I can understand if the thought of repairing your endoscopes in your facility seems far-fetched. All I can tell you is that it can be done. Because my hospital has done it - and saved substantial money and improved efficiency along the way. Best of all, our scope vendor has played a key role in the success of our in-house repair program. Here's our story.

The breaking point
Three years ago, Lehigh Valley Hospital's GI/pulmonary endoscopy lab had a lot of cases, a lot of scopes and, of course, a lot of repair bills. Then we started our in-house endoscope repair program. Now, we're still performing a lot of endoscopies (about 10,000 a year) and we still have a lot of scopes (about 60), but we've slashed our repair bills (by $365,855) by having someone trained to repair and maintain our scopes.

In 1999, our repair bills were astronomical - about $310,000 for the year. At the time, both the original equipment manufacturer (OEM) and a third-party repair company were repairing our scopes. Using a third-party firm for some repairs did save money over previous years, but costs were still high. For example, one vendor charged us $35,500 for scope aeration - a step necessary for most repairs. Beyond that, scopes averaged about six repairs per year, which translated to about 60 days per year each scope was out of service.

Luckily, in 2000, our OEM, which was restructuring, approached us and asked, "What can we do to better serve you? What do you want?" Well, I told them, first of all, I want costs to come down. And I told them I didn't like sending my scopes off for 10 days at a time to Baltimore, New York, California - I wanted somebody here. The OEM told me it was developing a school for just such training.

Picking the right person
When this opportunity arose, we had a great GI assistant, Todd Leibenguth, who was with us five years. Todd was very involved with repairs - he coordinated the process and acted as a go-between for our physicians with repair vendors, letting them know what was wrong with the scopes.

Todd was the guy I wanted to learn how to fix the scopes because he knew how the physicians like the scopes to feel, he had patient contact and he had technical knowledge from talking to the repair companies all the time.

So we sent Todd off for two weeks' training; he recently did another week as a refresher. He was on the line, learning how the OEM's technicians inspect and repair all endoscopes.

"I learned all minor repairs," says Mr. Leibenguth, "such as fixing air leaks, tightening angulation wires and replacing switch buttons. If the whole insertion tube goes bad - and that kind of thing only happens every six months or a year with heavy use - I can't do that. But what happens every month or day-to-day, I can take care of."

Coincidentally, just before Todd underwent training, he moved to LVH's biotechnical engineering department. However, if you're considering an in-house repair program, I recommend you consider endoscopy-trained staff first.

"Biomed techs are well-versed in electronics, but scopes aren't just electrical - they're more mechanical," says Mr. Leibenguth. "Take, for example, applying bending rubber glue: It's a cross between an art form and mechanics. By doing the procedures for five years, I have a better understanding for what the scope should feel like.

"If you have a tech who's in the rooms, has patient contact and wants to learn to repair scopes, that's the ideal person."

Down time
In the past, if a scope went down, the process went something like this:

• You reprocessed the scope as best you could (you can't send it out contaminated)
• you put it in the case and filled out sheets of paperwork;
• the scope had to be taken to the loading dock;
• it spent days in transit;
• a couple days after that, the vendor would tell you the scope arrived and what the estimated repair cost would be;
• the scope waits to be fixed, and technicians spend a day to a week repairing it;
• the OEM ships the scope;
• finally, you receive, reprocess and recirculate it.

It took a week or three, depending on the severity of the problem. Todd, on the other hand, is just across town. If a scope needs a repair, we reprocess it and either Todd or our hospital's courier system picks it up. Either way, within a couple hours of knowing a scope needs fixing, it's in Todd's hands. Within hours of finding the defect, he is repairing it. And the scope will be returned as soon as possible. Some repairs might take a few days - but Todd lets us know right away how long it will take.

Excellent results
Here's how we've benefitted:

• By paying only for Todd's salary and the OEM parts he uses to repair the endoscopes, we saved $365,855 in the first three years - more than $114,000 in 2001 and $128,000 in 2002. Annual expenditures went from a high of $308,713 in 1999 to $185,866 in 2003.
• The waiting time for endoscope repair has been halved or eliminated. It's also eliminated the need to get loaner instruments (if you can get them at all or in a timely manner, that is) that your reprocessing staff might be unfamiliar with. We now consider three days long.
• Scopes get preventive maintenance every six months. "Most times major repairs could be prevented," says Mr. Leibenguth. "I give the scopes a once-over to catch small things before anything major has a chance to happen. For example, the scope could just be starting to get sloppy, and I'll get it tightened up before the physicians have a chance to say something." Scope repair frequency is down to 1.4 per year.
• The GI lab staff know Todd and feel comfortable with him. "A physician will have a nurse or tech tell me to check something because it feels weird," says Mr. Leibenguth, "and nine times out of 10, they're right." They respect his opinion; if I tell physicians Todd recommends something, they do it. And I'm confident in who's working on my equipment.

The in-house repair program now covers all three hospital sites that perform endoscopies. In the fall, we sent another biomed technician to the OEM's training course; he will assist with minor repairs and fill in when Todd's on vacation.

New perspective
Want to know how successful the in-house repair program is (and how spoiled we've become)? A couple months ago, three scopes needed major repairs. One of my business office staff was upset over the repair bill. I said, "How can you call this a huge bill? This is less than the average huge bill used to be."