Scope repair costs cut by $12,000 in one center

Training, handling procedures improve scope care

Determining the best way to sterilize and repair a flexible endoscope’s damage after it’s been used to check an airplane gas tank for leaks is not a problem that most same-day surgery managers encounter. Staff members and physicians understand more about the fragile nature of scopes than they did 15 years ago, when this incident occurred at a hospital-based outpatient surgery program.

Today, the gastroenterologist would never consider using a scope to check his airplane, nor would the staff allow it.

The fact remains, however, that scope repair can represent a substantial portion of an outpatient surgery program’s budget.

After determining that her center’s repair cost of $12.33 per procedure was out of line with similar facilities by comparing her costs to the repair costs of endoscopy centers in her area that she surveyed, Helen Rolf, RN, BSN, nurse manager at Green Spring Station Endoscopy in Lutherville, MD, initiated an effort to address the cost. "The average cost of repair for other facilities in our area was $7.08 per procedure," she says.

"The toughest part of getting starting was obtaining good data to identify our problem," Rolf admits. Her contact with other ambulatory centers that offered endoscopy led to the formation of an informal peer group of nurse managers who share benchmark data on a quarterly basis, she explains.

"It does take time to set up a peer group, but I am glad that I got us started because it gives us good benchmarking data that is related specifically to endoscopy," Rolf adds. (For information on the peer group, see resources, below.)

"We perform over 6,000 procedures each year, so over $12 per procedure for repairs is significant," she points out. One year later, her repair costs have dropped to $10.26 per procedure and still are dropping, Rolf says. While still above the $7.08 per procedure average repair cost for her benchmarking group, this decrease in repair costs represents a savings of more than $12,000 in the first year.

There were several reasons for the high cost of repair, Rolf notes. "First, we changed the way we practiced and went from having two or three GI [gastrointestinal] techs handle the scopes to having many different people handle the scopes," she says.

This change occurred when the same-day surgery program began using certified registered nurse anesthetists (CRNAs). "With the surgeon, the CRNA, an RN, and the tech in the room for each procedure, it became crowded," Rolf explains. To alleviate the crowding, the GI tech no longer stays for each procedure, and the CRNA or the RN assumes some of the room turnaround responsibilities, including changing the scope between procedures, she says.

One of the first steps Rolf took to address the problem was to evaluate repair vendors. "I had always used the original manufacturer to repair the scopes, but I began to investigate other companies," she notes. "I actually visited plants and compared the services that each company could provide."

After checking out different companies, including the manufacturer she had always used, Rolf chose another vendor because a key part of the vendor’s service was education.

Endoscopes do not look fragile from the exterior, and because few people have seen the inside, it is difficult for staff members to understand how delicate they are, Rolf notes.

"The first educational meeting we had for all of our staff members was our vendor showing us a dissected scope and explaining how the glass light fibers and the scope tip with the computer chip can easily be broken if the scope is mishandled," she says.

The demonstration was an important first step because the handling safety procedures that were implemented made sense to staff members and they had seen how simple actions such as coiling the scope too tightly could damage the parts inside the scope, she points out.

"We lined the cabinet in which we store scopes with a foam covering so the scopes wouldn’t bump against the walls, and we emphasized careful handling in the procedure rooms and during transport of the scopes," Rolf adds.

Some of the new procedures included laying the scopes on the table with the knobs facing up rather than down to avoid loosening the knobs and coiling the scope lightly rather than tightly when carrying it to avoid damaging the light fibers, she says. "We also do not stack scopes, and we even got each scope a basin to use when transporting it from the procedure room to the reprocessing room," Rolf notes.

Also, staff ensure that forceps are never near the scope on the table, she says. "This avoids accidental punctures in the rubber tubing," Rolf explains.

Staff education did not stop with one meeting, she says. "Our efforts to keep staff members aware of the need to handle scopes carefully continues with staff meetings and ongoing educational programs," Rolf says. "The key is to keep it interesting, just like we did with the first presentation," she adds.

Keicha R. Schipa, senior territory manager of Integrated Medical Systems, a medical equipment repair company in Birmingham, AL, says 70% of scope repairs that are performed are due to care and handling problems, as opposed to 30% of repairs due to normal wear and tear.

"This means that 70% of the repairs that same-day surgery programs are experiencing are preventable," she says.

One of the most common mistakes made in the care of scopes is improper leak testing, says Schipa. "Leak testing is a detailed process that requires time to ensure that fluid is not getting into the scope," she points out. "Most centers do not test effectively because they don’t test after every case; they don’t insufflate before putting the scope into water; they don’t test long enough; or they don’t purge the tube of air properly."

Not only does improper leak testing lead to more repairs of the scope, but it also presents a patient safety concern because a scope that leaks contains contaminated water that could expose the patient to infection, she adds.

Improper leak testing was one of the problems identified at Green Spring Station Endoscopy, so leak testing competencies now are performed for all new GI techs, Rolf explains.

Physicians also spent a morning with the scope repair vendor learning how their techniques could damage scopes, she says. While staff might not feel comfortable challenging a physician’s scope handling technique directly, Rolf does say that nurses have been known to point out, "Helen would not be happy to see you do that with the scope."

Sources/Resources

For more information, contact:

  • Helen Rolf, RN, BSN, Nurse Manager, Green Spring Station Endoscopy, 10751 Falls Road, Suite 425, Lutherville, MD 21093. Phone: (410) 583-2760. Fax: (410) 583-2759. E-mail: hrolf1@jhmi.edu.

For information on how to establish a nurse manager peer group or benchmarking data that the group collects, contact Helen Rolf by e-mail.

For more about scope repair programs, contact:

  • Integrated Medical Systems, 1823 27th Ave. S., Birmingham, AL 35209. Phone: (800) 783-9251 or (205) 251-9154. Fax: (205) 803-4057. E-mail: info@imsrepair.com or sales@imsrepair.com. Web: www.imsrepair.com.
  • Olympus America, P.O. Box 9058, Two Corporate Center Drive, Melville, NY 11747. Phone: (800) 645-8160 or (631) 844-5000. Web: www.olympusamerica.com.
  • Pentax Medical, 102 Chestnut Ridge Road, Montvale, NJ 07645. Phone: (800) 431-5880 or (201) 571-2300. Web: www.pentaxmedical.com.
  • Endoscopy Support Services, 3 Fallsview Lane, Brewster, NY 10509. Phone: (800) 349-3636 or (845) 277-1700. Web: www.endoscopy.com.
  • Precision Endoscopy of America, 10969 McCormick Road, Hunt Valley, MD 21031. Phone: (800) 285-5959 or (410) 527-9596. Web: www.precisionendoscopy.com.