Choosing a Surgical Repair Vendor
by Anne Reed
Instruments, cables, scopes, containers, power pieces, and more. It’s a huge variety of equipment that requires constant attention to keep it all functioning soundly. The typical Central Sterile Processing department is charged with the responsibility to monitor and maintain thousands of different items used in surgery, and it’s a task that can drive any conscientious manager to distraction.
If not maintained carefully and correctly, surgeons complain, O.R. managers protest, and the C. S. manager is accountable. So, among the myriad of decontamination and sterilization duties already incumbent upon a busy C. S. Director, he or she must proactively oversee a system of preventive maintenance that anticipates problems and stops them before they grow into serious issues.
It can, indeed, be an imposing challenge. Unfortunately, however, when looking to repair sources, it’s all too common to look for the closest or cheapest source, and that habit can be the beginning of a costly and lengthy nightmare, with disastrous results. The choice of one’s repair vendor is every bit as important as the choice of vendors for expensive capital equipment purchases, but the options need to be examined closely, because the levels of expertise and integrity differ greatly among the many repair vendors in the industry today.
With surgical equipment inventories averaging in the millions of dollars, and replacement costs on the rise, supervisors are obliged to ensure these assets are protected. It is a fact, though, that instrument and equipment repair is an emerging market. The industry is flush with inexperienced and/or untrained technicians who can represent a serious threat to the life of one’s equipment. To avoid problems, insist that your repair vendor meet a series of minimum standards.
Minimum Standards Check List for All Repair Vendors (including on-location)
- Do they have a minimum of 5 million dollars in completed product liability insurance? This is not negotiable. To protect the hospital, risk managers are asking department supervisors to require a copy of an updated policy for all repair vendors be on file. Lesser coverage is simply not adequate in this economy, and most small vendors don’t carry any coverage at all. That can become a major hospital liability if your facility is ever involved in any malpractice litigation that also names manufacturers and service organizations.
- What are their warranties and what do they cover? Flexible and rigid scope warranties, for example, are commonly 90 days, but some rigid repair companies guarantee their work for a full year. Look for warranties that always meet or exceed industry minimum standards. This shows a company that is confident in its quality.
- How extensive is their replacement parts inventory? If they don’t have the necessary parts in stock, your instrument may be tagged “non-repairable,” even if it can easily be repaired. No matter what their specialty is, a vendor must be solvent enough to maintain a huge variety of parts to repair a number of brands of equipment within that field. It requires a substantial investment.
- Are their parts and materials brand new? It is very common for small repair operators to cannibalize parts from other customers’ equipment. This can involve anything from rod lenses in scopes, motors in power equipment, or even screws and springs from bone instruments. In worse case scenarios, they have been known to completely strip scope or power equipment housings of all parts, and send the unit back tagged “non-repairable.” Unsuspecting customers are actually helping to stock their parts inventory, and because they don’t usually realize the item has been stripped of all its components, innocently order a replacement from the manufacturer. It’s only when the “non-repairable” unit is sent for a second opinion that the theft is discovered. Sadly, such companies continue to operate.
- Are all parts and materials of medical grade quality? Stories abound of endoscopes being sealed with bathtub caulk or airplane glue. Obviously, it’s an inept repair, but worse, it can destroy your scope and force you to prematurely replace it. In addition, if materials are not medical grade, it becomes a patient safety issue.
- Are they really an actual repair company, or are they merely a repair “broker” who picks up your equipment and out-sources it to any number of questionable and unknown repair vendors? It’s preferable to know exactly where your equipment is going, and not trust a middleman to choose the repair house for you. Ask to tour the repair facility if in doubt.
- Do they provide free Inservices? Since a high percentage of repairs are the result of user misuse and abuse, much damage can be prevented with education. A qualified repair technician can routinely identify such problems, and help train your staff to avoid them.
- Do they warehouse a huge inventory of loaner equipment to meet your needs? Ask for details and actual numbers. Housing a handful of a few patterns does not constitute a sufficient comfort level to ensure that the proper loaner is going to be available at the exact time your equipment breaks down. Are those loaners free? They should be.
- How extensive is the customer service support in their actual repair center? When you can’t reach your local representative and you need to know the status of your repair, you don’t have time to be playing phone tag. A well-trained staff in place, complete with departmental managers, will ensure that someone can give you the answers you need when you need them.
- Can they provide repairs for obsolete equipment? Manufacturers routinely introduce multi generations of equipment with components that aren’t always compatible with the equipment you own. Before long, they will stop providing service to the older models in an effort to promote sales on the newest ones. Equipped and skilled independents are often capable of providing continued support to these “obsolete” items, and that helps you maximize the life of your equipment.
- Do they promote “flat rate” pricing? Be aware that the only way to profit from quoting a flat rate is by rejecting as “non-repairable,” extensively damaged items that others could fix, and/or using inferior grade parts and materials. You will pay more in the long run in repeated repairs or premature replacement.
- Do they have a repair contract with your national group purchasing organizations? Dollars spent with such vendors qualify you for significant pre-negotiated discounts in addition to year-end rebates. Most vendors who succeed in obtaining such agreements are reputable.
- Ensure they are licensed to do business in your state and that they are financially solvent. You don’t want to send equipment to a company who’s being pursued by creditors and/or on the verge of bankruptcy. You may never see it again.
Additional Minimum Standards Check List for On-Location Instrument Repair Vendors Only
- Where were they trained? Unless they came directly from an OEM or a well-known repair company, chances are they are self-taught. Your instruments are too valuable to allow someone to practice on them.
- What do their work orders look like? If your copy doesn’t show line item pricing for the actual work performed during that visit, then it appears as if there is something to hide, and there often is. Padding work orders this way is very common. You should be able to see from the paperwork presented exactly what was done on what items. Also look for hidden surcharges not detailed on their published price list like trip charges, minimums, labor, etc.
- Are they skilled and equipped to handle a large assortment of instruments or are they limited to the simple items? M.I.S. instruments and micro instruments, for example, require special expertise and more expensive replacement parts.
- Can they provide additional services for you like color coding, needle holder insert replacement, leak testing, diamond dusting, container repair, etc. The fewer vendors you have to consult for repair, the more time you save.
- How do they test electrosurgical insulation? There are many obsolete devices still in use that can actually damage the insulation of laparoscopic/endoscopic insulation. Consequently, you pay for re-insulating instruments that may have been fine prior to testing.
- Do they know how instruments are expected to function? What materials do they use to test the edges and action of a finished instrument—bone, plastic, rubber, cardboard, etc.? It should simulate that which the instrument impacts on a patient. Invite them to demonstrate their expertise. Ask leading questions when interviewing a potential repair technician.
- Do they provide computerized tray tracking with print-outs for your records?
- What’s in a name? Plenty, if their name hints that they are part of an enormous coast to coast organization, when in reality they are a start-up company with a van and a sales pitch. Some small vendors actually try to pass themselves off as part of a larger repair organization by using deceptive insinuations, while others imply that they are directly aligned with a series of manufacturers to handle repairs on their behalf. Scrutinize their brochures. Well-established companies support their representatives with professional materials, so if their promotional literature appears somewhat primitive, then it’s probably a vendor with a limited repair background.
- Obtain a copy of their “Completed Product Liability” insurance policy for your protection.
- Require an updated list of references with phone numbers and call them for validation.
Making Your Repair Responsibilities Easier
- Establish a trusting relationship with a well-trained surgical equipment/instrument specialist who understands your expectations. You can enjoy a face-to-face relationship with the person who actually performs the repairs, and Quality Control issues can be handled on the spot.
- Avoid the “Repair Box” syndrome, and practice preventive maintenance for entire trays. The repair specialist should inspect all instruments in the sets for damage, but you should only be charged for the ones that needed attention.
- A well-defined preventive maintenance program will pay for itself. Set up a routine maintenance plan for all trays and stick to it. Based on usage, all sets should be rotated so that they are refurbished at pre-determined intervals. Your repair technician should be able to provide you with computerized tracking reports to keep you informed of the status of the sets at all times.
- Budget realistically for repair and preventive maintenance. Your replacement costs will diminish dramatically.
- When using an OEM, or a local van service under contract to an OEM, always consider obtaining a second opinion on “non-repairable” equipment before discarding and/or replacing it.
- Buy quality German-engineered instruments that can be cross-utilized and universally serviced.
- Let your repair technician professionally color code your instruments and sets so you don’t have to pay an F.T.E. to keep applying, removing, and reapplying sticky tape.
- Get warranty information in writing.
- Avoid repair “discounters,” and “Flat Rate” offers. They can’t do sophisticated repairs on extensively damaged instruments, and moreover they can even do additional damage.
- Use companies that can repair a wide variety of instruments and equipment. One stop shopping, assuming they are qualified, saves you time.
- Don’t make price the only criteria. At best, you’ll get a “quick fix” that will require your attention again and again. Solid technical expertise and OEM standard parts simply cost a little more, but will save you in the long run.
It’s important to recognize that the proper repair of surgical instruments and equipment requires skill, experience, and a significant capital investment. Because your inventory is too expensive to gamble with, investigate carefully the repair vendor you empower to maintain it. A poor choice can cost you time, money, and needless frustration. A sound choice, on the other hand, should bring you the peace of mind of knowing that your equipment is always being serviced and maintained correctly.
Reprinted with permission of Infection Control Today magazine.