Facilitator:
Terri Stoner

Charge: Evaluate current and future fiberoptic bronchoscope needs and develop a 3-year plan for purchase, sterilization, or high level disinfection, inventory and storage and prevention of damage for fiberoptic bronchoscopes. Offer recommendations and a financial plan for a 3-year strategic plan covering the following issues:

1. Complete an inventory of current equipment, including accessories that include age, purchase price, users, repair history, and current replacement value. Develop a list of all accounts to which expenses are assigned for the use, repair or purchase of supplies related to this equipment. Evaluate current practices and offer suggestions for efficient use, inventory, cleaning, and sterilization as well as storage and distribution of fiberoptic bronchoscopes
2. Identify sites of fiberoptic bronchoscope use in UI Hospitals and Clinics. Develop criteria and recommendations on how the inventory of fiberoptic bronchoscopes should be managed.
3. Gather information and offer recommendations on sterilization and storage techniques Offer recommendations how repair costs for fiberoptic bronchoscope inventory can be minimized.
4. Develop a recommendation regarding purchase vs. leasing of equipment.
5. Specifically identify all dollars that can be saved and removed from specific budgeted accounts.

Charge One: Complete an inventory of current equipment, including age, purchase price, users, repair history, and current replacement value. A complete inventory did not exist prior to the formation of this team. Nor was an itemized repair history specific to each scope available. In addition, no benchmark data for scope repair was available. Lastly, depreciation vs. repair cost vs. replacement cost analysis has never been completed. This is of particular note due to the age of a number of the scopes.

Recommendations:

1. A complete inventory was compiled and will be maintained by CSS and Respiratory Care.
2. Tracking tags were placed on all scopes to allow for ease of inventory and tracking of repair costs.
3. Benchmark repair data was obtained from both external sources and internal data. The team is also making recommendations for improved instrument trays for distribution.
4. Fiberoptic bronchoscopes should be considered for replacement at the end of depreciated life (currently three years). The team recommends replacement of our oldest units this fiscal year.
5. The Committee recommends bronchoscopy procedural standardization of equipment, personnel, and monitoring (during and after the procedure) for efficiency and patient safety.

Charge Two: Evaluate current practices and offer suggestions for efficient use of fiberoptic bronchoscopes. Identify sites of fiberoptic bronchoscope use in UI Hospitals and Clinics.

Major areas of use of scopes within UI Hospitals and Clinics are the Adult Pulmonary Bronchoscopy Services, the SICU, and in the operating rooms by both anesthesia and surgery personnel. Scopes are used to a lesser extent in the PICU and Peds Pulmonary Function Lab, and on the floors, notably the Cardiothoracic Patient Care units. Standards and practices vary markedly in the various areas due to levels of training of users, degree of support personnel, and nature of patient needs in each area. The Team feels that the Adult Pulmonary Bronchoscopy Services might act as a model for other areas. Notable of this service is complete inventory and repair records, complete on-site cleaning, and dedicated support personnel in the form of Respiratory Therapists.

Recommendations:

1. Personnel using the scopes should undertake basic training in the care and use of fiberoptic bronchoscopes on patients. This would specifically target House Staff in the appropriate areas, and would likely involve independent, Web-based self-study with testing.
2. Development by the Department of Respiratory Care and the Surgical Intensive Care Unit of a use-model based on the Adult Pulmonary Bronchoscopy Services. Appropriate staffing resources for Respiratory Care must be provided. Centralizing inventories of SICU and Anesthesia where the equipment can be properly cleaned and stored could further enhance this.
3. Loan of Bronchoscope equipment from the Operating Rooms is discouraged. Bronchoscope Services are available on a 24-hour basis in the institution.

Charge Three: Gather information and offer recommendations on sterilization and storage techniques. Offer recommendations on how repair costs for fiberoptic bronchoscope inventory can be minimized.

The Adult Pulmonary Bronchoscopy Services offers a good example of inventory control, cleaning and storage techniques. Scopes are cleaned on-site, are hung in specifically designed storage devices, and are kept secure. Out of necessity, the scopes in other areas are cleaned off-site, transported and stored in a less than ideal fashion. The Team feels that this contributes to increased equipment repair costs. Centralize inventory of disposable accessories into Processed Stores, utilizes best pricing from group purchasing.

Recommendations:

1. On-site cleaning during regular hours of the Anesthesia and SICU bronchoscopes. The team is recommending the purchase of a Steris machine for the Anesthesia Workroom.
2. Appropriate secure, hanging storage of SICU, Anesthesia, and OR scopes in each area. This would require the purchase of specifically designed cabinets.
3. High Level Disinfection, rather than gas sterilization, of Operating Room scopes to lengthen bronchoscope life. This has already been done.
4. Centralization of the acquisition of accessories, the team has requested all associated products be stocked in Processed Stores, the request has been submitted for the team by Respiratory Care Department.

Charge Four: Develop a recommendation regarding purchase vs. leasing of equipment. Leasing was not reviewed as an option.

Team members were very willing to discuss and resolve these issues. A very large barrier of where, when, and if a Bronchoscopy should be done continues to be a question. This team would not be the appropriate place to resolve this issue; however, the resolution of this question would enhance patient care and improve our capital equipment availability.

The majority of the team recommendations have been successfully implemented. Final stages of implementation awaiting approval are:

1. Centralizing bronchoscope equipment into the Anesthesia Workroom after the purchase and installation of the Steris unit. Anesthesia will pursue a capital purchase request for this unit.
2. Bronchoscope equipment needs to be evaluated on an ongoing basis. Bronchoscopes are on a three years depreciation schedule. Evaluation would be done with the assistance of the Respiratory Care Staff.
3. Inservicing staff that the loan of Bronchoscope equipment from the Operating Rooms is discouraged. Bronchoscope Services are available on a 24-hour basis in the institution.
4. Support for a new initiative by Respiratory Care in support of increased services to SICU.

Charge Five: Specifically identify all dollars that can be saved and removed from specific budgeted accounts.

1. 7000 77420- SICU, $2,000 due to centralized purchasing of bronchoscope accessories through Processed Stores.
2. Other major operational savings come from the improved turnaround time for Operating Roo Prior to these recommendations, the sterilization of bronchoscopes would take longer than 18 hours; now, it takes less than one hour. There is far less damage to the scope utilizing high level disinfection, which is a cost saving that we hope to document over time.
3. Another significant savings is the amount of time it takes to inventory and order bronchoscope supplies: By centralizing them within Processed Stores we hope to eliminate multiple departments and staff’s inventories.
4. Repair and Use benchmark data is now being accumulated which will be a valuable in maintaining adequate inventories.