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Are Your Endoscopes Being Reprocessed Too Slowly? How to Use Data to Speed Things Up

July 2, 2019Sri Mandava Cost Reduction Hospital Finance Hospital Management Infection Control Managing Endoscopes Operational Efficiency

With all the protocols that endoscope techs and sterile processing staff must follow to properly high level disinfect every scope, flexible endoscopes can disappear into a black hole when they are needed most – only to pop up again when it is too late. There are several contributors to this inefficiency: long waiting periods in between staff hand-offs, excessive travel time to shuttle scopes from patient rooms to sterile processing and back, and then a time-consuming process to actually reprocess endoscopes. When all is said and done, a busy facility may take 6 to 10 hours or more to reprocess a single scope.

If Endoscopy or PeriOp is allowing delays to happen in the reprocessing cycle, they are risking patient safety and department profitability. If scopes are not turned around fast enough for use in the next procedure, patients may have to wait for scopes to become available before their procedure can begin. This introduces unnecessary patient risks into the department. The business risks of an inefficient reprocessing cycle are delayed or canceled cases. These often-avoidable situations result in financial harm to the department. Some hospitals may try to cover up for reprocessing inefficiencies by inflating the number of scopes that they own, which leads to its own financial issues.

With so many moving parts, it can be a virtual nightmare to sit down and analyze the bottlenecks that are creating these long reprocessing times. There’s the time to get the scope from the bedside to sterile processing, the time to get from sterile processing through the entire reprocessing cycle, and then the time to return a scope to clean storage. There are multiple runners transporting scopes around and multiple techs involved in the reprocessing process. So how can hospitals get their reprocessing times down from 6-10 hours to a more reasonable 3-4 hours, doubling throughput for their expensive scopes?

Managers must constantly monitor accurate and verifiable data to make sure that any bottlenecks in the reprocessing cycle are identified and systematically eliminated. Slow moving employees must be identified to make sure that the good performers are rewarded while the slower performers are given the opportunity to improve. Without this data, bottlenecks are likely to persist because benchmarks cannot be set, and measurements of performance cannot be adequately tracked.

However, obtaining the proper data to analyze the roadblocks to an efficient process has proven to be quite a challenge. This is where scope tracking systems, such as iRIScope from Mobile Aspects, can help deliver the necessary data. These systems manage the tracking and usage of an entire endoscope inventory, and include analyses of scope reprocessing efficiency based on timestamps automatically gathered by the system. Data can be reviewed and targets can be set and tracked to drive improvements to the scope reprocessing cycle. iRIScope also helps track down missing scopes by recording a real-time chain of custody, so missing scopes can be identified and tracked down immediately. iRIScope will also help manage all of the usage, reprocessing and repair details of your entire scope inventory, and will offer up actionable analytics on how to improve the management of your expensive scopes. Finally, built in patient safety features also minimize the risk from adverse health events caused by inadequately reprocessed scopes. Put these together and you can minimize the amount of time required to reprocess an endoscope while maintaining the highest reprocessing standards possible and safeguarding your patients.

Are Stock Outs Giving You Headaches? How To Eliminate Them With Supply Automation Software

June 27, 2019Sri Mandava Cath Lab Cost Reduction Hospital Finance Hospital Management Operating Rooms Operational Efficiency Patient Safety Radiology Supply Chain The Business of Surgery Tissue Management

With many hospitals still relying on manual processes or antiquated technologies for managing their expensive supplies and implants, they are facing a multitude of consequences that are affecting their ability to provide safe and efficient healthcare. Some of the consequences of inadequate supply management techniques include using expired implants, gross overstocking of supplies, poor revenue reimbursement and frequent stock-outs.

Stock-outs of important supplies tend to have cascading negative effects on hospital procedural areas. Some of the results of stock-outs include:

Delayed or canceled procedures as replacement items are located or ordered
Negatively impacted patient safety from using suboptimal supplies or implants
Increased costs due to same-day or rush deliveries for replacement items

With all of these negative consequences associated with stock-outs, what can hospitals do? Most of the time, stock-outs occur due to inaccurate inventory levels. Inaccurate inventory levels begin to occur a few days or weeks after inventory reconciliations for hospitals take place using manual or other inadequate inventory management technologies. Because not every transaction is captured due to human error, negligence or shrinkage, what the system believes is on hand and what is actually on hand begin to drift apart. During these periods, as actual and documented inventory levels differ, there tend to be stock-outs on one hand and overstocked inventory on the other.

The foremost way to drastically reduce or even eliminate stock-outs is by implementing an advanced sensing technology such as RFID for keeping a perpetually accurate count of items on hand. With RFID cabinet systems, such as iRISupply from Mobile Aspects, eyeballing inventory to calculate re-order levels and inventory reconciliations become a thing of the past. The RFID technology replaces all antiquated inventory management systems with a real-time inventory count that can be as accurate as 99% ˗ which is 15% higher than typical experiences with manually intensive systems such as bar-codes, push-buttons or eyeballing. With this technology in place, on-hand inventory counts become much more accurate, making stock-outs less frequent as a result.

The second key ingredient to reducing or eliminating stock-outs is a powerful software system with built-in data analytics for robust inventory management. A system like iRISupply marries inventory management software with RFID cabinets to provide a complete system for managing key supplies and implants. This software will 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 or 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, stock-outs can be successfully and sustainably eliminated.

The Problem With Broken Endoscopes And How To Avoid Them

June 20, 2019Sri Mandava Cost Reduction Hospital Finance Hospital Management Infection Control Managing Endoscopes Patient Safety

Flexible endoscopes can cost a hospital a lot of money – and cost patients valuable time – when going through avoidable repairs. Repairing flexible endoscopes often requires expensive maintenance from third-party organizations, delayed or canceled cases due to unusable scopes and procurement of expensive loaner scopes to handle the required workload. Spending time and effort to avoid these costs is an important part of running an efficient and profitable endoscopy operation.

Typically, hospitals view endoscope downtime as an unavoidable reality in running an endoscopy practice. However, this doesn’t have to be so. As this article by Kate O’Rourke at Gastroenterology & Endoscopy News discusses:

“Roughly 85% of endoscope repairs are avoidable,” said Louis Mariani, an endoscope service expert at Olympus. The distal end is the most fragile part of the endoscope, accounting for nearly 45% of all endoscope damage. The distal end houses a protective cover, charge-coupled device, camera, light guide lenses, and nozzle for air and water.

“Damage to any of these components can cause image issues, light issues, and even harbor patient debris,” Mr. Mariani said. “A broken lens cover or nozzle entering a patient can be a very serious concern, because patient debris can be lodged into a break or breach of material.” A lint-free cloth is key for cleaning endoscopes; gauze should never be used to wipe the distal end, which can potentially cause lint to enter the instrument, he said.

The main cause of damage to the distal end is impact, with the floor or peripheral equipment. “Impact can occur during transport, inspection or maintenance, and can have serious consequences,” said Eric Smith, an Olympus endoscope support specialist. The air/water nozzle has a small opening that flushes water and air over the objective lens, and this can be deformed or slightly serrated by impact.

… Minimizing fluid invasion, which accounts for nearly 25% of endoscope damage, can save a facility thousands of dollars. To prevent this type of damage, users should perform a leak test by submerging the entire endoscope in water. “Once the scope is submerged, you want to rotate both the knobs, so you are going to go up, down, left and right, to ensure the bending section isn’t leaking,” Mr. Mariani said. “Most leaks occur in the flexible section of the scope’s distal end.”

…Insertion tube damage accounts for 10% of endoscope damage and manifests as buckles, dents and lacerations. Improperly positioning the scope can easily cause the insertion tube to buckle. “We live by the ‘see something, say something’ rule,” Mr. Mariani said. “If you see anyone putting unnecessary pressure on the insertion tube, speak up in a kind manner and explain what can happen when the insertion tube is compromised.”

…Damage to the biopsy channel accounts for another 10% of endoscope damage. This channel is surrounded by other channels, fibers and cables, so any direct damage or puncture can damage the surrounding components. “Imagine if an open forceps was retracted through the biopsy channel. You can see how that could cause some serious damage,” Mr. Mariani said. Small punctures in the channel show up during a leak test as tiny bubbles that can be missed, and scrapes and scratches in the channel pose many challenges to cleaning.

…Proper storage is key to keeping endoscopes functional. Endoscopes should hang freely in a closed, well-ventilated storage cabinet to avoid damage and facilitate drying. Cabinets should have a HEPA filter, support the endoscope control body, allow the distal end to hang freely, avoid crowding, and provide a place to store accessories or supplies. “If you don’t have one, make sure a written policy and procedure for cleaning cabinets is developed,” Mr. Smith said.

Roughly 8% of repairs fall into the other category and include chemical damage, which can be prevented by following the manufacturer’s instructions for removing chemical residue. Applying too much pressure or misaligning an endoscope when connecting it to a light source also can cause damage.

…Taking a few extra precautions in handling reprocessing, transport and storage of endoscopes can help facilities reduce repair expenditures while maximizing scope uptime. “Endoscopes are complicated instruments with complex parts and components,” Mr. Mariani said. “It is so important to routinely inspect your endoscopes for damage and functionality.”

Read the full article here: Avoiding the Broken Endoscope Blues

In order to reduce downtime with your endoscopes, you must first have access to data about your endoscope repair history and who is handling and damaging your scopes. Endoscope tracking systems such as iRIScope from Mobile Aspects track all transactions in the endoscope usage lifecycle including all incidences of repair. With this data, you can closely examine the causes of all of your endoscope repairs and trace back damages to individuals within the organization. You will be able to identify techs and physicians who need to be re-trained on how to properly handle scopes in a way that minimizes damage to delicate parts like the distal tip or the channels. You will even be able to use the data to understand which scopes are being used most often and those that are being underutilized. With this data, you can plan to balance the load on each of your scopes so that the same few scopes aren’t being used over and over again, reducing the need for costly repairs. Having access to the data and using it reduce the incidence of endoscope repairs can mean a much more efficient and profitable practice and happier patients.

Survey: Hospital CFOs Planning To Focus On Cost Reductions In 2020

June 13, 2019Sri Mandava Cost Reduction Hospital Finance Hospital Management Operational Efficiency The Business of Surgery

According to a recent survey, a vast majority of hospital financial leaders agreed that focusing on cost reductions will be one of their main priorities in 2020. The same survey also revealed that hospital CFOs and other financial leaders need to bulk up their investment in data analytics and management dashboards.

The survey, conducted by Black Book, included responses from nearly 1,600 hospital and health system Chief Financial Officers, Vice Presidents of Finance and other finance leaders to spot trends about organizational priorities for the upcoming year. The company’s press release noted:

“62% of survey respondents say advanced analytics is the most needed skill set to be developed in the financial ranks of health systems in 2019-2020. 95% of CFOs agree that the CFO of the future will require a much more robust data analytics skill set than 2019 CFOs.

91% of CFOs surveyed state their top priorities for 2020 will be managing cost reductions followed by 85% needing to predict the impact of new payment models through enhanced reporting.

76% of all financial leaders from supervisor through CFO levels report needing better performance management dashboards as overall satisfaction with current technology and reporting systems is less than 9%.

92% of survey respondents believe the CFO of the future must be a better job leveraging technology and staff with IT skills for health providers to succeed financially.

As health systems CFOs steam ahead toward digital transformational technology, 83% believe the finance function must provide more advanced analytic support that most current decision support and cost accounting vendors have offered, particularly those attached to enterprise EHRs.

“Financial leaders will need to recruit and retain staff who possess traditional financial expertise, flexibility in adopting new payment models, willingness to accept nontraditional responsibilities such as cybersecurity, patient satisfaction and innovation, but most importantly the eagerness to learn new technologies and process designs,” said Brown. “The technological complexities of transforming financial systems and business integrations across health system units may well hasten the retirement of many old-guard CFOs from the industry.”

In 2020, all respondents concluded the most highly sought leadership skillsets that health system CEOs and boards will see in their financial team executives are:

Technology Acquisition and Implementation (89%)

Data Analytics (85%)

Financial Business Strategy (82%)

Financial Operations Administration Through Technologies (81%)

“To assess whether the digital transformation is having an impact on the health system, the C-Suite needs a strategy that is more transformational and less incremental, thus the evolving role of the CFO taking more technological control is inevitable,” said Brown. “The degree of transformation required to achieve the results of value-based centric provider to align with financial business strategies and digital initiatives is the task at hand for the future CFO.”

Read the full article here: Black Book Charts a Future Course for the Healthcare CFO

Most hospitals are learning to live in the new value-based care environment in real-time and adjusting on the fly. Many hospitals and health systems are looking to achieve significant savings by eliminating waste in their supply chain. As the article mentions, making substantial reductions in organizational spend requires powerful and accurate data about expenses and comprehensive data analytics capabilities. 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 could contribute tens of millions of dollars to the bottom line.

How Technology Can Help Your Hospital Reach High Compliance Rates In Endoscope Reprocessing

May 30, 2019Sri Mandava Hospital Management Infection Control Managing Endoscopes Patient Safety Regulatory Compliance

Over the last decade, incidences of outbreaks from infections that can be attributed to poorly disinfected endoscopes have been showing up in the news regularly. So much so that regulatory bodies from the US Congress to the FDA have been increasing their scrutiny of these extremely useful, yet sometimes problematic reusable medical instruments.

Many different groups have taken on the mantle to help hospitals learn from each other to institute best practices for effective reprocessing of endoscopes. One such group recently presented their findings at the Global Surgical Conference & Expo 2019. Presenters Daniel Fedderson, BSN, RN, MAJ, AN and Kenneth Romito, MSN, RN, MAJ, AN explained how they have taken their perioperative team to a 96%+ compliance rate for reprocessing. Their article in The Periop Life captured the main takeaways of their presentation:

“The intricate design of flexible endoscopes and multiple steps required for cleaning and high-level disinfection (HLD) make the process vulnerable to human error.

As perioperative nurses, we know that missing just one step or failure to complete any phase in endoscope reprocessing can result in patient exposure to harmful contaminants that can lead to infections, increased hospital stays, increased medical costs, and even death.

Auditing the Process

We recommended applying an evidence-based approach to improving standardization around reprocessing flexible endoscopes within our organization, and implemented audits conducted at three-month intervals with feedback to stakeholders to establish a standardized approach.

These four practices were key to effectively and successfully implement the audits:

Use an audit quality feedback loop administered at regular intervals consistently over time.

Measure clinical practice against well-established standards and/or evidence-based practice.

Incorporate a multidisciplinary approach with an established leader or facilitator to conduct and analyze the audits.

Assess leadership, education, training, and competency in addition to clinical practices as part of the auditing process.

Achieving Compliance

Robust leadership buy-in proved invaluable in implementing these audit best-practices by driving the changes in clinical performance and standardization of policies and equipment. However, building a structure around auditing best practices for safe endoscope reprocessing was a first step. Next, we needed a way to address ongoing process compliance.

To achieve buy-in among every team member, we focused on establishing a culture supporting the Highly Reliable Organization (HRO) goals of quality, safety, and continuous process improvement around endoscope reprocessing.

Three specific principles of high reliability in particular made the difference:

Preoccupation with failure—To prevent process failures, each audit focused on quality loop iteration, diminishing gaps between observed practices, evidence-based practice recommendations by professional organizations, and manufacturer IFUs.

Deference to expertise—By applying the HRO principle of deference to expertise, we established a task force with subject matter experts empowered to transform HLD practices within the framework of our evidence-based audit process.

Commitment to resilience—The HLD task force became a fully chartered HLD committee with a full-time employee hired as committee chair to support the organization’s commitment to the HRO goals of quality, safety, and continuous process improvement related to HLD.

These efforts continue to prove successful. After our fourth audit of established processes in September 2018, which included 65 steps across five clinics, our team achieved a 96.9% compliance rate. Today the work of the HLD task force continues, as do our measured successes in safer endoscope reprocessing.”

Read the entire article here: Achieving High Reliability in Flexible Endoscope High-Level Disinfection

As the article notes, an effective way to improve endoscope disinfection efficacy is to introduce strong standards and perform occasional audits to make sure employees are following protocols closely. But what happens when no one is watching? Do you trust that all of your employees, when no one is looking over their shoulder, will reprocess scopes properly and never skip any steps? Most facilities still have staff go through their HLD routines based on memorization, but recent technology products have been introduced in recent years to ensure staff follow the same process each and every time – even when no one is watching.

One such product is iRIScope from Mobile Aspects. The way that iRIScope and other systems like it work is to walk staff through the HLD process for each scope in a workflow that matches the hospital’s existing standard operating procedures. By using a combination of RFID technology and touchscreen kiosks, staff are guided through the HLD process and are required to log all steps as completed before they can move on to the next step. If a step is missed, a reminder to complete that step is displayed and the missed step is logged in the system. This ensures that no scopes are missing any of the key steps in the HLD process. It also allows managers to properly train their employees by highlighting the employees that are most prone to skipping steps. Using this data helps managers train up their staff efficiently based on analytics coming out of the system, rather than observations noticed only during audits.

Why Hospitals Need To Re-Evaluate Their Supply Chain Automation Efforts

May 22, 2019Sri Mandava Cost Reduction Hospital Finance Hospital Management Operational Efficiency Supply Chain The Business of Surgery

Over the last decade, hospitals have made a varying amount of investments into their supply chains to drive costs out of their organizations. While many hospitals have been at the forefront of moving to automation technologies such as RFID and bar-coding, many other hospitals still rely on pen and paper-based manual processes to run their supply chain operations. In today’s healthcare environment, where margins are under constant attack from multiple fronts, hospitals must re-evaluate their supply chain automation efforts as one way to drive out costs.

Supply expenses have now surpassed labor expenses as the top cost for healthcare facilities. As the US healthcare market continues to evolve, there are several factors that are putting pressure on hospitals to take a fresh look at how they are making their supply chains more efficient. As this article by Cory Turner at Health Data Management explains:

“According to the National Academy of Medicine, the U.S. healthcare system has “squandered” an estimated $765 billion annually – this includes products that went expired on shelves. With this cost continuing to rise and going to waste, healthcare organizations can no longer overlook new technologies to solve outdated practices.

Numerous shifts, including both advancements in technology and the industry landscape, have changed the healthcare supply chain exponentially:

With better understanding and exchange of data between clinical and operating systems, organizations are able to enhance coordination and structure. Though this, hospital systems can allow data to provide availability on specific supplies to enhance a practitioner’s efficiency and effectiveness. This convenience ultimately creates a more consistent and enhanced standard of care for patients.

Mergers and acquisitions. The healthcare industry is vastly changing and with an increase of mergers and acquisitions, organizations need to have a stronger buying and operational power to fully integrate their supply chain processes. This requires new software to meet the demand across several different departments, regions, and specialties to create a standardized system of supplies.

Changing communications for job retention. High nurse turnover greatly impacts healthcare facilities, personnel and the patient experience. To manage recruitment, organizations are updating current job descriptions, taking out technical tasks such as collecting supplies and instead, giving them to aids or technicians.

Automated processing solution. By replacing manual processes with automation, healthcare practitioners can streamline tasks for the betterment of the patient. For example, when a physician orders specific products or equipment, the request for the required supplies are sent to the supply center or the warehouse, and smart technologies able to manage and deliver the necessary equipment to the operating or patient room.

Data-driven physicians. Successful supply chain management involves physicians in the decision-making process. And with data analytics, physicians can gather advanced insights to select the appropriate tools and medications that are cost effective for better patient outcomes. This allows physicians to make informed decisions on supply options and encourage them to be more involved in the supply chain recommendations for care.

Advanced solutions in supply chain management are transforming today’s hospitals and healthcare systems. With a customer-centric supply chain system, healthcare practitioners can dramatically and accurately save time, resources, and enhance its ecosystem for the betterment of patients.

Without the use of AI [artificial intelligence], ML [machine learning] and data analytics, hospitals would be challenged by outdated systems that strain their overall infrastructure. It is ease of use, automation, and analysis that provides supply chain managers with free time to strategically enhance systems and generate new opportunities for growth.

Qualities of a modern supply chain include the following characteristics.

Focused on the patient. An interconnected supply chain network can provide facilities with complete visibility, from point of original down to delivery to the patient. Hospitals can then appropriately manage supplies and waste, including disposables syringes, trauma kits and crash carts. This allows staff to maintain orderly by having the right supplies in the right facility and avoid delays caused by lack of supplies and preparation.

Tied to outcomes. With a modern supply chain network, patient care and outcomes are tracked by supplies and procedures to ensure proper treatment, based on historical success rate. With the addition of AI, ML, and augmented analytics, supply chain systems are able to provide predictions, analysis and solutions that are driven by data science.

Consistently up-to-date. With emergent patients and unpredictable outcomes, it is especially important to have a global network that can provide updates on commerce and flow of resources as they move through live control points from the warehouse to operating room or patient room. With IoT-driven sensors, real-time updates can be communicated to all disparate parties, when appropriate.

Prepared and predictive. Advanced technologies allow the network to monitor the state of supplies from purchasing, delivery, physician use, and restock. It can help calculate if supplies will be delivered on time and maintain the stock level to avoid waste and risk. When the possibility of risk occurs, supply chain teams are flagged the concern for further intervention.

Productive and independent. Not only will the supply chain use experience to understand patterns and draw from different data sets to create a holistic view of the network, it will also the same technology to course-correct issues when needed. This self-sufficiency will allow for physicians and healthcare executives to focus on more important issues that require a dynamic perspective, rather than constantly having to monitor the supply chain.

Healthcare facilities should start to view the supply chain as key area for improvement when looking to update organization-wide processes. With advanced technology, data and inventory can be tracked and used to predict future needs, best practices can be prescribed, and executives can focus on more valued-added, patient-facing activities.

While largely in the background of everyday duties, small but mighty changes in the supply chain network will make vast improvements in the day-to-day, advancing patient and healthcare outcomes overall.”

Read the full article here: How tech can improve supply chain performance for providers

Many hospitals and health systems are looking to achieve significant savings by eliminating waste in their supply chain. As the article mentions, driving out waste from the supply chain requires high quality, real-time data. 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. The system is also completely interoperable with Epic, Cerner and other EMR vendors, helping to drive powerful insights by looking across your clinical systems. These cost-savings opportunities can help hospitals increase their margins and could contribute tens of millions of dollars to their bottom line.

Government Continues Probe Into Manufacturers of Contaminated Duodenoscopes

May 16, 2019Sri Mandava Hospital Management Infection Control Managing Endoscopes Patient Safety Regulatory Compliance

The US Government is continuing its scrutiny of Olympus and the other major endoscope manufacturers following several reports of infections related to duodenoscopes in recent years. The latest chapter includes a letter written by a US Senator asking for additional information regarding duodenoscope investigations.

Sen. Patty Murray (D-WA) wrote a letter to the three major duodenoscope manufacturers requesting additional information about what the companies are doing to mitigate the existing dangers posed by their equipment. As this article by Ana Mulero in Regulatory Focus continues:

“I am writing today to understand how your company plans to respond to these troubling findings and what changes may be necessary going forward to ensure patient safety,” Murray said. She referred to the preliminary results of the postmarket surveillance studies that the US Food and Drug Administration (FDA) imposed as requirements on all three manufacturers—Olympus, Pentax and Fujifilm—marketing duodenoscopes in the US market.

FDA’s update last month on the mandated studies reported rates of contamination that were even higher than those reported as of March 2018. Culturing results showed up to 5.4% of properly collected samples testing positive for high-concern organisms such as E. coli as of March, according to FDA. The new preliminary results marked a 3% spike in the contamination rate versus 2018 for such organisms.

The results, which remain preliminary as they are based on a portion of FDA-mandated samples, came after FDA sent warning letters to the duodenoscope manufacturers over inadequate study progress. At the time, Olympus spokesperson Mark Miller told Focus that the firm “takes this matter very seriously.”

The progress on human factors studies, required for postmarket surveillance, are now marked as adequate for each of the three duodenoscope manufacturers. But each sampling and culturing study remains in a noncompliant status. FDA also observed an uptick in the total number of medical device reports (MDRs) on patient infections and device contamination after the agency had reported an observed “steady decline.” The agency said last month that it had received 205 MDRs between 15 October 2018 through 31 March after declining to less than 100 MDRs in 2017.

Final results on the sampling and culturing studies are expected this year, FDA reported last December.

Murray recognized “important steps have been taken to reduce outbreaks.” But “it is unacceptable that one in 20 patients who undergo a procedure using a duodenoscope may acquire an infection as a result of that procedure—even when hospitals have followed cleaning instructions properly.” Murray made note of a 2016 report issued to highlight challenges in identifying and responding to such safety issues.

The letter gives the firms until 23 May to respond to seven questions. Questions range from the firms’ projected timeline for completing both postmarket surveillance studies to whether the firms have plans for device redesigns.

“I remain concerned about the risk of infection posed by these devices and committed to ensuring rigorous oversight of the safety of Olympus medical devices,” said Murray of each of the duodenoscope makers.”

Read the entire article here: Updated: Murray Questions Devicemakers on Contaminated Duodenoscopes

As evidence continues to mount about the potential dangers of duodenoscopes, hospitals must ensure that they’re doing everything they can to protect themselves and their patients from harm. Sen. Murray rightly points out that even by following proper reprocessing techniques, duodenoscopes can still show infection rates of over 5%. To minimize risk, 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 automatically. 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 duodenoscopes and all other flexible endoscopes are being properly reprocessed every single time.

Are You Reprocessing Endoscopes Efficiently?

May 9, 2019Sri Mandava Cost Reduction Hospital Management Infection Control Managing Endoscopes Operating Rooms Operational Efficiency

In today’s environment, Endoscopy and PeriOperative departments need to be very careful to follow their endoscope reprocessing protocols extremely closely. With all the reports of superbug outbreaks due to the inadequate disinfection of scopes, it is the primary job of sterile processing (or whichever department oversees reprocessing scopes) to provide safe endoscopes to use on patients.

On the business side of the equation, Endoscopy and PeriOperative departments must also ensure that their operations are run smoothly and efficiently. A big part of that job is to make sure that endoscopes are reprocessed efficiently so that the turnaround times between endoscope usages are minimized. The endoscope reprocessing cycle can be broken down into 3 main components:

Time to get from bedside to the sterile processing department (SPD): In this step it is critical to make sure that endoscopes are quickly cleaned at the bedside after each procedure and returned to SPD. Communication protocols must be established that allow for the efficient return of scopes to SPD.
Time to go through the entire reprocessing cycle: Once an endoscope reaches SPD, staff must make sure to efficiently put each scope through the entire reprocessing cycle. Any scopes that spend too much time in any part of the reprocessing cycle (such as the sink clean or AER cycle) can create a snowball of delays – much like small delays at an airport leading to big delays later in the day due to the cascading effects of traffic. Staff must be trained to be vigilant in moving scopes from one step to the next, and not letting them linger too long in one area.
Time to get from reprocessing to clean storage: The final step of endoscope reprocessing is returning the disinfected scope to clean storage. In this step, it is purely good communication and clear protocols that will ensure that scopes don’t get held up between SPD and the endoscope storage area.

If a department experiences delays in any or several of these steps, inefficiencies are sure to occur. Managers must constantly monitor this data to make sure that any bottlenecks in the reprocessing cycle are identified and systematically eliminated.

If Endoscopy or PeriOp is allowing delays to happen in the reprocessing cycle, they are risking patient safety and department profitability. If scopes are not turned around fast enough for use in the next procedure, patients may have to wait for scopes to become available before their procedure can begin. This introduces unnecessary patient risks into the department. The business risks of an inefficient reprocessing cycle are delayed or canceled cases. These often avoidable situations result in financial harm to the department. Some hospitals may try to cover up for reprocessing inefficiencies by inflating the number of scopes that they own, which leads to its own financial issues.

To keep your scope reprocessing cycles running efficiently, you need to have access to accurate data that breaks down how long each step of the reprocessing cycle takes. With that data in hand, bottlenecks can be identified, and targets can be set to systematically reduce the bottlenecks until they are eliminated. Slow moving employees can also be identified to make sure that they good performers are rewarded while the slower performers are given the opportunity to improve. Without this data, bottlenecks are likely to persist because benchmarks cannot be set, and measurement of performance cannot adequately be tracked.

Scope reprocessing efficiency data has the potential to bring massive productivity gains to your Endoscopy or PeriOperative department. Academic medical centers and large health systems especially require this data due to the sheer number of scopes they must reprocess and the large areas their scopes travel across. Scope tracking systems, such as iRIScope from Mobile Aspects, help manage the tracking and usage of an entire endoscope inventory, and include analyses of scope reprocessing efficiency based on timestamps automatically gathered by the system. Data can be reviewed and targets can be set and tracked to drive improvements to the scope reprocessing cycle. iRIScope also helps track down missing scopes by recording a real-time chain of custody, so missing scopes can be identified and tracked down immediately. iRIScope will also help manage all of the usage, reprocessing and repair details of your entire scope inventory, and will offer up actionable analytics on how to improve the management of your expensive scopes. Built in patient safety features also minimize the risk from adverse health events caused by inadequately reprocessed scopes.

Nearly Half Million Dollars In Endoscopes Stolen From Pennsylvania Hospital

May 1, 2019Sri Mandava Hospital Finance Hospital Management Managing Endoscopes

During a recent weekend shift, nearly a half million dollars’ worth of colonoscopes were stolen from a hospital outside of Philadelphia. 3 thieves were suspected of walking out of Lankenau Medical Center with the equipment in broad daylight.

This is not the first time this has happened with flexible endoscopes. In 2017, over $1 million dollars in endoscopes and related equipment were stolen from Toronto Western Hospital, among other similar thefts. In both the Toronto Western Hospital and Lankenau Medical Center thefts, the equipment was stolen during the weekend, when hospital activity is considerably lower. As this article from Philly.com explains:

“Police are searching for three people who walked into Lankenau Medical Center in Wynnewood over the weekend and stole 18 colonoscopy devices worth a combined $450,000.

“What we’re finding out is that there’s a black market available for them,” Lower Merion Police Superintendent Michael J. McGrath said Thursday.

The theft happened between 3 and 5 p.m. Saturday, police said, after a newer-model Jeep Wrangler dropped off two of the three suspects at the front of the Lancaster Avenue hospital. They made their way to a “secured area,” police said.

“They appeared to know precisely where to go, and they pried the door open,” McGrath said.

Surveillance video shows the suspects walking out of the hospital carrying three bulging backpacks. The theft was reported to police two days later, about 7:20 a.m.”

Read the entire article here: Three steal 18 colonoscopes worth $450K from Lankenau Medical Center, police say

The issue, which has been experienced before by many hospitals in the US, continues to highlight the need for hospitals to increase security on their fleet of endoscopes that are often valued in excess of $1 million. Additionally, the Joint Commission checks to make sure that flexible endoscopes are routinely locked in cabinets during their inspections. With both of these forces requiring them to focus on security, hospitals can use regular roll-top endoscope cabinets, or turn to higher-security endoscopy cabinets for flexible scopes such as iRIScope from Mobile Aspects. These higher-security options include RFID technology and secure badge access to ensure that only people that should be touching their expensive scopes are able to do so. They also provide many other tracking and security features including missing scope alerts and patient safety alerts.

Track Tissue From Dock To Patient With This Automation Technology

April 24, 2019Sri Mandava Clinical Documentation Hospital Management Joint Commission Operating Rooms Regulatory Compliance The Business of Surgery Tissue Management

Many Perioperative departments have told us that their recent visits by The Joint Commission (TJC) included a more in-depth review of their tissue implant logs. A number of Perioperative administrators and nurses agreed that during their last visit from TJC they wanted to see a higher level of documentation when it comes to tracking tissue and related specimens within the hospital.

One requirement that multiple nurses have said was under additional scrutiny was the ability to track tissue starting at the receiving dock of the hospital. Traditionally, hospitals have begun tracking their tissue starting at the receiving department within Periop. However, TJC is starting to look for detailed documentation of tissue receipt and packaging details starting at the hospital dock. Given that hospitals have historically started tracking tissue upon receipt in the department, they now must adjust their processes to meet this new standard.

The main challenge with beginning tissue log records at the receiving dock is that shipping department employees are often limited in their time and tissue data is not their primary focus. Because of this, getting shipping department employees at the dock to begin the extremely detailed tissue log with their limited time has proven to be a challenge Hospitals using paper tissue logs are especially at risk of poor practices due to the requirement of paper records traveling from the dock to the Periop department in a reliable manner. Hospitals need to graduate from paper logs in an effort to document the many details required to keep an accurate and compliant tissue log

One possible solution to this emerging problem is iRISecure from Mobile Aspects. iRISecure takes advantage of patented RFID-based workflows to minimize any data input requirements from staff and to make sure that compliance is a no-brainer. To solve the problem of having shipping employees enter critical information at the dock, iRISecure includes a simple computer interface to create a record of tissue receipt that then travels electronically with the tissue until it is used on a patient. The tissue inventory manager then associates the remaining product information to an RFID tag affixed to the tissue. From there, iRISecure ensures that all tissue transactions are recorded and traced to the correct patients without any manual data entry from nurses or techs. When TJC comes and requests to see your tissue logs, they are brought up at the touch of a button and quickly satisfy the TJC auditors – as our customers have recently attested.

In addition, iRISecure is a full inventory management system that helps tissue managers run lean tissue operations using real-time data and analytics coming out of the system. iRISecure can recommend the ideal stocking levels for inventory based on actual usage data coming out of the system. The system can also simplify the expiration tracking process by delivering expiration warnings straight to your inbox. The savings from running a leaner tissue practice can pay for the system (and then some).

If your operating room administrator or tissue manager is worried about the quality of their tissue documentation, iRISecure is definitely worth a look. The best-of-breed technology separates itself from the pack by making TJC compliance for tissue documentation as simple as possible using RFID technology. Manual data entry at the dock and in Periop and countless hours spent searching for missing data will be a thing of the past, and reporting and data analytics coming out of the software will help you continuously improve your tissue operations.

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