Preventive Versus Reactive Maintenance: A Case Study
Surgical instruments and equipment are critical components of patient safety, positive outcomes and good customer service. Unfortunately, devices often don’t get the attention they deserve – and the consequences can be, at best, frustrating for the surgeon, and, at worst, devastating for the patient.
Instruments in need of sharpening, for example, can tear skin, while also increasing the risk for additional damage to the device. Instruments that can’t be taken apart and easily cleaned can harbor bone, blood and other bioburden that makes it difficult for a surgeon to operate the device properly (and, even more importantly, can contribute to hospital-acquired infections). Keeping instruments in tip-top shape requires a proactive approach – one that addresses issues before they become a liability.
“When you get items back from the OR with a repair tag, it’s already too late. Something has gone wrong,” said Rick Costello, MBA, CCSVP, president and chief operating officer of IMS Instruments Corp. While repair tags are necessary, he stressed that relying on this type of reactive approach is neither prudent nor cost-effective. He also explained that it’s not enough to just send out broken devices without practicing due diligence and embracing quality processes to ensure that the broken or otherwise malfunctioning device isn’t subjected to the same damage in the future.
“Any time a tagged instrument comes down from the OR, write it down in a log – the doctor’s name, the problem — and see if it’s a ‘self-inflicted wound,’ something that was done to cause the damage that could have been avoided,” he noted. “Diagnose what happened and take corrective action to make sure it doesn’t happen again.”
Costello also shared some enlightening data from two 50-hospital studies: one where preventive maintenance was followed according to tray rotation; the other, based on time. For nearly 7,500 trays (across nine major services) that underwent tray rotations, the average number of uses before being sent out for preventive maintenance was 48. For the time-based study that assessed 13,000 trays and 400,000 instruments (across 21 different specialties), most services in the hospitals only performed preventive maintenance two to three times a year (and some hospitals were even fewer than that).
Education and communication plays an important role in the quality improvement process, he explained, and repair companies and device manufacturers can and should play a key role.
“Whoever is doing the preventive maintenance on your instruments needs to communicate what they’re doing and what they’re finding, in as much detail as possible, so you can find the right solutions,” Costello reasoned, adding that CSSD and OR professionals also benefit from ongoing education on care and handling of instrumentation. This education can be found in the Certified Instrument Specialist (CIS) textbook, among other resources.
While some facilities may be reluctant to engage in proactive preventive maintenance, there’s plenty of data to show that spending a small amount on the front end is far better on the budget than enduring big repairs and premature replacement on the backend. Just a cataract set alone will cost $2,495 new, whereas a completely restored set will run about $225 – less than 10% the cost of replacement. Even more savings can be seen on more complex sets.
Preventive maintenance is important for all instruments, but it makes good sense for facilities to put the most time, effort and money into their most valuable equipment. “This is a good place to start,” Costello said.
Contact IMS for more surgical instrument maintenance information.