Each year, Novant Health’s Clinical Equipment Management Program (CEMP) sets goals intended to take the in-house clinical engineering program to ever higher levels of service. The group’s goal for 2010 was to incorporate flexible endoscope and surgical instrument repair into the CEMP service realm. Achieving this goal would allow Novant—a healthcare system based in Winston-Salem, NC, that comprises more than a dozen hospitals—to centralize and track repairs across the system while eliminating the need for expensive, long-term service contracts with the original equipment manufacturer.

By 2011, CEMP had begun a phased rollout of its scope repair and instrument sharpening program to the various facilities in the system. By the end of 2012, the program was saving the system $900,000 a year—a figure that was matched in 2013.

This opportunity for centralization and savings evolved as Novant Health grew over the years, acquiring new hospitals. The various facilities in the system all had their own processes for repairing endoscopes and sharpening instruments. “A lot of money was being spent on endoscope repair,” noted Alison Lauer, director of clinical equipment/engineering at Novant Health. And with the need to begin incorporating endoscopes into the organization’s medical device inventory, as specified by the Joint Commission, Ms. Lauer figured, “Why not take it all the way and see if we can improve the process?” Centralizing services such as endoscope repair and instrument sharpening would allow for a more efficient allocation of resources and reduce costs. However, CEMP first needed to develop the expertise and acquire the equipment needed to perform these services.

For the instrument sharpening program, an instrument sharpening truck was procured. By 2013, the truck was sharpening general instruments on-site at 11 of the 13 facilities in the system at that time.

For the scope repair program, start-up was much more involved. CEMP did not have previous experience servicing endoscopes; thus, a crucial early step was to partner with surgical services for help in designing the scope repair program. A team of surgical services leaders, physicians, and CEMP leaders was formed to complete a needs assessment and to help CEMP understand what would be needed to make the program successful. For example, the team decided on acceptable turnaround times for different categories of repairs, and it suggested that an inventory of loaner scopes be maintained.

 The program that resulted from these efforts operates as follows:

• A scope repair lab was established at Novant’s Logistic Center (NLC), which is centrally located to 10 of the 13 facilities in the program. Scopes that need to be sent between the scope repair lab and the hospitals are transported on trucks that are already making daily runs to deliver supplies from the NLC.
• Minor repairs (categorized as Level 1 and 2 repairs) are completed at the scope repair lab, and scopes are returned to the hospital departments within three business days. These account for 80% of flexible scope repairs and 90% of rigid scope repairs. An EndoBench (a piece of scope test equipment purchased for this program) is used to verify the quality of the repair before the scope is returned to the hospital.
• Scopes needing major repairs (categorized as Level 3 and 4 repairs) are sent to a contracted vendor partner. The selection of one vendor for this role eliminated the use of multiple vendors by the various facilities and promoted standardized pricing.
• The vendor partner also provides an inventory of loaner scopes, which are housed at the NLC. The loaner inventory provides a supply of scopes that are available when needed, without requiring that capital be spent on maintaining a stock of backup scopes. In addition, the vendor partner provides technical training for CEMP’s scope repair technicians when needed.
• Monthly conference calls among department leaders are held to provide an open environment for tracking the progress of the program and discussing ideas for improvements. (During the initial rollout and the early stages of the program, the calls were held weekly.)

In addition to the cost savings outlined above, this program supports the proper management of the endoscopes at all of Novant’s hospitals. For example, scopes in the program are inventoried and can be tracked by serial number, which aligns with the Joint Commission’s requirement, mentioned earlier, that endoscopes be included in a facility’s medical equipment inventory. The program also tracks the repair history for each scope by serial number, allowing analysis of the number of repairs, as well as the cost incurred, for each device. Novant reports that this data facilitates tracking repair trends, which can be used to identify opportunities for staff education about proper care and handling of the devices.

Best Practices

This money-saving initiative is an outgrowth of Novant’s CEMP setting annual goals to increase the clinical engineering program’s value to the organization. The group recognized that the growth of the organization had made it feasible to expand the range of services that CEMP offered to allow for a more efficient allocation of resources and to reduce costs.

Significantly, rather than going it alone, CEMP included in the planning and implementation processes those entities that could help it perform an accurate needs assessment and design and operate an effective program. For example:

• Because CEMP did not have previous experience servicing endoscopes, a crucial early step was to partner with OR and sterile processing staff to set objectives and design solutions. Ms. Lauer indicated that there was initial skepticism about whether the program would work: “Turnaround time was a key issue for staff; and the quality of the repairs was of course a concern.” But now, she notes, everybody recognizes the value of the program. “By year two, even the naysayers were impressed.”
• Also, the decision to partner with a vendor helped CEMP fill several additional needs: The vendor provided training for in-house scope repair technicians, it offered expert repair services when more complex scope repairs were required, and it supplied loaner scopes that could be used on an as-needed basis.

CEMP also recognized the need for open communication—throughout program development, during implementation, and on an ongoing basis. CEMP kept clinical leaders apprised of the program’s progress, they distributed the transition schedule months ahead of the go-live dates, they were on-site at the hospitals to educate staff on the new program and processes, and they held—and still hold—regular conference calls with department leaders to provide an open environment for tracking the progress of the program and to discuss any opportunities for improvement.

Congratulations and thanks to Alison Lauer for submitting Novant’s application for the Health Devices Achievement Award.