Advances in anesthesia and the impact of those changes on the market are just two topics industry experts discuss in this TechNation roundtable article. The experts on the panel are CE-Tech Service Manager David Deforge, President of Paragon Service Thomas G. Green, Dräger Director of Marketing David Karchner and Mercury Medical’s Director of Clinical Services Jim Ruggiero.
Deforge: The integration of physiological monitors including built-in anesthetic gas modules are now the standard in higher-end anesthesia machines. Heated absorber systems, which reduce moisture in the breathing system, is a benefit for the patient, the clinician and the service technician. The ability to capture data electronically and store this information for medical records, EMR, has been a goal for many years and the OEMs use this as a selling tool. The use of the automated pre-use checkout procedures are becoming a standard. Increased ventilator modes and options are a tool for the clinician to provide improved care for their patients, ranging from neonates to geriatrics.
Green: The main improvements in anesthesia equipment over the past 5-8 years have been ventilation modes that were previously only used in the ICUs. These include Pressure Support Ventilation (PSV), Synchronized Intermittent Mandatory Ventilation (SIMV) and Synchronized Mandatory Minute Ventilation (SIMV) and various derivatives of each mode. These modes are a very nice feature for orthopedic cases where the patient initiates the breath and the ventilator completes the breath.
Karchner: Dräger continues to focus its Research and Development on improving the efficiency of anesthesia delivery. This not only includes proven tools like the Apollo’s Low Flow Wizard, which can significantly reduce the cost of anesthetic agents, but also future technologies that allow customers to achieve faster OR turnaround times and offer enhanced ventilation capabilities.
Ruggiero: I think some of the latest advances in anesthesia equipment are the more sophisticated ventilators and ventilation modes like Volume Control Ventilation (VCV) and Pressure Control Ventilation (PCV) with volume guarantee, along with Pressure Support (PS) ventilation. The integrated ventilators provide a wide range of setting and waveform displays, enabling the end-user more effective care across the wide range of patient sizes and acuity types. One significant change that is worthy of the initial investment is a machine’s capability to interface into the hospital HL7 architecture to provide Electronic Medical Records (EMR).
Deforge: The improved ventilator options, automated checkout procedures, built in monitors and heated absorber systems will increase the cost of the machines, with the goal of improving patient safety and allow the institution to keep up with the pace of the ever-changing healthcare environment. This will also make the older generation machines seem inadequate for today’s needs. Until the older generation machines are replaced, it will become more of a challenge to maintain them due to a shortage of repair parts. Facilities and/or anesthesia departments must be pro-active and budget to buy newer machines.
Green: If an anesthesia provider deems these ventilation modes necessary for patient care, then it could result in the sale of replacement equipment.
Karchner: It will be more important than ever for the healthcare provider to work together with their vendor to quantify the value these differentiating technologies offer over the useful life of the anesthesia workstation. Many of these new technologies create the opportunity to significantly reduce existing fixed costs and the patient’s length of stay.
Ruggiero: These changes will impact the anesthesia equipment market by improving patient outcomes. The more sophisticated the equipment becomes, the better chances of detecting problems while anesthetizing patients and making the necessary corrections in real time. More than 30 years ago, most anesthesia machines didn’t even come with an oxygen monitor on them. Advances in technology have contributed to a decrease in morbidity and an increase in quality of perioperative management. In addition, with the interface of the anesthesia equipment into the hospital IT servers, information can be integrated into the patient’s medical records.
Deforge: The facility has a few options. The first option is that they can purchase pre-owned equipment from a reputable pre-owned equipment company. These companies have the anesthesia machines with the specifications that they are looking for at a lower cost than buying new. The second option is to budget a certain percentage of the machines per year to phase in this new technology. Lastly, the facility can upgrade their existing system’s software/hardware if available.
Green: Purchasing refurbished modern anesthesia equipment from a reputable refurbisher is a great alternative.
Karchner: First, today’s anesthesia machines are more software driven than ever before, which means that a facility with a limited budget can add features/functions that may not be budgeted for today at a later time. In addition, utilizing each vendor’s entire anesthesia portfolio is a great way to save money. For instance, Dräger has implemented a user interface (UI) strategy where our entire anesthesia portfolio (Apollo, Fabius GS premium, Fabius Tiro, Fabius MRI) utilizes a common UI. The purchasing team can choose the machine that best meets the technology needs of each OR, while reducing the associated training costs of the clinical team.
Ruggiero: Facilities with a limited budget should consider either a certified used refurbished anesthesia machine with a full year warranty or look into a rent-to-own program.
Deforge: Before purchasing, it is very important to do your homework on these devices. Besides price shopping on this large initial investment, you need to calculate the annual maintenance costs. These costs include PM kits, service tools, applications, technical training and reliability of the machines. In the last few years, other companies have joined the anesthesia market. Now, besides the “big two,” you have other options to research.
Green: Check the refurbisher/service provider’s resume. Are they factory service trained on the device to be purchased/serviced? Do they perform field service to hospitals and surgery centers? Where do they obtain parts? Do they have adequate liability insurance? Will they provide local references?
Karchner: When looking at the cost of service for an anesthesia machine, it’s important to look beyond preventive maintenance parts. Sometimes, anesthesia vendors will only provide the cost of PM parts when replying to a Request for Proposals (RFP). Unfortunately, PM parts might be just the tip of the iceberg when looking at service costs. We encourage customers during the sales cycle to dig beyond PM parts to understand the true cost of service. Many times, the best action is to get a comprehensive service quote from each vendor to gain cost transparency.
Ruggiero: Do your homework when it comes to purchasing or hiring a company to perform your anesthesia equipment service. Make sure that when you’re buying an anesthesia machine, new or used, that you compare the options and what you’re getting for your money. Are they performing a full refurbishment, taking the machine down to the skeleton and rebuilding it with new parts, or just throwing a paint job on it? Another thing to consider is the cost of ownership or annual preventive maintenance cost. Some of the newer machines from Mindray are less than half of the cost of their competitors, and their annual maintenance cost is less than hundred dollars.
Deforge: While looking for a third-party anesthesia equipment provider look into the company’s willingness to stand by their sales with warranty and service after the sale. Use references, what the company gives you, and the references you find on your own. Performing research will give you peace of mind on this purchase decision and will help you determine the integrity of the provider. If this anesthesia provider is also providing your anesthesia machine maintenance, get proof of their training records.
Karchner: The acquisition of an anesthesia workstation is an important one, as it’s something that many healthcare providers only do every 10-12 years. And because of that, it’s important for healthcare providers to look at the long-term strategies of each vendor. Is the existing technology being offered upgradeable? What’s the strategy from a service perspective? How long have they been in the anesthesia market? Are they invested enough in the anesthesia market to be able to provide support for the useful life of your anesthesia purchase (10-12 years)? Also, it’s never a bad idea for a healthcare provider to request 10-15 references from each vendor for the equipment being purchased.
Ruggiero: Some of the most important things to look for in a reputable third-party anesthesia equipment provider is how long the company has been in business. Are they an ISO certified company? Are they insured and for how much liability insurance per occurrence? Are their technicians factory certified by the OEM?
Deforge: Yes. By using a reputable third-party, preowned medical equipment company you can purchase refurbished anesthesia machines with the advances and improvements you are looking for, without the new system price tag. If available, upgrading your existing anesthesia machines’ software with the latest ventilator options could provide the equipment advances and improvements that you are looking for.
Green: Yes. Most anesthesia equipment refurbishers have modern anesthesia equipment models in stock for a great alternative to purchasing new at a savings of 25 to 35 percent.
Karchner: This is absolutely possible, but it is highly dependent of the platform purchased. While today’s machines are more upgradeable than ever, not all anesthesia platforms are created equal, and this can make a difference over the useful life of a machine. For instance, if the practice of low- and minimal-flow anesthesia is a future goal for your healthcare facility in order to save on agent costs, make sure that the platform was designed for lower flows. Is the platform designed to reduce or eliminate condensation? Is the gas sampled by the gas bench recirculated back to the breathing system?
Ruggiero: Yes, it is possible to keep up with the latest technology and advancements without buying brand new. Refurbished equipment is the best alternative to buying new, especially when certain model anesthesia machines are still being manufactured by the OEM and the latest features and options can be added with a simple software upgrade.
Deforge: By working with your purchasing/materials management and your department managers, you can request that the OEM provides the literature, training and specialty tools that are needed to support the equipment that you are purchasing. This is best accomplished as a condition of sale. Having these necessities from the beginning will improve patient safety, increase equipment up time and lower overall maintenance costs.
Green: Most literature, operator’s manuals and service manuals are available online. If not, call the company for these resources.
Karchner: The best time to have these discussions is during the acquisition of the equipment. Consult your vendor’s sales executive to better understand the training strategy, the distribution strategy for service parts and any special tools that are required to service the product.
Ruggiero: The best way to ensure that you will receive the necessary literature and training tools is to put it in writing. My suggestion is to add it to the purchase order for the equipment.
Deforge: It is important to know and have a good working relationship with the service technician. As the service provider it will be beneficial to all parties involved to educate the clinical staff, such as the anesthesiologist, CRNA and anesthesia techs. This education should include user functions and steps that can resolve potential service issues. This will result in direct cost savings by reducing unnecessary service calls and also improve user satisfaction and overall patient safety.
Green: Always check the reputation and background of each company. How long have they been in the medical business? Does the company specialize in anesthesia equipment or sell everything? What are the owner’s qualifications?
Karchner: That as anesthesia vendors, we’re here to help you throughout the life of the equipment, and that includes the time of purchase. And while an anesthesia purchase is something that your healthcare facility may do only once every 10-12 years, it’s something that we do every day.
Ruggiero: The difference between “End of Service” and “End of Life” on anesthesia equipment. End of Service refers to the last date of when the manufacturer will perform service on your anesthesia equipment, where End of Life is when the manufacturer will no longer support the equipment or carry spare parts.
*By entering your email address, you agree to receive emails regarding TechNation Magazine, Webinars, and Exclusive Promos.
© 2021, TechNation Magazine. Site designed by MD Publishing, Inc.