There have been many attempts to develop methods to calculate when to replace medical devices. Many of them use some type of formula based on a percentage of repair costs vs. replacement costs. Others will also factor in a device’s age, repair history and the manufacturer’s projected end of support date. Although having some type of formula may appear to be useful in providing an objective method for deciding when to replace devices, it is vitally important to consider additional factors in your decision making.
The most important factor to remember is that you can not treat equipment replacement in isolation. Each device is part of the total system of healthcare delivery and its replacement can have an impact on many departments. For example: replacing infusion pumps can have a large impact on nursing staffs since they will be required to not only take time from valuable patient care as they to learn to use them, but it might also result in additional payroll costs to the nursing department if the have to train nurses outside of their normal working hours. There may also be efficiency issues to consider as nurses adjust to the idiosyncrasies of the new devices. Alarm sounds and terminology may be different and filling and loading cassettes may require new techniques. Space in the nursing stations where supplies are stored might be affected if packaging sizes differ. The Materiels Services department can also be impacted because the new manufacturer’s packaging and minimum delivery quantities may require additional warehouse and shelving space. Beyond the materiel, training and other associated costs, during the period of time when users are adjusting to the device and developing a comfort level, there is always an increased element of patient risk.
Pumps are but one example. Replacing products such as intensive care monitors can create additional stress for nurses and physicians as they adapt to the new ways to change alarm parameters and learn to recognize new alarm tones. Operating room and anesthesia monitors can be especially problematic since the ears of surgical staff and anesthesiologists may have become especially attuned to differences in alarm tones.
The simple fact is that while it may be great for you to develop a sophisticated formula, you may be doing your hospitals a great disservice if you recommend that a product be replaced without first taking into account the impact of its replacement on the entire healthcare delivery process. We must always remember that the great thing that differentiates us from other engineering disciplines is that we have a sound knowledge of the clinical applications of devices and the role they play in the system of healthcare delivery. We must always carefully consider the needs of the users of those devices and their impact on the delivery of quality patient care.
