A Few Dollars More

No, this is not about an old Clint Eastwood movie; it is about the cost of ownership of medical devices.

In recent months, there have been several articles published and presentations made on preventive maintenance of medical devices. In most of the articles there is a lot of discussion of testing intervals, test procedures, and sharing results of the tests. Not one that I read or attended addressed the prime concern of most hospitals: COSTS. I am not sure what my colleagues are smoking, but for every hospital that I deal with or have dealt with over the past 10 years, costs and device availability are the main concerns. So let us spend a little time and look at where costs can be reduced.

The life cost of a device starts with the purchase order. Unfortunately, all too many devices are purchased with little or no technical input from those who are expected to maintain the device after its warranty period with any additional funds. Most of us in this business know that manufacturers often make three to seven times the profit on repair parts and services as they do on the sale of the device. Too many of us go out and second-source a repair part only to be told that the manufacturer controls the software needed to install that part. So instead of a $5,000 repair, it is now $10,000 for the manufacturer to install the part. Another all-too-common occurrence is that when a vendor comes in to fix one problem, other problems appear after the fix, or the tech calls, saying, “By the way, you are going to need a framistan. I can do it now, and that will save you another travel charge.” My question is, how come the tech has all these obscure parts with him and not the common part that is needed—and that now has to be shipped overnight?

At one hospital, I recently ran a report on which devices had the most repair calls in a 3-year period. I was expecting a sterilizer or x-ray equipment, but, instead, I found that it was an electrocardiogram recorder. Thinking that I must have bad data, I did a search on all the same model numbers in the system, and guess what? They were all high-repair items. The site manager wanted to increase the PM frequency on the recorders, but I suggested that we look at what the repairs were before making any changes. The most common reported problem was a missing modem cable; with two tie wraps, that problem was solved for less than a nickel. The next most common problem was no power. This was related to a power switch on the rear panel that could be bumped and turned off during normal movement. Why a designer puts two power switches on a device is beyond me, but if I ever find out who did it, I will call them at 3 am just as I have been paged for that problem. The problem was fixed with a switch guard for about $1.00.

My point is that after doing these “fixes,” four more of the same recorders arrived in the hospital. They must have been the last of the production run, because several weeks later we got word that the product was dropped from production. Well, what are a few more dollars in repair cost when the hospital saves 10% on buying units that are out of production? Unfortunately the materials-management people are very good at buying products but do not consider that what they buy will be in use for probably 10 years. The biomed knows what the life costs are but does not get a vote in what is bought. No wonder our costs are so high.

David Harrington is director of staff development and training at Technology in Medicine Inc, Holliston, Mass.