By Anne Reed, BS

This article discusses:
• One surgical equipment repair source vs. multiple repair vendors
• Reduction in instrumental costs when using on-location surgical instrument repair technicians.
• Educational benefits for staff and administration.

Surgical instruments that function properly - that's all a good surgeon asks for, yet many continue to claim that their facilities simply don't provide them with consistently sharp, perfectly aligned instruments on a routine basis. In years past, there was good reason. When a surgical instrument required maintenance, it was returned to the manufacturer with a purchase order that said "Repair or Replace." To repair it meant lengthy delays of up to eight weeks, and to replace it often meant sacrificing a healthy instrument for the sake of obtaining one quickly. Complete tray and set refurbishing was virtually unknown, and because of the related down time when instruments were out for service, hospitals were forced to keep extra sets in inventory to compensate for the absence of their damaged instruments.

Compounding the problem was the fact that the service efforts of many OEM's were considered secondary to their manufacturing process. Repair was a necessary evil, but the repair division was seldom viewed as a profit center; therefore, scant attention was paid to encourage instrument maintenance for the long term. In fact, lengthy turnaround times and high repair minimums were not unconscious incentives for hospitals to purchase replacements. The entire process was tedious, time-consuming, and costly and, as a result, instrument maintenance often suffered from lack of interest.

Today's environment, however, provides for a repair option that not only makes instrument care completely convenient, it saves money and maximizes the life of one's instrument investment at the same time. A qualified on-location instrument repair company can bring significant advantages directly to your facility.

Emergence of Independent Repair Providers
Mobile surgical instrument care began to revolutionize the industry in the late seventies when independent repair providers discovered that hospitals were at the mercy of manufacturers for their repair needs. With the emergence of independent repair vendors who specialized only in instrument maintenance and had no interest in the sale of a replacement, repair prices plummeted to realistic levels, and a new industry was born. As benefactors of this trend, it is the hospitals themselves who are now more educated about the importance of maintenance and the difference it can make not only to the surgeons, but in one's bottom line as well, Of course, in this age of budget tightening, it is imperative for perioperative decision-makers to look to the long-term preservation of their equipment in lieu of constant replacement, so the evolution of the on-location repair alternative was timely, and indeed, fortuitous for the hospitals.

Benefits of Repair Vendors
These "workshops-on-wheels" are often more than meets the eye. Sophisticated repair vendors equip their vehicles with the latest in repair machinery - hones, grinders, belt sanders, sand blasters, buffers, curing ovens, sonic cleaners, demagnetizers, air compressors, microscopes, etc., and a complete spare parts inventory that can rival any manufacturer's. Capabilities can include simple sharpening, realignment, color-coding, screw, spring, and ratchet replacement, complete instrument refinishing, tray and set refurbishment, case repair, needleholder insert replacement, etching, demagnetizing, basic endoscopic repairs, and more.

Meeting the challenges of busy surgical services managers is what this system provides, and that is why regular customers appreciate the advantages of same day service and quality repair in one package. Danny Kelso, Senior Purchasing Agent for Emory Adventist Hospital in Smyrna, Georgia, comments, "if you run a busy OR, you can ill afford to have a major or minor tray out of service for any length of time. It's not uncommon to take trays directly from the repair van to be sterilized and used in a case immediately. Furthermore, we can make instant decisions while consulting with the repair tech about whether to replace a worn instrument or return it to service." There are a number of reasons to cultivate a relationship with a qualified mobile repair technician from a reputable company.

Surgeon Satisfaction
A fine surgical instrument is to a surgeon what the perfectly engineered putter is to Tiger Woods, or what the perfectly strung and balanced tennis racquet is to Andre Agassi. Instruments are the tools of a trade and an extension of skill, and if an instrument is dull, bent, misaligned, or sprung, it will impact the efficiency with which an individual can perform a job. Just as every surgical procedure is extremely delicate, so is the repair of the surgical instrument. It must be fine-tuned with the same care and precision the doctor wields, and it must deliver the kind of edge and action the doctor expects in the operating room A qualified repair technician can be expected to know not only the requirements of each instrument (i.e., whether it cuts tissue, muscle, bone, sutures, etc.) but also the action and angle of its approach (i.e., whether it scrapes, snips, clips, bites, etc.) He can test the repaired instrument and immediately address concerns if it does not have the right feel, action or balance. Furthermore, the personal preferences of individual surgeons can often be accommodated by consulting with the technician at the facility during a repair visit.

One Repair Source Vs. Multitude Repairs
Sourcing repairs to numerous vendors is confusing when something goes wrong, and the resulting finger-pointing can be devastating if vendors will not assume responsibility when it is uncertain who is actually responsible for the repair. By routinely using the same on-location repair vendor, absolute accountability is never an issue. It makes good sense to narrow down the repair choice to one vendor, instead of utilizing a number of remote facilities that do not establish an ongoing relationship.

Reduced Purchase Orders
The cost to generate a purchase order in many facilities can be as high as $50.00 each. By sourcing out a number of repairs to the same on-location vendor who provides a broad family of services, one can assign the repair of scopes, power equipment, instruments, etc. to the same purchase order and help shrink the paperwork load of the hospital. After a solid working relationship is established, many facilities use a blanket purchase order to expedite the repair process.

Extended Repair Potential
Repair opportunities exist today that were not accessible until recently. This accessibility is due to the enhanced availability of replacement parts and repair technology that had previously been closely held by the OEMs. A professional independent repair representative from a company with national support will be on the cutting edge of these trends and will have the necessary components on hand to complete the repair of an instrument formerly considered non-repairable.

Asset vs. Liability
Routine instrument maintenance is an expenditure that will save money in the long run and should never be perceived as a liability to the budget. Simply put, instruments will last longer and replacement costs will diminish. Dedicated instrument care will allow facilities to achieve the maximum life out of the instrument investment. An on-location provider is the only choice when it comes to realizing the greatest results of a dedicated preventive maintenance plan for all sets and trays because the convenience of same day service enhances the success of the program.

Reduction of Instrument Inventory
With access to same day repair, the need for back-up sets is reduced. Managers enjoy the peace of mind from knowing that damaged instruments will receive immediate attention and can be returned to useful service shortly. Stocking excess inventory to compensate for the absence of instruments is virtually eliminated. Furthermore, some small facilities function with a limited amount of trays anyway, resulting in increased usage and accelerated wear and tear. Because of this shortage, these facilities cannot afford to be without any of their sets, and so an on-location repair vendor is the only viable solution to their repair needs.

While assessing instrument damage, the repair technician is also shouldering much of the responsibility for routine instrument inspection that would normally fall to the sterile processing employees. A capable repair specialist will provide free inspections on all trays and sets, helping to reduce the departmental man-hours involved.

Preventive Maintenance
Routine visits from a mobile instrument technician can make the facility more efficient by actually addressing small problems before they grow into bigger ones that are more expensive to solve. The technician can also troubleshoot preventable instrument abuse issues and demonstrate ways to avoid misuse that causes costly damage. Preventive maintenance that preserves the instrument indefinitely should be the goal.

Well-maintained instruments are less likely to succumb to intraoperative failure. Consequently, patient safety is not compromised and the hospital's exposure to liability is reduced.

Unlike pick-up and delivery services, the technician who actually repairs the instruments is at the facility, so the technician is immediately accountable to an administrator for the repair result. Administrators function as the technician's quality control supervisor, and of course, if the work doesn't meet expectations, the problem can be addressed without delay.

Warranty Repairs
Internally, it can be an ordeal to track the return of various instruments to their respective manufacturer. Whether still under warranty or not, the time spent managing the paperwork and logistics of your instruments' status and whereabouts can be self-defeating. On-location repair prices typically are so low that even when an instrument is still eligible for warranty work, it is often more cost-effective to let on-location technicians repair it and get it back into service immediately instead of hassling with warranty issues.

Repair Autonomy
It seems lately that every product salesperson in healthcare claims to be able to handle all repair needs. Unfortunately, they often only broker repairs. That means they send instruments to one of any number of unidentified repair providers whose history and quality is unknown. Then they acquire a commission on top of the repair price, and the facility pays more. Not only is control of their repair process lost, the cost is higher, too. Instrument repairs should be treated with greater importance than just allowing a salesperson to select the repair source at random.

A professional independent repair technician works on all types and brands of instruments and often puts them through some aggressive and vigorous assaults during the repair process. Consequently, the technician knows many of the subtle differences in quality among the various manufacturer's products. When purchasing replacements, it is often beneficial to consult with someone who has no vested interest in the transaction but is seasoned in handling the instruments. Technicians can help prevent facilities from buying an inferior product because as an experienced repair specialist, the technician can speak about the craftsmanship and durability on familiar patterns

Most group purchasing organizations have agreements with the nationally known mobile repair services, so facilities can become contract-compliant and take advantage of reduced repair prices at the same time. Furthermore, the GPOs look for companies with a reliable reputation in the industry that can bring the most in-service to their members.

Weekend and Evening Tray and Set Refurbishing
Mobilized repair vendors have the flexibility to work around a busy surgery schedule. Evening and weekend visits can be arranged so that access to the instruments is not inhibited by caseload. The weekend repair programs offered by the manufacturers are cost prohibitive and represent a major logistical hassle. As a result, many hospitals schedule all their tray and set refurbishing jobs on Saturday and Sunday with their on-location technician because it is less expensive, and the instruments never leave the facility.

Some hospitals enjoy a complete refurbishing of all their trays and sets during a weekend, and large mobile repair companies can send in multiple vans and technicians to complete this seemingly behemoth assignment before Monday morning surgeries commence.

Instrument Repair Tracking
How often does a needleholder need new inserts? How long do the scissors stay sharp? Why are instruments bent? To help improve utilization and the productivity of the instrumentation process, large mobilized repair companies offer computerized instrument repair tracking programs. By collaborating with technicians to record repair frequency, it is easy to identify bottlenecks and other opportunities for improvement to achieve measurable results. It also enables administrators to draw comparisons to benchmarks from similar institutions.

Access to immediate repair often encourages managers to think in terms of upgrading the quality of their instruments. Maintaining high-grade instruments is more economically sound in the long term that repeatedly replacing inferior brands. Furthermore, there is increased surgeon satisfaction in the choice of top-of-the-line instruments.

Educational Resource
Technicians who represent the nationally known companies are often trained to provide administrators and the staff in-service programs on the care and handling of instruments, endoscopes, etc. Tap into their expertise and invite them to make presentations not only to the staff but to local and regional professional organizations, as well.

A cutting edge instrument maintenance program should really be a collaborative effort between the department and the onsite repair technician. One can improve resource utilization by partnering with an industry leader to implement an action plan that will not only increase productivity of the instrumentation process, but also enhance user satisfaction. It's a matter of taking the initiative to evaluate, prioritize, and re-engineer the maintenance program to realize all the benefits of a mutually supportive relationship with a results-oriented mobile vendor.

The proper care and handling of instruments is an indication to surgeons that not only are administrators aware of their professional needs, but that they continue to be proactive in addressing them. Better surgical results, better patient care, and a more efficient perioperative environment - it is achievable by augmenting your team with the skills of a qualified Mobile surgical instrument specialist.

Reprinted with permission from Infection Control Today