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Hospitals Still Struggle To Combat Infectious Bacteria In Their Scopes

April 25, 2018Sri Mandava Hospital Management Infection Control Joint Commission Managing Endoscopes Patient Safety

Recent research has once again shined the spotlight on the struggle hospitals face to rid their reusable medical endoscopes of dangerous bacteria. In this particular study, published in the American Journal of Infection Control, 71% of “patient-ready” scopes at 3 major US hospitals tested positive for bacteria.

The study found problems in various types of endoscopes used for colonoscopies, lung procedures, kidney stone removal and other routine operations. As this article by Chad Terhune at Kaiser Health News elaborates:

“Researchers said the findings at the hospitals, which weren’t named, confirm earlier work showing that these issues aren’t simply confined to duodenoscopes, gastrointestinal devices tied to at least 35 deaths in the U.S. since 2013, including three at UCLA’s Ronald Reagan Medical Center. Scope-related infections also were reported in 2015 at Cedars-Sinai Medical Center in Los Angeles and Pasadena’s Huntington Hospital.

The bacteria this latest study found weren’t superbugs, but researchers said there were potential pathogens that would put patients at high risk of infection. The study didn’t track whether the patients became sick from possible exposure.

The study’s authors said the intricate design of many endoscopes continues to hinder effective cleaning and those problems are compounded when healthcare workers skip steps or ignore basic protocols in a rush to get scopes ready for the next patient. The study identified issues with colonoscopes, bronchoscopes, ureteroscopes and gastroscopes, among others.

“Sadly, in the 10 years since we’ve been looking into the quality of endoscope reprocessing, we haven’t seen improvement in the field,” said Cori Ofstead, the study’s lead author and an epidemiologist in St. Paul, Minn., referring to how the devices are prepared for reuse.

“If anything, the situation is worse because more people are having these minimally invasive procedures and physicians are doing more complicated procedures with endoscopes that, frankly, are not even clean,” Ofstead said.

The rise of antibiotic-resistant superbugs such as CRE (carbapenem-resistant Enterobacteriaceae), which can be fatal in up to half of patients, has made addressing these problems more urgent. About 2 million Americans are sickened by drug-resistant bacteria each year and 23,000 die, according to the federal Centers for Disease Control and Prevention.

“We’re not moving fast enough to a safer world of reusable medical devices,” said Michael Drues, an industry consultant in Grafton, Mass., who advises device companies and regulators. “There is plenty of fault to go around on device companies, hospitals, clinicians, on basically everybody.”

Despite the potential risks, medical experts caution patients not to cancel or postpone lifesaving procedures involving endoscopes. These snake-like devices often spare patients from the complications of more invasive surgeries.

“Patients should speak to their provider and think about the risks versus the benefits,” said Haas, who is also director of epidemiology at Lenox Hill Hospital in New York City.

The Food and Drug Administration and Olympus Corp., a leading endoscope manufacturer in the U.S. and worldwide, both said they were reviewing the study.

Last month, the FDA issued warning letters to Olympus and two other scope makers for failing to conduct real-world studies on whether healthcare facilities can effectively clean and disinfect their duodenoscopes. The FDA ordered the manufacturers to conduct those reviews in 2015 after several scope-related outbreaks in Los Angeles, Seattle and Chicago made national headlines.

Olympus spokesman Mark Miller said the Tokyo-based company intends to “meet the milestones set forth by the FDA…Patient safety has always been and remains our highest priority.”

The latest study examined 45 endoscopes, with all but two manufactured by Olympus. The other two were Karl Storz models.

Last year, researchers visited three hospitals and performed visual examinations and tests to detect fluid and contamination on reusable endoscopes marked ready for use on patients. One hospital met the current guidelines for cleaning and disinfecting scopes, while the other two committed numerous breaches in protocol.

Nevertheless, 62% of the disinfected scopes at the top-performing hospital tested positive for bacteria, including potential pathogens. It was even worse at the other two — 85% and 92%.

The study painted a troubling picture at the two lower-performing hospitals, which were well aware researchers were watching.

Among the safety issues: Hospital technicians wore the same gloves for handling soiled scopes fresh after a procedure and later, when they were disinfected and employees wiped down scopes with reused towels. Storage cabinets for scopes were visibly dirty and dripping wet scopes were hung up to dry, which is a known risk because bacteria thrive on the moisture left inside. The two hospitals also turned off a cleaning cycle on a commonly used “washing machine,” known as an automated endoscope reprocessor, to save time.

“It was very disturbing to find such improper practices in big health systems, especially since these institutions were accredited and we assumed that meant everything would have been done properly,” said Ofstead, chief executive of the medical research firm Ofstead & Associates.

Ofstead and her coauthors recommended moving faster toward sterilization of all medical scopes using gas or chemicals. That would be a step above the current requirements for high-level disinfection, which involves manual scrubbing and automated washing. A shift to sterilization would likely require significant changes in equipment design and major investments by hospitals and clinics.

In their current form, many endoscopes aren’t built to withstand repeated sterilization. Some also have long, narrow channels where blood, tissue and other debris can get trapped inside.

In some cases, disposable, single-use scopes are an option, and new products are starting to gain acceptance. In other instances, certain parts of a scope might be disposable or removable to aid cleaning.

The Joint Commission, which accredits many U.S. hospitals and surgery centers, issued a safety alert last year about disinfection and sterilization of medical devices in response to a growing rate of noncompliance. In 2016, the Joint Commission cited 60% of accredited hospitals for noncompliance, and 74% of all “immediate threat to life” citations from surveyors related to improperly sterilized or disinfected equipment.

Michelle Alfa, a professor in the department of medical microbiology at the University of Manitoba, said accreditors may need to conduct more frequent inspections and endoscopy labs should be shut down “if they don’t get their act together. These results are totally unacceptable.””

Read the entire article here: Hospitals and device makers still struggle to rid medical scopes of infectious bacteria

The infection risk with endoscopes across all the major scope manufacturers continues to be an issue for hospitals. Hospitals must continue to be vigilant in their use of endoscopes and must ensure processes are followed strictly to minimize infection risk. Where strong processes are missing, hospitals must work to ensure the proper people and systems are in place to upgrade processes to the highest standards. Software systems such as iRIScope have been introduced in recent years to help hospitals ensure that each of their flexible endoscopes is reprocessed the proper way each time, and documentation of their reprocessing is kept electronically using advanced RFID technology.

How Supply Price Inaccuracies Can Affect The Bottom Line

April 18, 2018Sri Mandava Big Data Cost Reduction Hospital Finance Hospital IT Hospital Management Operational Efficiency Supply Chain The Business of Surgery

Due to the nature of how hospitals and health systems acquire supplies, product prices are constantly changing. Different hospitals in the same health system, and even different departments within the same hospital, may be paying different rates for the same items, and those prices are typically in flux.

With supply chains and individual departments within hospitals tasked with the goal of stripping out waste and inefficiency from their operations, inaccurate product prices can be a thorn in their sides. This article by Peter Nelson at Health Data Management looks deeper into how pricing inaccuracies can negatively affect a hospital’s operations:

“A simple human error such as failing to update a price change on a distributor website can create confusion and errors, and ultimately lead to delays in completing transactions. Price discrepancies are also expensive, costing healthcare providers alone in excess of $92 million annually to process these exceptions.

This price accuracy situation is in diametrical opposition to the supply chain’s opportunity to strip waste and inefficiency out of the system so the industry can remain focused on providing outstanding levels of patient care.

Price accuracy is one of the most labor-intensive and error-prone issues healthcare organizations face. Every player in the healthcare supply chain believes its pricing data represents the truth, but too often, these prices exist in silos. While pricing data from a manufacturer or distributor may reflect a product’s current price, it may not take into consideration a healthcare system’s negotiated contract or specific discounts available.

In fact, contract price misalignment is a root cause of many price discrepancy issues. For instance, the majority of hospitals purchase supplies from a distributor. Distributors, in turn, receive pricing information from manufacturers. If a healthcare organization negotiates a purchasing contract directly with a manufacturer, that pricing information typically takes 45 to 60 days to be updated and reflected in the distributor’s pricing.

Too many organizations have managed this complex pricing process with outdated manual approaches like fax and email—that’s a sure-fire recipe for miscommunication and delays in contract activations. This results in contracting staff spending hours trying to determine contract start dates and whether a specific organization is entitled to a certain price on a certain date.

Multiply that by hundreds of thousands of pages of pricing data, and it’s easy to see the scale of the inefficiencies at the heart of healthcare price accuracy.

While there’s no magic genie coming to the rescue to solve the price discrepancy issue, the power of technology is increasingly driving collaboration among a trusted community of manufacturers, distributors, group purchasing organizations and hospitals to enable these trading partners to spot price discrepancy issues early in the purchase order process.

Even better, an automated supply chain will know how pricing changes impact specific healthcare organizations based on its buying contracts and can alert those providers in advance of any price changes taking effect, so it can make purchase decisions accordingly.”

Read the entire article here: How improved supply price accuracy can save money

Without the right systems and processes for price accuracy in place, hospitals will continue to struggle with the downsides of inaccurate supply prices. Technology and automation may hold the key to better price transparency and accuracy for hospitals looking for a solution for this tricky problem. Best practices to eliminate this issue include implementing software like iRISupply, which can provide a source of truth for all information related to implants and supplies in the procedural areas of a hospital. This system can provide a bridge between materials management, billing and electronic medical record software to coordinate pricing information across disparate systems.

Supply Stock-Outs Have An Outsized Effect On The Bottom Line

April 3, 2018Sri Mandava Cath Lab Cost Reduction Hospital Finance Hospital Management Operating Rooms Operational Efficiency Patient Safety Radiology The Business of Surgery

A recent survey conducted by Cardinal Health showed that 40% of hospital staff have cancelled a case due to an out-of-stock supply, and 69% of staff have had to delay a case while a missing supply is being tracked down. Having spoken to hundreds of staff in operating rooms, cath labs and interventional radiology labs, we have similarly heard many clinicians complain about manual inventory processes leading to supply stock-outs and causing major headaches including cancelled or delayed cases. The survey also revealed that 23% of staff have seen or heard of a patient that was harmed due to a lack of supplies, a sad finding that makes the financial complications of missing supplies pale in contrast.

Having stock-outs occur just a few times a week could be costing your hospital dearly. With each minute of delayed OR time costing between $20-$80 depending on case complexity, a relatively busy OR in a 250-bed hospital could be experiencing losses of $25,000-$50,000 annually just from the cost of delayed cases due to missing supplies. Cancelled cases due to out-of-stock supplies could be costing that same hospital multiple times that amount due to the costs of re-scheduling and the potential of losing a cancelled case to another facility.

In addition to the costs of the missing supplies, manual inventory processes also lead to complications with expired inventory. The Cardinal Health survey showed that 27% of staff have seen or heard of expired product being used on a patient due to poor inventory control practices. This comes as no surprise, as we have witnessed the usage of expired inventory at hospitals first-hand. Without the proper processes and vigilance to prevent these “never events” from happening, this will continue to be a risk for hospitals.

Read the entire article here: Survey Finds 40 Percent of Health Care Providers Have Canceled Surgical Cases Due to Lack of Supplies

Without the right systems and processes for supply and implant management in place, hospitals will continue to put their business and their patients’ safety on the line. Most hospital employees have witnessed or heard of delayed or cancelled cases from missing inventory and many have also heard of patient safety issues due poor inventory controls. Best practices to eliminate this risk include implementing systems like iRISupply, which provide all the requisite controls, reports and alerts to allow hospitals to minimize out-of-stock events to prevent delayed or cancelled cases and related patient safety issues without putting additional work on their staff.

Duodenoscope Surveillance Protocols Released By FDA and CDC

March 28, 2018Sri Mandava Infection Control Managing Endoscopes Patient Safety Regulatory Compliance

The U.S. Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDC) and American Society for Microbiology (ASM), along with other endoscope culturing experts, recently announced the availability of voluntary, standardized protocols that were developed for duodenoscope surveillance sampling and culturing.

As noted by the FDA:

“Hospitals and health care facilities that utilize duodenoscopes can, in addition to meticulously following manufacturer reprocessing instructions, take these additional steps to further reduce the risk of infection and increase the safety of these medical devices. These protocols are an update to the Interim Duodenoscope Surveillance Protocol released by CDC in March 2015.

Duodenoscopes are flexible, lighted tubes that are used to treat patients undergoing endoscopic retrograde cholangiopancreatography (ECRP). These procedures often are life-saving and are the least invasive way of draining fluids from pancreatic and biliary ducts blocked by cancerous tumors, gallstones or other conditions. More than 500,000 ERCPs are performed each year in the United States. Duodenoscopes undergo a multi-step cleaning and high-level disinfection procedure called reprocessing so that they can be reused between patients. However, the complex design of duodenoscopes makes it difficult to remove contaminants compared to other types of endoscopes. If not thoroughly cleaned and disinfected, tissue or fluid from one patient can remain in a duodenoscope when it is used on a subsequent patient. In rare cases, this can lead to patient-to-patient infection.

Microbiological sampling and culturing of duodenoscopes involves sampling duodenoscope channels as well as the distal end of the endoscope and then culturing those samples with the goal of detecting bacterial contamination that may be present on the duodenoscope after reprocessing.”

Read the full guidelines here: Duodenoscope Surveillance Sampling & Culturing

The infection risk with duodenoscopes across all the major scope manufacturers continues to be an issue for hospitals. Hospitals must continue to be vigilant in their use of duodeonscopes and must ensure processes are followed strictly to minimize infection risk. Where strong processes are missing, hospitals must work to ensure the proper people and systems are in place to upgrade processes to the highest standards. Software systems such as iRIScope have been introduced in recent years to help hospitals ensure that each of their flexible endoscopes is reprocessed the proper way each time, and documentation of their reprocessing is kept electronically using advanced RFID technology.

Accreditation Firms Like Joint Commission Receive Further Scrutiny From Congress

March 22, 2018Sri Mandava Hospital Management Infection Control Managing Endoscopes Patient Safety Regulatory Compliance

Following the publication of a Wall Street Journal article last year, hospital accreditation organizations have received unwanted attention from the US Government. Members of the House Energy and Commerce Committee have requested additional information from the Centers for Medicare & Medicaid Services (CMS) and 4 major hospital accreditation organizations regarding their processes.

Concerned with CMS’ oversight of the accreditation organizations, the members of the committee and have asked the various organizations to provide documentation surrounding the accreditation process for hospitals by March 23. As this article by Maria Castellucci at Modern Healthcare notes:

“The committee wrote in the letters that it is “concerned about the adequacy of CMS’ oversight” of accreditation organizations and the rigor of their survey processes. In addition to the WSJ article, the committee pointed to a 2015 congressional report that found accreditation organizations missed 39% of condition level deficiencies at hospitals that were subsequently reported by state survey agencies in validation surveys.

About 90% of U.S. hospitals—or 3,500—are accredited by private organizations. The WSJ investigation found that the Joint Commission, which accredits about 80% of U.S. hospitals, rarely pulls its accreditation. In 2014, the Joint Commission revoked accreditation for just 1% of facilities in 2014.

The committee has asked the organizations to provide copies of hospital applications for Medicare accreditation; copies of performance reviews, survey feedback, corrective action plans and responses to those plans; and any correspondence with the CMS.

In addition to the CMS and the Joint Commission, the letters were sent to the Bureau of Healthcare Facilities Accreditation, the Center for Improvement in Healthcare Quality and DNV GL Healthcare.

The Joint Commission plans to respond to the committee’s request, said Kim McCullough, the commission’s associate director of communications, in an email. The probe “is an opportunity to share more on the work we do to improve healthcare quality and patient safety by facilitating high reliability,” she added.

In an interview with Modern Healthcare in December, Joint Commission CEO Dr. Mark Chassin said the organization views denial of accreditation as a “failure.” The commission prefers to work with hospitals to help them improve on deficiencies.

The CMS, which is charged with overseeing the accreditation organizations and the state survey agencies, has been asked to provide copies of the most recent contracts with state survey agencies that detail responsibilities for the healthcare providers to comply with certification; any correspondence between state surveyor agencies and accreditation organizations; and copies of any complaints the CMS has received since fiscal 2012 that allege patient harm or misconduct in acute-care hospitals as well as actions the CMS took in response.

A CMS spokesman said in an email Tuesday afternoon that the agency will review and respond to the committee’s requests.

The letters were sent by Reps. Greg Walden (R-Ore.), Gregg Harper (R-Miss.) and Michael Burgess (R-Texas). The organizations and the CMS have until March 23 to respond.”

Read the entire article here: House committee probes CMS, Joint Commission over accreditation process

One possible result of this congressional probe may be that hospital inspection reports will be made public in order to give additional information to consumers regarding their choice of healthcare providers. Is your hospital ready for your inspection reports to be made public? To prepare, hospitals have to make sure that they are following all of their detailed processes all of the time. Any breakdown in your processes would be made public via an inspection report, putting your hospital’s reputation and finances at risk. Consider automation tools that help track the processes that The Joint Commission and other accreditation agencies focus on during their inspections. Systems such as iRIScope have been developed to ensure that processes and protocols are being followed since your managers can’t watch over every step of the way.

FDA Issues Warning To Duodenscope Manufacturers

March 13, 2018Sri Mandava Infection Control Managing Endoscopes Patient Safety Regulatory Compliance

Last week, the U.S. Food and Drug Administration (FDA) sent a warning to all three major duodenoscope manufacturers. The warnings were sent due to the failure of Olympus, Pentax and Fujifilm to comply with postmarket surveillance study requirements set with them by the FDA in 2015.

During the FDA’s investigation of duodenoscope-related infections in 2015, they required the 3 major duodenoscope manufacturers to determine whether healthcare facilities were able to properly clean and disinfect the devices. The postmarket studies included two parts – a study to sample and culture reprocessed duodenoscopes that are in clinical use to learn more about issues that contribute to contamination, and a human factors study to assess how well trained hospital staff are following the reprocessing instructions.

This release put out by the FDA explains the progress of each of the manufacturers to date and their requirements for the manufacturers going forward:

“To date, Olympus has failed to commence data collection, and Pentax and Fujifilm have failed to provide sufficient data, as required for their respective studies to sample and culture reprocessed duodenoscopes that are in clinical use. Olympus and Pentax also have not complied with requirements for their respective human factors studies to assess how well hospital staff are following reprocessing instructions; Fujifilm has been meeting its requirements for its human factors study.

“The FDA has taken important steps to improve the reprocessing of duodenoscopes, and we’ve seen a reduction in reports of patient infections, but we need the required postmarket studies to determine whether these measures are being properly implemented in real world clinical settings and whether we need to take additional action to further improve the safety of these devices,” said Jeff Shuren, M.D., director of the FDA’s Center for Devices and Radiological Health. “We expect these device manufacturers to meet their study obligations to ensure patient safety.”

Duodenoscopes are flexible, lighted tubes that are threaded through the mouth, throat and stomach into the top of the small intestine (duodenum) and are used during endoscopic retrograde cholangiopancreatography, a potentially life-saving procedure to diagnose and treat problems in the pancreas and bile ducts. In 2013, the FDA learned about a potential association between multi-drug resistant bacteria and duodenoscopes. Upon further investigation, it became clear that these cases of infection were occurring despite confirmation that device users were following proper manufacturer cleaning and disinfection or sterilization instructions.

Since then, the FDA has worked with all three duodenoscope manufacturers that market duodenoscopes in the U.S. to review validated processing instructions and to take corrective actions to remove and replace models from the market with faulty designs that made them difficult to clean and reprocess. On February 26, 2018, the FDA, Centers for Disease Control and Prevention (CDC), and the American Society for Microbiology (ASM), together with other endoscope culturing experts, released voluntary standardized protocols for duodenoscope surveillance sampling and culturing. For healthcare facilities that choose to implement duodenoscope surveillance sampling and culturing, these protocols can be used to help monitor the quality of a facility’s endoscope reprocessing procedures. Adequate monitoring may reduce the risk of infection.

FDA expects that Olympus, Fujifilm and Pentax will submit a plan by March 24, 2018 that outlines how study milestones will be achieved. For the sampling and culturing study, the FDA expects 50 percent of samples collected in the study to be processed by August 31, 2018 and 100 percent by the end of 2018. For Olympus’s and Pentax’s human factors studies, the agency expects 50 percent of testing to be completed by May 31, 2018 and 100 percent by June 30, 2018. If the companies fail to adequately respond to the warning letter, the FDA may take additional action such as seizure, injunction and civil money penalties.

The FDA continues to work with manufacturers and other stakeholders to improve the safety of duodenoscopes and other reusable medical devices to help protect patients from bacterial infections associated with these medical devices.”

Read the entire notice here: FDA warns duodenoscope manufacturers about failure to comply with required postmarket surveillance studies to assess contamination risk

Disappointed With The ROI From Your EHR Investment? You’re Not Alone

February 26, 2018Sri Mandava Big Data Clinical Documentation Cost Reduction Hospital Finance Hospital IT Hospital Management Operational Efficiency Revenue Cycle The Business of Surgery

Yet another study has been published showing the disappointing return on investment that hospitals are experiencing with their electronic health record (EHR) implementations. The new study, published in the Journal of the American Medical Association (JAMA), showed that the costs of administering billing and insurance-related functions may actually have increased following EHR roll-outs.

This is a blow to many hospitals that were lead to believe that their EHR implementation would lead to efficiencies and cost-savings on many fronts, including the billing function. However, as this article by Greg Slabodkin at Health Data Management discusses:

“Electronic health records were expected to reduce administrative costs for providers, but a study of a large academic healthcare system with a certified EHR system reveals that the estimated costs of billing and insurance-related activities were substantial and varied depending on the type of clinical encounter.

Researchers from Duke University and Harvard Business School estimated the billing and insurance-related costs for five types of patient encounters—primary care visits, discharged emergency department visits, general medicine inpatient stays, ambulatory surgical procedures, as well as inpatient surgical procedures.

According to the results of their study published February 20 in the Journal of the American Medical Association, the estimated costs of billing and insurance-related activities ranged from about $20 for a primary care visit to approximately $215 for an inpatient surgical procedure—representing 3 percent to 25 percent of professional revenue.

“For primary care visits, this translated to an estimated more than $99,000 of billing and insurance-related expenses annually for each primary care physician working in the system just to get paid,” states a separate editorial accompanying the JAMA study.

Overall, estimated processing time and total costs for billing and insurance-related activities were:

13 minutes and $20.49 for a primary care visit.

32 minutes and $61.54 for a discharged emergency department visit.

73 minutes and $124.26 for a general inpatient stay.

75 minutes and $170.40 for an ambulatory surgical procedure.

100 minutes and $215.10 for an inpatient surgical procedure.

As a result, the JAMA editorial concludes: the study “suggests that, if anything, administrative time needed for billing has increased for physicians and other staff as EHRs have become more widespread.”

“We keep hearing about electronic health records and how they are supposed to improve the efficiency of hospital administration,” says study co-author Barak Richman of the Duke University School of Law and the Duke-Margolis Center for Health Policy. “We found that, as a general percentage of revenue, the amount expended on billing and administrative costs is just as high as it was before EHRs were adopted. Some people thought that EHRs were going to be the solution—and, they’re not.”

Read the entire article here: EHRs fall short in reducing administrative costs

As more evidence comes to light that EHRs are not the cost-savings systems that many hospitals once thought they would be, hospital administrators must find other ways to increase the value of their EHR deployments. EHRs are not going away any time soon due to the wealth of data they create and store, so other avenues should be explored to derive more value from them. One way to do this is to eliminate tasks that can be made redundant by EHRs. For example, natural language processing tools can help turn transcription data into notes that need to be only verified instead of typed in from scratch. Additionally, automated data capture systems, such as iRISupply, can provide high quality data by integrating RFID data capture technology directly into your EHR, eliminating the need to have clinicians re-enter supply and implant information into the EHR during hectic procedures.

The Key To Figuring Out Your Cost Per Case

February 21, 2018Sri Mandava Big Data Cath Lab Clinical Documentation Cost Reduction Hospital Finance Hospital IT Hospital Management Operating Rooms Operational Efficiency Radiology Revenue Cycle Supply Chain The Business of Surgery

Historically, the cost of a surgical procedure has been a difficult equation to solve. As the US healthcare system moves more and more toward a value-based system, hospitals require now more than ever an accurate understanding of their procedure costs. These accurate procedure costs then need to be compared to outcomes in order to perform key analyses such as: which surgeons have the best/worst outcomes relative to cost; which procedures have the best/worst outcomes relative to cost; which surgical supplies have the best/worst outcomes relative to cost; how is my hospital performing in cost per case vs. my peers, etc.

The main components that need to be gathered to calculate the cost of any case include: labor costs, overhead costs and supply costs. The first two items are typically easy to calculate because the formulas for overhead costs and labor costs are well-understood by financial experts in hospitals. Multiplying these factors by the duration of a case will give an accurate depiction of a case’s overhead and labor costs. However, as this article by Peter Nelson at Health Data Management explains, supply costs can be a little tricky to calculate:

“More often than not, bedside and procedural documentation for supplies remains a time-consuming, largely manual process.

It’s not uncommon for a clinician to add a product by name or even scan a product barcode only to discover the system doesn’t recognize the data. The clinician then must find the information and manually enter the data into the EHR, an occurrence that takes place about 50 percent of the time.

Not only is this inefficient, but it’s also error prone. Clinicians often use their own terms to identify a product. The result is incorrect, incomplete or missing information that makes it nearly impossible for supply chain and revenue cycle teams to accurately identify every product involved in a procedure.

This has implications for reimbursement, not to mention the wasted clinical time spent in the EHR find[ing] supply data versus providing more valuable patient care.

If the industry wants to accurately account for the products used in the course of care, prepare for recalls and capture a greater percentage of case charges, it must ensure the systems supporting every aspect of care are connected and able to share timely and accurate data.

…Data is the lynchpin to understanding the total cost of care. The industry must do everything possible to maximize existing investments in EHR, ERP and supply chain systems to ensure that clean, accurate data can be accessed and shared across these systems to help improve efficiency and enhance patient care.”

Read the entire article here: How healthcare can solve supply cost confusion

As hospitals look to accurately calculate their cost per case, the system that they are using for supply and implant documentation becomes critical. They must have a supply management system that integrates with their EHR and materials management systems. These integrated systems, sharing a single item master, will allow data to flow seamlessly throughout the various information systems regarding supply spend. As the article mentions, this is the critical component for accurately calculating cost per case. If your current supply and implant documentation system is falling short, consider a system such as iRISupply that integrates with your EHR and materials management systems to send verified and accurate supply and implant usage data between the 3 systems. For many hospitals, this is the missing piece to mastering cost per case and value-based outcome measurement.

Pentax Issues Recall of Some of Its Duodenoscopes

February 15, 2018Sri Mandava Infection Control Managing Endoscopes Patient Safety Regulatory Compliance

Pentax Medical recently issued an urgent recall of one of its duodenoscope models. Pentax is informing customers of its voluntary recall of all ED-3490TK duodenoscopes. As part of the recall, Pentax aims to replace the forceps elevator mechanism, O-ring seal and distal end cap. There will also be an update issued to the Operation Manual that recommends annual maintenance. Ultimately, Pentax hopes to reduce the potential for leakage of patient fluids into the closed elevator channel and under the distal cap. The US Food and Drug Administration (FDA) cleared the updated design and labeling for the ED-3490TK on February 7, 2018. Per the FDA, the reprocessing instructions for the duodenoscope model have not changed since the February 2016 update.

As this article by Elaine Silvestrini at Drugwatch further explains:

“The scopes are used in endoscopic procedures, and models by several companies have posed problems for cleaning between procedures. Doctors use the scopes to place small cameras inside patients and perform minimally invasive surgeries and tests. They can be used for things like gallstones, pancreatitis and draining bile ducts.

Design Makes Scopes Hard to Clean

Their complicated design may make it difficult to thoroughly clean and sterilize them of patient fluids and organisms between procedures.

Scopes made by Olympus have been implicated in a superbug outbreak, and scopes made by Fujifilm have been removed from the market altogether.

The latest Pentax recall involves the ED-3490TK duodenoscope, which has been linked to risk of spreading bacterial infections.

Last year, Pentax reported that the scope involved in the newest recall had design flaws that could lead to infection in patients. The cleaning instructions for the scopes had previously been updated in February 2016.”

Read the entire notice here: Pentax Issues Urgent Recall of Duodenoscopes for Bug Fixes

How To Set And Track Hang-Time Limits For Flexible Endoscopes

February 7, 2018Sri Mandava Hospital Management Infection Control Joint Commission Managing Endoscopes Operating Rooms Operational Efficiency Patient Safety Regulatory Compliance

Hang-time limits for flexible endoscopes have been a hot topic among GI, Infection Control and Sterile Processing professionals for the last several years. With no consensus emerging in hang-time limits (sometimes called an endoscope’s shelf life), hospitals are left to make this decision on their own. With different stakeholders within the hospital looking at different guidelines, such as those from SGNA or AAMI, conflicting data may be reviewed before making a decision. Furthermore, since there is no consensus, some hospitals have taken a conservative view of the research and set very low limits, while other hospitals have pointed to the lack of conclusive research and have set higher limits.

How Different Oversight Bodies Have Set Their Guidelines

Many major industry and research groups have recently published their best practices for flexible endoscope reprocessing. A lot of attention has been placed on the subject over the past few years due to the spike in reports of endoscope-related infection risks at US hospitals. In an effort to help hospitals standardize and improve upon their endoscope reprocessing protocols, several groups have published their guidelines including:

Centers for Disease Control and Prevention (CDC)
American Society for Gastrointestinal Endoscopy (ASGE)
Society of Gastroenterology Nurses and Associates (SGNA)
Association for the Advancement of Medical Instrumentation (AAMI)
Association of periOperative Registered Nurses (AORN)

While these different societies have come to similar conclusions about best practices relating to endoscope reprocessing, finding consensus when it comes to hang-time limits has been elusive. The reason is that the various research papers that have been published on the subject point to differing, though not necessarily conflicting, data points. Some recent studies point out that there is no significant risk of contamination after 5 days of hanging in storage, while others point to no significant risk after 7 to 14 days.

Per ASGE’s comprehensive flexible endoscope guideline published in 2011, “although reuse within 10 to 14 days appears to be safe, the data are insufficient to provide a maximal duration for use of appropriately cleaned, reprocessed, dried and stored flexible endoscopes…In the interest of utmost caution, AORN and the Association for Professionals in Infection Control and Epidemiology espouse maximal storage intervals without reprocessing of 5 and 7 days, respectively.”

How Other Hospitals Have Set Their Hang-Time Limits

As part of our industry research, we have talked to hundreds of hospitals and ambulatory centers about where they have set their hang-time limits. By far, the most common limit we have seen is 7 days (nearly 90% of hospitals sampled). Though 7 days seems to be the most common, we have heard other hospitals using the following limits in this order: 5 days (nearly 10%), 14/15 days (less than 5%) and 30 days (less than 2%).

We have also heard some hospitals that have not set a limit because they believe they have such high usage rates of their scopes that they never sit in storage for more than a couple of days before they are used again in a procedure. We do not recommend this practice for 2 reasons. First is that since the hospital is not actively monitoring their hang-time limits, they don’t have any actual data showing how long each scope is in storage between each use. They are using anecdotal data to make decisions rather than making evidence-based decisions. Second, they are making decisions based on the current state of their endoscopy practice. However, their scope usage rates will change over time as their number of scopes increases, their physicians turnover, procedure volume increases or decreases, procedure types go in or out of favor, etc. You have to start measuring this vital statistic, set a reasonable limit and monitor it in order to ensure the long-term health of your practice and patients.

How Hospitals Monitor Their Hang-Time Limits

Nearly 95% of the hospitals that we have talked to indicate that they use paper tags to track their hang-time limits. This method requires paper or plastic tags to be placed on each scope immediately after reprocessing that shows either the last date of reprocessing or the date at which the hang-time limit will elapse. While having a system in place is better than no system, this particular process has several drawbacks:

It’s inefficient: When using physical tags to track the hang-time limit of each scope, the burden is on clinical staff or techs to check each tag daily to see which scopes are approaching their limit. When you’re tracking dozens or hundreds of scopes in a particular hospital, the amount of time spent rounding each area to check all the scope tags can add up to several hours per week. This is time that could be better spent on patient care.
It’s not sterile: The minute you attach a tag to a reprocessed scope, you are putting a non-sterile object on your high-level disinfected or sterilized scope. Whenever someone checks a tag, they put their hands on the tag, and that tag in turn touches your scope. Whatever germs that were on the employee’s hand may have transferred on to the reprocessed scope, adding a non-sterile element into the equation.
Surveyors don’t like it: We have heard stories about surveyors from agencies like The Joint Commission who have had issues with these manual methods of tracking endoscope hang time. They point to 2 main reasons why these methods are sub-optimal: a) they require a paper trail, while many surveyors prefer electronic logs and b) they introduce a potentially non-sterile component to your HLD endoscopes.

There’s a Better Way: Automation

Systems such as iRIScope from Mobile Aspects have been introduced in the last several years to take manual documentation for endoscope management and turn them into electronic records. Using RFID technology, you can now literally have your scopes alert you when they need to be reprocessed.

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 reprocessing stored in a database, intelligent analytics built into iRIScope will push endoscope reprocessing 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. All the time staff spends looking at paper tags to see which scopes need to be washed is now turned into time spent on patient care. And patient safety and accreditation likelihood have improved because your disinfected scopes are less prone to contamination.

To get more information on how iRIScope can automate your scope management processes, visit Mobile Aspects website and schedule a demo.