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FDA Discussion Of Duodenoscopes Points To Several Causes For Safety Issues

November 13, 2019Sri Mandava Hospital Management Infection Control Joint Commission Managing Endoscopes Patient Safety Regulatory Compliance

The United States Food and Drug Administration (FDA) recently held a panel discussion to review the causes and possible solutions to safety issues arising from the use of duodenoscopes. Participants in the FDA’s General Hospital and Personal Use Panel of the Medical Devices Advisory Committee discussed how particular aspects of duodenoscopes have led to recent outbreaks of superbugs at certain sites.

The FDA panel covered topics that covered how to improve or replace the high-level disinfection process for duodenoscopes in order to increase patient safety. While participants from both public and private organizations had various ideas for improving safety, they all agreed that there is much to be done to make duodenoscopes safer to use. As this article by Shannon Firth at MedPage Today states:

“Panel chair Frank Lewis Jr., MD, executive director emeritus for the American Board of Surgery, called the lack of adequate worker training and oversight the “dominant factor” behind the problems in reprocessing the scopes. Many of these technicians are low-wage, low-literacy workers who are asked to follow manuals that may include hundreds of steps, and some are bullied into working more quickly.

Guest speaker Cori Ofstead, MSPH, an expert on human factors and quality assurance from St. Paul, Minnesota, said recent surveys of reprocessing professionals from the International Association of Healthcare Central Service Materiel Management, showed that only 36% of technicians did any visible inspection of endoscopes after reprocessing, 17% skipped steps, and 40% reported experiencing or observing bullying on a daily basis.

Panelist Gary Socola, CEO of Highpower Validation Testing & Lab Services in Rochester, New York, noted that only four states in the U.S. require certification for these technicians.

“There’s very good training out there … and people want to learn, we just have to make that possible,” he said.

Because the FDA has no jurisdiction over training, Lewis recommended that the agency work with manufacturers, the Joint Commission, and other relevant agencies (including the Centers for Medicare & Medicaid Services) on strategies for improving training and worker conditions.

…When asked about the use of high-level disinfection versus sterilization, most members felt that high-level disinfection provides an “adequate margin of safety.”

Sterilization offers a higher margin of safety but carries its own challenges. (The advisory committee also provided recommendations to the FDA on Wednesday and Thursday on how to address issues around ethylene oxide sterilization of medical devices.)

Jason Dominitz, MD, a gastroenterologist at the Veterans Health Administration in Seattle, held that requiring sterilization would limit access.

But Isaac Benowitz, MD, a pediatrician and epidemiologist for the CDC, said all the data he’s seen suggest high-level disinfection is “rarely done properly” and urged switching to sterilization.

“We’ve been making incremental changes and improvements in high level disinfection and devices for decades and we’re still here talking about it,” said Benowitz.

…The FDA continues to emphasize that for the “appropriate population,” the benefits of duodenoscopes still outweigh their risks.

While medical device reporting data of infection rates associated with contaminated duodenoscopes have fallen since 2015, reports of contaminated duodenoscopes have risen, according to Haugen’s presentation. The increased contamination rates may be due to improved sampling and culturing by healthcare facilities, she noted.

An analysis of data from 2015 to 2019 in and outside of the U.S. found two death reports, a sharp reduction from the peak of 39 deaths in the fall of 2016, Haugen said. Of the 79 total death reports, 69 occurred in the U.S.

Haugen noted that causality can’t be established with these reports and that adverse event rates are often under-reported.

Interim results of FDA’s mandated postmarket studies reported in July 2019 found that “high concern organisms” were found in about 4-6% of devices.”

Read the entire article here: FDA Panel: Workers a Key Factor in Dirty Duodenoscope Saga

As discussion continue about how to improve the safety of duodenoscopes and other flexible endoscopes, hospitals must ensure that they’re doing everything they can to protect themselves and their patients from harm. The FDA panel rightly points out that a major risk factor of using duodenoscopes stems from issues with reprocessing difficulties and from the staff in charge of reprocessing scopes. Make sure that your staff is following the proper processes and protocols each and every time a duodenoscope is reprocessed. Systems such as iRIScope can display the proper workflow for reprocessing duodenoscopes and document the process electronically. Any breaches of protocol can be discovered in real-time to protect patients and identify which staff members need additional training on reprocessing techniques. You owe it to your staff and your patients to offer everyone the peace of mind that duodenoscopes and all other flexible endoscopes are being properly reprocessed every single time.

How Community Hospitals and ASCs Can Keep Up With Endoscope Documentation Requirements

November 8, 2019Sri Mandava Hospital Management Infection Control Joint Commission Managing Endoscopes Patient Safety Regulatory Compliance

When community hospitals and ambulatory surgery centers (ASCs) are visited by accreditation agencies like The Joint Commission (TJC) or DNV, they are held to the same strict endoscope documentation requirements as academic medical centers. While it may seem unfair for these smaller facilities with access to fewer resources to be held to the same strict requirements as larger academic medical centers, the trend won’t be going away any time soon.

Typically, community hospitals and ASCs have less complex endoscopy operations including:

Fewer endoscopes to manage
Less staff members handling endoscopes
A small number of procedure rooms, even as low as 1

Despite having less complexity, these smaller centers must keep up with documentation requirements around endoscopes, which include electronic recordkeeping of key activities such as high level disinfection in automated endoscope reprocessors (AERs), tracking of scopes to patients and enforcing hang-time thresholds for clean scopes.

So how can community hospitals and ASCs, which have limited resources compared to much bigger academic medical centers, keep up with the stringent documentation requirements for their scopes? One possible solution is to use a modular scope tracking and documentation system like iRIScope. iRIScope allows community hospitals and ASCs take advantage of all the great features of a scope-tracking system designed for the rigors of a busy academic medical center, but at a significantly lower price point.

For community hospitals and ASCs, iRIScope uses data-collection kiosks at key points of the endoscope usage lifecycle to capture important data around steps such as pre-cleaning, leak tests, AER cycles and endoscope check-in and check-out at clean storage. The system will ensure that your staff adheres to a standard process for high-level disinfection (HLD) of scopes by guiding them through your preferred workflow. Most importantly the system meets the high standards for documentation set by TJC, DNV and the other accreditation bureaus by automatically recording key steps in an electronic format. The data is accessible to anyone in the hospital instantaneously via a web interface. Powerful web reports and dashboards will help your hospital provide real-time data to accreditors when they visit, and will also help you understand how to continuously improve operations by tracking where bottlenecks are occurring. Lastly, the system will proactively send out alerts for patient safety. These alerts are automatically sent any time a scope is returned to clean storage without completing all of the requisite HLD steps, or when a scope exceeds its hospital-designated hang-time threshold.

Survey: Health System Profit Margins Up, But Still Below 2015 Levels

November 1, 2019Sri Mandava Cost Reduction Hospital Finance Hospital Management Operational Efficiency Revenue Cycle Supply Chain The Business of Surgery

According to a recent survey, health system operating margins improved in 2018, but still remained significantly below 2015 levels. The analysis, conducted by Navigant, looked at the financial performance of over 100 large health systems that together own 44% of total hospitals in the US.

The survey revealed that the average health system improved its operating margin by 13% in 2018, following an average decline of 38% over the previous two years.. This article by Jacqueline LaPointe at RevCycle Intelligence elaborates:

“The recent improvement in health system operating margins stemmed from better expense control and revenue turnaround, the analysis showed. In 2018, revenue growth exceeded expense growth for the first time in three years, researchers reported, and revenues increased at more than double expenses from 2017 to 2018.

But increases in clinical volume was not behind the revenue turnaround, researchers stressed. In fact, inpatient admissions increased by just one percent in 2018, which was below the rate of population growth, the analysis stated.

Instead, researchers pointed to healthcare merger and acquisition activity.

Fifteen of the health systems analyzed had revenue growth of more than 15 percent while ten experienced revenue growth exceeding 20 percent, the analysis found. Researchers highlighted one system in particular that nearly doubled its revenues by acquiring a large investor-owned nursing home chain.

Other major healthcare mergers and acquisitions, including mergers between UPMC and Pinnacle Health, Advocate Health Care and Aurora Health Care, and Piedmont Healthcare and several Georgia hospitals, also resulted in non-incremental growth in the 2018 fiscal year, researchers reported.

However, smaller health systems performed better from 2015 to 2018 compared to their larger peers with scale, the analysis uncovered.

Health system scale as measured by total patient revenue in 2018 was a negative predictor of operating performance during the four-year period, researchers found. Additionally, smaller health systems experienced greater change in operating profit during the period compared to larger organizations, the analysis stated.

“These findings highlight obvious challenges for systems that have grown through mergers and acquisitions to actually realize the operational synergies they identified in their premerger planning,” Jeff Goldsmith, PhD, analysis lead author and Guidehouse national advisor, explained in the release. “It is taking larger systems longer to achieve claimed synergies from mergers than perhaps their managements realized.”

Healthcare merger and acquisition activity may contribute to both revenue and expense growth depending on the deal. But commercial revenue yield improvement, enhanced revenue cycle management, and EHR optimization also helped health systems improve financial performance from 2017 to 2018, the analysis showed.

In particular, improved revenue cycle management and EHR optimization resulted in health systems prioritizing charge capture, revenue reconciliation, and clinical document improvement, which “has shown to lead to higher quality and increased financial performance, such as reduced insurer claims denials and increased speed of collections,” researchers explained.

Moving forward, health systems should focus on improving operating margins to guarantee future financial success, especially in a value-based and consumer-centric world, researchers stated.

The factors leading to operating margin deterioration from 2015 to 2017 will continue to impact health systems. Those factors include value-based contracts with commercial payers, an increase in publicly funded patients, and increasing claim denial and collection rates from patients with high financial responsibility, researchers explained.

To continue financial performance improvements, researchers advised health systems to:

Control expenses related to labor, supply, and contracted services (e.g., clinical, support services, health IT, finance)

Realize a return on investment on physician employment and clinical IT, including leveraging data analytics to identify and fix clinician resource use variation

Rationalize service lines to decrease programmatic duplication in neighboring hospitals and do away with programs with marginal volumes and/or poor quality

Surveil and manage revenue portfolios and be willing to make continual corrections in expense trends in the face of revenue problems

Go after non-traditional providers, especially in the ambulatory space

“Our analysis reinforces our belief that rigorous control over staffing, improved clinical effectiveness, and better resource use are vitally important to the short- and long-term financial health of hospitals and health systems,” Alex Hunter, analysis co-author and Guidehouse managing director, concluded in the release.”

Read the full article here: Health System Operating Margins Improve, But Still Below 2015 Level

Most hospitals are learning to live in the new value-based care environment in real-time and adjusting on the fly. As the article mentions, hospitals and health systems should be looking to achieve significant savings by eliminating waste while simultaneously improving clinical documentation. One place that hospitals may find immediate opportunities to reduce their costs and improve their revenue is through better management of their implants and supplies, which make up the second biggest component of procedure costs after labor. If your organization lacks the proper tools to provide powerful data around your supply and implant usage, consider systems such as iRISupply which can collect real-time data around supply and implant usage using RFID technology. This real-time data can simultaneously drive revenue improvements by ensuring that clinical documentation is highly accurate, and also reduce costs by driving savings in supply spend. The automatic documentation of supplies and implants used in procedures will dramatically improve clinical documentation accuracy and free up clinicians to spend more time with patients. Powerful data analytics included with the software will give specific recommendations on which items to reduce or eliminate based on historical usage trends, and which items should be owned vs. consigned, leading to millions of dollars in cost-savings opportunities. These opportunities to drive revenue and reduce costs can help hospitals increase their margins and could contribute tens of millions of dollars to the bottom line.

How To Determine When To Sterilize Flexible Endoscopes

October 28, 2019Sri Mandava Hospital Management Infection Control Managing Endoscopes Patient Safety Regulatory Compliance

As the major endoscope manufacturers continue to work with regulators such as The United States Food and Drug Administration (FDA) to improve the safety of their endoscopes, many possible long-term solutions have been raised for discussion. Some thought leaders say that improving current high-level disinfection (HLD) processes will improve safety significantly, while many other experts are advocating for the use of disposable endoscopes or endoscopes with disposable components to increase patient safety. Many others have pushed toward a standard of using sterilization to reprocess endoscopes instead of HLD. While all of these ideas have merit, they have their own pros and cons related to feasibility, cost and convenience.

The challenges of endoscope sterilization are numerous. Many endoscopes aren’t approved for sterilization, for one. Sterilization also can be hazardous to staff due to exposure to the sterilization chemical ethylene oxide. Lastly, sterilization can end up being a more costly process per scope and can present logistical challenges to complete. While not all scopes can currently go through sterilization, hospitals should decide if sterilization does make sense for a subset of their scopes. Scope hygiene expert Lawrence F. Muscarella, PhD has proposed the adoption of a 3 tier classification system for determining which scopes are good candidates for sterilization. As this article by Alison McCook at Gastroenterology & Endoscopy News summarizes:

“Given that sterilizing all scopes is not feasible, Dr. Muscarella said facilities should determine which scopes they are able to sterilize, and those that are most likely to remain contaminated following reprocessing that includes high-level disinfection. The latter group of instruments—which he argued includes duodenoscopes and any other scopes that data show can carry contamination or contain complex moving parts, such as linear-array echoendoscopes—belong in his scheme’s group 1.

Group 2 devices are those that still can transmit dangerous infections but are simpler in design and easier to properly clean, according to Dr. Muscarella, and may include cystoscopes, ureteroscopes, gastroscopes and colonoscopes. These types of tools can be reprocessed using high-level disinfection, although facilities ideally should try to phase in sterilization, he added. Until that time, he recommended adopting one of the FDA’s other supplemental techniques to monitor scope safety, such as repeating high-level disinfection and/or taking cultures to check for contamination.

Group 3 scopes such as hysteroscopes and transthoracic echocardiography probes generally have a low likelihood of transmitting dangerous infections if properly cleaned, and can be reprocessed according to the manufacturers’ instructions. If persistent contamination with bacteria or damage is suspected, however, sterilization or adoption of one of the FDA’s other recommended supplemental measures may be necessary.

Dr. Muscarella said the goal of his protocol is to provide facilities advice they could feasibly follow as they try to increase their use of sterilization. “It seems different scopes are associated with different risks,” he said.

“What I wanted to do was develop a scheme that is more evidence-based; adopts a ramp-up model, rather than requiring an abrupt change in practice; and can be phased in over time without either as much disruption or placing patients at risk.”

Read the entire article here: Which Flexible Scopes Really Need Sterilization?

As evidence continues to mount about the potential dangers of flexible endoscopes such as duodenoscopes, hospitals must ensure that they’re doing everything they can to protect themselves and their patients from harm. Dr. Muscarella rightly points out facilities should consider if it makes sense to move some endoscopes to sterilization for their reprocessing protocol. Whether reprocessing using HLD or sterilization, make sure that your staff is following the proper processes and protocols each and every time an endoscope is reprocessed. Systems such as iRIScope can display the proper workflow for reprocessing scopes such as duodenoscopes and document the process in real-time. Any breaches of protocol can be alerted in real-time to protect patients and identify which staff members need additional training on reprocessing techniques. You owe it to your staff and your patients to offer everyone the peace of mind that your flexible endoscopes are being properly reprocessed every single time.

New Study Puts Price Tag of US Healthcare Waste At Nearly $1 Trillion

October 16, 2019Sri Mandava Cost Reduction Hospital Finance Hospital Management Operational Efficiency Supply Chain The Business of Surgery

A new study published in the Journal of the American Medical Association (JAMA) estimated the annual cost of waste in the US healthcare system between $760 billion to $935 billion. The study, conducted by researchers at Humana and UPMC, looked at 54 published reports that explored the costs of waste in US healthcare.

As this article from Christopher Cheney at HealthLeaders Media summarized:

“They tallied waste in six categories identified in 2010 by the Institute of medicine (IOM): failure of care delivery, failure of care coordination, overtreatment or low-value care, pricing failure, fraud and abuse, and administrative complexity. Pricing failure includes medication pricing, payer-based health services pricing, and laboratory-based and ambulatory pricing.

In 2019, total U.S. healthcare spending is projected at $3.82 trillion.

The JAMA researchers generated several key data points:

Annual wasteful spending on healthcare is estimated from $760 billion to $935 billion.

Interventions to reduce waste in the six IOM categories would result in annual savings from $191 billion to $282 billion.

The annual cost of wasteful spending from administrative complexity accounts for the highest category of waste, estimated at $265.6 billion.

The annual cost of waste from pricing failure is estimated from $230.7 billion to $240.5 billion.

The annual cost of waste from failure of care delivery is estimated from $102.4 billion to $165.7 billion.

The annual cost of waste from overtreatment or low-value care is estimated from $75.7 billion to $101.2 billion.

The annual cost of waste from fraud and abuse is estimated from $58.5 billion to $83.9 billion.

The annual cost of waste from failure of care coordination is estimated from $27.2 billion to $78.2 billion.

The impact of likely interventions to reduce wasteful spending are significant but limited, the researchers wrote.

“The best available evidence about the cost savings of interventions targeting waste, when scaled nationally, account for only approximately 25% of total wasteful spending. These findings highlight the challenges inherent in rapidly changing the course of a health system that accounts for more than $3.8 trillion in annual spending, 17.8% of the nation’s GDP.”

Assessing the data

The highest amount of wasteful spending was associated with the administrative complexity category. The development and adoption of value-based payment models has the most potential to impact this category of wasteful spending, the researchers wrote.

“In value-based models, in particular those in which clinicians take on financial risk for the total cost of care of the populations they serve, many of the administrative tools used by payers to reduce waste (such as prior authorization) can be discontinued or delegated to the clinicians, reducing complexity for clinicians and aligning incentives for them to reduce waste and improve value in their clinical decision-making.”

…An editorial accompanying the new research says the findings are a significant contribution to the ongoing effort to rein in the country’s healthcare spending.

“At a time when the United States is once again mired in a great debate about the future of its healthcare system, the data reported in the article … should become part of the national discussion. It would be nearly impossible for all waste to be eliminated in any healthcare system, just as it is impossible to know the true cost of any change in the delivery and financing of healthcare without understanding possible savings, and recognizing that there is complexity in knowing the savings,” the editorial says.

Concentrating on wasteful spending is crucial, the editorial says. “While no single solution will solve the continuous increases in U.S. healthcare spending, identifying, reducing, and eliminating waste are important and appropriate places to start.”

Download a copy of the article here: Wasteful Spending in U.S. Healthcare Estimated at $760 billion to $935 billion

With so many areas to reduce waste in US healthcare, it’s hard to know where to start. Many hospitals and health systems are starting to achieve significant savings by eliminating waste in their supply chain. Making substantial improvements to supply chain spend requires powerful and accurate data about spending patterns. One place that hospitals may find immediate opportunities for reducing their costs is by better managing their implants and supplies, which make up the second biggest component of procedure costs after labor. If your organization lacks the proper tools to provide powerful data around your supply chain spend, consider systems such as iRISupply which can collect real-time data around supply and implant usage using RFID technology and provide actionable insights to help with vendor negotiations, on-hand inventory levels and owned-consigned item mix. Powerful data analytics included with the software will give specific recommendations on which items to reduce or eliminate, and which items should be owned vs. consigned, leading to millions of dollars in cost-savings opportunities. These cost-savings opportunities can help hospitals increase their margins and provide valuable dollars to the bottom line.

ECRI Top Health Technology Hazards List Includes Poor Sterilization Practices

October 10, 2019Sri Mandava Hospital Management Infection Control Managing Endoscopes Patient Safety

The ECRI Institute, based in Philadelphia, has just released its annual list of health technology hazards for 2020. This year’s list includes an entry at number 3 for poor sterilization practices, echoing prior year concerns about sub-standard disinfection practices for flexible endoscopes.

ECRI’s list is the result of extensive research by its own engineers, scientists and clinicians, as well as investigation into its own problem reporting network. The list considers criteria such as severity, frequency and insidiousness when ranking the hazards. It’s no surprise that sterilization practices came in as number 3 on the list, as reports of safety breaches due to poorly sterilized or disinfected medical equipment continue to occur all around the country. The Executive Brief published by ECRI Institute explains why endoscope reprocessing continues to be such a concern:

“This concern exists in all healthcare settings where patients may come in contact with contaminated items, particularly those intended to enter sterile tissue or the vascular system. However, not all healthcare settings have similar resources for core infection prevention and control (IPC) practices. Settings that may lack the sterilization program resources commonly found in acute care facilities, for example, include medical offices (e.g., OB/GYN, dermatology), dental offices, and similar locations that are not serviced by a central sterile processing department.

During IPC consultations in these settings, ECRI Institute has observed numerous oversights and improper actions associated with sterilization processes. While the prevalence of such failures is unknown, the potential exists for this to be an insidious, widespread patient safety risk.”

Read the entire Executive Brief here: Top 10 Health Technology Hazards for 2020

As the spotlight on reusable medical equipment such as endoscopes and surgical instruments continues to shine, hospitals and ambulatory surgical centers must continue to be vigilant in enforcing the highest standards for sterilization and high-level disinfection. We must make sure that team members are performing the steps of the sterilization or reprocessing cycle consistently and are documenting their findings along the way. If your department wants to automate the workflow and documentation process of the endoscope reprocessing cycle, consider a software system like iRIScope. Systems like these ensure that your staff are performing consistent, repeatable and documented steps during reprocessing. They also minimize manual efforts to document the process by incorporating advanced data collection technologies like RFID directly in to the workflow.

A Scope Tracking Solution That Can Grow With Your Hospital

October 3, 2019Sri Mandava Hospital Management Infection Control Joint Commission Managing Endoscopes Patient Safety Regulatory Compliance

The Joint Commission (TJC), the United States Food & Drug Administration (FDA) and several other regulatory and accreditation agencies have recently put more focus on flexible endoscopes in their guidance to US hospitals and surgery centers. It comes as no surprise, as over the last decade the number of reported outbreaks based on inadequately reprocessed scopes has increased significantly.

To increase their vigilance, many hospitals and surgery centers are evaluating technologies that can help them track their scopes and automate the documentation of key steps along their usage lifecycle. This is being done especially with TJC and other accreditation bureaus in mind, as they have cracked down on lax scope documentation practices in recent years. With several solutions on the market that bring different features to the table, we’ll focus on one particular solution that is unique in its modular design – allowing hospitals to tailor their scope tracking and storage solution to their needs.

There are two primary components of an endoscope documentation system. The first will capture all of the scope transactions that take place at the clean storage area of the scopes. The second will capture the various steps during the high-level disinfection (HLD) process that each hospital would like to track. Combined, these two components give a full picture of the entire endoscope usage lifecycle to ensure high standards of reprocessing compliance, staff accountability and patient safety.

While some smaller hospitals and surgery centers require only limited tracking functionality, other larger hospitals and health systems require a lot more functionality due the complexity of their operations. iRIScope, from Mobile Aspects, approaches the challenge of automating endoscope tracking with a modular system. This modularity allows hospitals and surgery centers to tailor a system that fits their initial requirements, and to also have a system that grows with them as their needs and requirements change.

Smaller hospitals or surgery centers may only desire a scope tracking solution with basic functionality such as tracking scopes to patients and ensuring all scopes go through a standard reprocessing cycle each time. Having this data will be key for when TJC or other inspectors audit the endoscopy practices. With this data in electronic, easily-accessible format, hospitals can provide data in real-time as auditors go through their tracing methodology. iRIScope gathers this data by placing data capturing kiosks at key points along the endoscope usage lifecycle, such as at clean storage and reprocessing areas. Providing a turnkey solution such as this can be a cost-effective way to prepare for electronic data requirements in endoscopy.

A busier environment, such as an academic medical center or a large free-standing endoscopy center, may have different requirements due to the number of scopes under management and round-the-clock operations. With many more scopes to manage and many more employees accessing scopes after hours (when supervision is minimal), centers like these may need more security around their scopes to protect from mismanagement, theft or other unnecessary usage or contact. To solve this unique requirement, iRIScope has optional RFID-enabled scope storage cabinets that can keep an extra eye on scopes in busy centers by automatically associating staff and patients to each endoscope taken. Real-time alerts built into iRIScope also help to prevent scopes from being misplaced or lost during long trips between floors or buildings.

Depending on their infection control requirements, some endoscopy operations may want to enable additional safety features within iRIScope. For example, some centers may want to track their reprocessing protocols beginning in the procedure room by using additional kiosks to capture the time stamp of when the bedside cleaning begins. In situations such as these, iRIScope can be enabled to track this step and any other specific steps during reprocessing that the department considers critical. Some centers may also want to follow high-level disinfection with forced air through endoscope channels as recommended by many agencies. iRIScope allows this module to be added to any or all smart cabinets installed in the department, depending on their specific requirements.

As hospitals and health systems grow, and as endoscope reprocessing and handling standards change, endoscopy managers need a system that will grow with them. With the modular design of iRIScope, endoscopes can now be managed in a way that matches existing workflows and protocols, and can grow and adapt to changing requirements as time passes. This makes sure that any investment in the iRIScope tracking system will be a secure and sound decision.

Why Channel Drying Is So Crucial To Endoscope Infection Control

September 26, 2019Sri Mandava Hospital Management Infection Control Joint Commission Managing Endoscopes Patient Safety Regulatory Compliance

Because endoscopes are reusable medical instruments, one of their biggest risks is the very real possibility of passing diseases to patients through contact with inadequately disinfected scopes. Though the risk of passing diseases through scopes is relatively low, the danger is always there, especially when high-level disinfection (HLD) protocols aren’t closely followed. One area where many healthcare providers fall short is in the drying of endoscopes following HLD.

Several guiding bodies, from the US Food & Drug Administration (FDA) to the Society for Gastroenterology Nurses and Associates (SGNA) have put out guidance stating that endoscopes must be properly dried following HLD before contact with the next patient. While the concept is simple and widely-understood in theory, it is not always adhered to in practice. One of the major reasons is that many busy Endoscopy centers don’t allow enough time from when scopes are unloaded from Automated Endoscope Reprocessors (AERs) to their use in a procedure. In situations like these, not allowing a scope to properly dry internally and externally increases the potential for disease transmission. Additionally, not allowing scopes to hang vertically to allow any moisture to drain properly post-HLD can allow moisture to build up inside the scope.

Though there is some conflicting guidance, many studies have shown that wet or moist endoscopes carry much higher risk of harboring bacteria than dry ones. One such study from Lawrence F. Muscarella, Ph.D. strongly suggests that endoscope drying should take place after every reprocessing cycle due to the threat of transmission of waterborne bacteria in damp endoscopes (Muscarella, L. F. (2006). Inconsistencies in endoscope-reprocessing and infection-control guidelines: The importance of endoscope drying. American Journal of Gastroenterology, 101(9), 2147-2154). Without this crucial step, it has been widely published that moisture build up within an endoscope can lead to extremely higher rates of bacteria growth.

There are systems on the market that can help staff adhere to basic drying procedures such as blowing filtered air through channels and having scopes hang vertically in storage. One such system is iRIScope from Mobile Aspects, which was introduced in the last several years to guide healthcare providers through the proper, society-recommended HLD protocols every single time. With iRIScope, sterile technicians will be guided through the entire HLD process to make sure that any potentially harmful diseases are minimized via proper HLD techniques. The system also includes smart storage cabinets that allow scopes to hang vertically with forced air running through the channels. Built-in technology will even alert your staff if improperly reprocessed scopes are hung in storage, or if it’s time to re-disinfect a scope based on local protocols. With a second pair of eyes on your scopes at all times, you can ensure that patients are kept safe while simultaneously following society and Joint Commission guidelines.

How To Reduce Unnecessary Contact With Endoscopes Using RFID Technology

September 19, 2019Sri Mandava Hospital Management Infection Control Managing Endoscopes Patient Safety Regulatory Compliance

One of the biggest risks of using flexible endoscopes in healthcare stems from the reusable nature of the expensive instruments. Though the risk of passing disease on through endoscopes is relatively low, the danger is always there even when following the instructions for use provided by the manufacturers. The high-level disinfection process for medical endoscopes can still leave some residual bacteria as shown by several recent studies.

Adding to this complication is that there is a lot of time that passes between when endoscopes are high level disinfected and when they are used on patients. During this time, several humans may come into contact with disinfected scopes during normal business operations. Runners transport scopes from sterile processing to the storage areas, techs scan endoscopes in and out of clean storage and nurses pull endoscopes for upcoming procedures and transport them to the lab.

Any human contact with endoscopes increases the possibility of transmission of disease. While many points of contact with endoscopes are unpreventable, healthcare providers must attempt to eliminate physical contact with endoscopes whenever possible to maintain the highest levels of patient safety. One of the easiest places to eliminate human contact with endoscopes relates to the way most hospitals and outpatient centers track scope hang-time limits. Most hospitals approach this challenge by applying paper tags to scopes that list the last date of high-level disinfection for each scope and/or the expiration date for the scope. If endoscopes are checked daily for these expiration dates, each scope may be touched 7 to 30 additional times by an employee (depending on the hang-time limit set by the hospital) before the next use on a patient.

However, there is a way to eliminate these unnecessary touches by using automation technologies. iRIScope from Mobile Aspects was introduced in the last several years to take manual documentation for endoscope management and turn it into electronic records. Using RFID technology, you can now literally have your scopes alert you when they need to be re-washed (and get rid of those pesky paper tags).

The way RFID technology helps automate endoscope management is both simple and highly effective. Attaching medical-grade RFID tags to your endoscopes allows each scope to be tracked electronically as it goes through the HLD process. Because you now have an electronic time stamp of each scope’s most recent wash stored in a database, intelligent analytics built into iRIScope smart cabinets will push endoscope re-wash alerts right to your inbox.

No more log books, no more paper tags – just electronic documentation that makes your department more effective and more efficient. Patient safety and accreditation likelihood will improve because your disinfected scopes are less prone to contamination. All the time staff spends looking at paper tags to see which scopes need to be washed can be turned into time spent on patient care. And all potential for human error in miscalculating the re-wash limits can be eliminated.

How To Use Predictive Analytics In The Hospital Supply Chain

September 12, 2019Sri Mandava Big Data Cost Reduction Hospital Finance Hospital IT Hospital Management Operational Efficiency Supply Chain The Business of Surgery

Many hospitals still rely on manual processes or antiquated technologies for managing their expensive supplies and implants. The concept of predictive analytics and artificial intelligence (AI) in their supply chains may seem like a remote possibility, but this doesn’t necessarily have to be the case.

Advances in hospital supply chain technologies over the last decade have now made it possible for hospitals to realize the benefits of predictive analytics in inventory management. Real-time data gathering technologies, such as RFID-enabled smart cabinets, can help hospitals gather the data needed to harness the incredible power of AI and predictive analytics. As this article by Chris Luoma at Health Data Management explains:

“Properly managing inventory levels is a challenge. In fact, many hospitals still cling to the “more is better” mindset when it comes to supplies. More inventory on hand reduces the risk of running out, ensuring the highest possible care can be delivered to patients at all times. However, excess supply drives up costs and increases waste for those products that expire before use.

Just-in-time (JIT) delivery is one way hospitals combat overstock and waste. Although it requires quite a bit of manpower to execute, JIT delivery is a highly efficient system, well suited for the regular course of business. However, if there is a disruption, such as a natural disaster or flu outbreak, JIT is less efficient and costs can soar.

As more data becomes available through increased levels of automation, supply chain teams can use predictive analytics to better forecast demand. Synthesizing historical and real-time data from multiple systems will enable teams to gain insight into case mixes, anticipate the types of cases that are likely to come through the door, and the supplies required to support those cases.

Moreover, predictive analytics will enable more intelligent, data-informed decisions throughout the entire delivery process. With better planning, a distributor can understand what a provider needs to stock. Manufacturers can use that data to see what needs to be produced, including the raw materials. This will let the industry reduce excess capacity from delivery systems, and ultimately reduce risk.”

Read the entire article here: How predictive analytics will impact the supply chain in the 2020s

In order to better compete in the 2020s, hospitals will have to find ways to reduce waste throughout the system, including within the supply chain. Predictive analytics will bring the promise of increased efficiency and reduced waste to those hospitals and health systems that pursue its benefits. However, a key challenge will be ensuring a reliable, real-time view of all supplies and their usage trends so artificial intelligence can make the proper conclusions. A system like iRISupply marries inventory management software with RFID cabinets to provide a just-in-time system for managing key supplies and implants. This AI-ready software will also arm you with the data you need to make the best re-ordering and stocking decisions possible. iRISupply will not only provide you with the usage data and reports you need, but will take it one step further and provide actionable recommendations about which products are overstocked, understocked or that can even be eliminated altogether. Mobile Aspects supply chain experts will also sit down with you quarterly as part of a best-in-class customer success program to discuss strategies to optimize your inventory mix and review the data behind those suggestions. By closely managing PAR levels and setting up interfaces for automatic re-ordering, the twin problems of stock-outs and bloated inventories can be successfully and sustainably eliminated.

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