use multiple scope brands. “OEMs only work on theirs, but third parties can work on a variety if they’ve had the proper training and access to the proper repair parts and material,” says Mr. Berg. Third parties, he says, often charge flat monthly fees that apply whether you send 10 scopes or just one for repair.
No matter whom you choose, the structure of the contract is important. “Wrap into your lease agreement that you get so many repairs over a set amount of time,” says Mr. Berg. Also explore the cost of contracting annual preventative maintenance, which can save money down the road by catching small defects before they become major.
Additionally, codify how loaner replacements will be handled. “If you send a scope out and it takes three weeks to get it back — and you don’t have a loaned scope or replacement — that’s bad,” says Mr. Berg. “Look for what they call ‘repair replace,’ where if your endoscope is down, you call the servicer and they’ll ship you a new endoscope at an agreed-upon price.” That way, your clinicians won’t miss a beat.
“Ideally, we want damaged scopes replaced in a one-to-one fashion,” says Dr. Pauli. “If we’re losing an adult colonoscope for service, and we have one coming back in tomorrow, we can continue to do procedures back-to-back-to-back without delaying the throughput or a patient’s procedure. We don’t need to say, ‘Sorry, your case will be 30 minutes late because we’re cleaning the scope from two patients ago.’
“If you’re running a busy center, the number of cases you have is often related to the number of scopes you have available and how long it takes to clean them,” says Dr. Pauli. “It can result in significant delays in turnover.”
Ultimately, staff should ensure scopes don’t require frequent repairs. “Your people need the right training, and really give them the time to do it,” says Mr. Berg. “Some scopes have hundreds of reprocessing steps. The average person is not going to remember 100 steps, so give them the right training and resources so they can properly process these in the correct time.”
Dr. Pauli rarely encounters problems with scopes during procedures. “If I’m using an injection needle, and it is out and exposed when I’m pushing it down the channel, it’ll damage that channel,” he says. “But I won’t notice that while I’m using it; the channel will continue to work just fine.” Instead, staff will detect the damage through their leak testing.
In Dr. Pauli’s experience, the most common damage identified during use is a cable in the scope’s bending section popping or breaking, which tends to happen with older scopes that have been awkwardly bent or stretched on many occasions. However, he says most damage to scopes occurs during transport and handling by ancillary staff. Without dedicated containers that keep transported scopes bent at the proper degrees, they can be overbent and damaged. Occasionally scopes are also dropped, or the distal tip that contains the camera accidentally smashes into something. He’s heard of longer scopes being damaged when a storage cabinet door is closed on part of the scope.
In endoscopy, scope availability means everything. By combining proper preventative care with a trusted repair provider, outpatient facilities can feel much more confident that their endoscopy lines will always remain humming. OSM
Note: This three-part article series is supported by Karl Storz.
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