Since expanded healthcare coverage under the Affordable Care Act (ACA) took effect in January 2014, emergency departments (EDs) have seen a steady increase in the number of patients utilizing their services. According to the American College of Emergency Physicians, 46 percent of providers admit to seeing an upsurge in patient visits and another 86 percent anticipate continued patient growth over the next three years. This increase in demand has put a strain on already strapped ED resources—namely personnel—and is forcing hospitals to seek out new, safe and cost-effective tools that enable clinicians to deliver high-quality care while meeting stringent regulations and at a more efficient pace than ever before.
For some hospitals, this search has lead them to migrate from reusable to single-use (disposable) medical devices. But from a business standpoint, what value do disposable medical devices offer over their reusable counterparts? How much do they save? What clinical benefits do they deliver? And most importantly, what kind of ROI can hospitals expect?
In this article, we’ll use the vaginal speculum to illustrate the potential cost, cross contamination and convenience benefits that a typical ED might see as a result not just of switching from a traditional, metal speculum to a plastic disposable version—a switch many have already made—but more specifically of switching from a basic disposable speculum that still requires an external reusable light source to new, single-use, models with built-in, single-use lights.
While we know that change can be hard, particularly in an industry as slow-moving as healthcare, this discussion aims to demonstrate why it may be best to leave some “old school” devices in the past.
To determine the true cost of a metal speculum, one has to consider not only the initial cost of purchasing the device, which can run anywhere from $10 - $50 per unit, but also costs associated with reprocessing and maintaining the device over its lifespan.
Because devices like the speculum are used on multiple patients on any given day, they have to be sterilized after each use, and that requires extensive equipment that, depending on a hospitals sterilization policies, can cost upwards of $1,500. Add to that the annual cost of cleaning solution and ancillary items—such as sheaths or bulbs—that also need to be purchased and cared for, as well as expenses associated with training staff, inspection and recordkeeping, and the per unit cost goes up significantly.
In addition, using a metal speculum slows down the process of caring for patients, and that time is money that hospitals need to allocate for. For example, it takes time for staff to clean the device, put it through disinfection, inspect it for potential damage, repackage it and put back in place for the next patient—and this has to happen after each and every completed pelvic exam. Or think about how often a clinician might have to look for an external light-source before the exam even begins—because a bulb has burned out, another member of the staff is using it or the light has been moved and misplaced. In a busy office, all of this equipment replacement and/or sterilization can take upwards of two hours out of the day; in a high-volume ED, it can eat up even more time. In an industry as resource sensitive as healthcare, all that time is money down the drain.
While many EDs already have realized these cost and time constraints and have migrated to disposable speculums, many haven’t truly embraced the notion of “disposable” because the devices they use still require an external light source. Whether that light source sits on the floor, hangs from the ceiling or is a rechargeable wireless or battery-operated version, ED providers must still locate them prior to an exam, make sure they are charged, replace burned-our bulbs, clean the lights, etc…all of which negates many of the inherent benefits of being able simply to throw the speculum away after each procedure. All of this still costs time and money and continues to take providers away focusing on delivering the best patient care.
A new generation of single-use speculums now offer built-in light sources that, like the device itself, come out of the package ready for use and are disposed of after a single use. These new versions allow hospitals to eliminate many of the costs, including maintenance and reprocessing, associated with both reusable devices and external light sources.
While reusable speculums may be the more conventional choice for some providers, single-use devices, especially those with integrated light sources, provide the same quality without any of the upkeep, resulting in true value for your facility.
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There is a growing body of evidence—and countless real-world examples—that demonstrate how so-called “disinfected” medical devices are not as clean as we think. A study from the Journal of Hospital Infection for example recently found that 86 percent of “disinfected” laryngoscope handles in hospitals still had bacteria on them post sterilization. To put that finding in perspective, in March 2010, Dallas-based Parkland Memorial Hospital was forced to notify 73 female patients that they were potentially exposed to infectious agents—including HIV and hepatitis—due to both equipment failure and the reuse of an improperly sterilized vaginal speculum. Not only did the cross-contamination scare have the potential to significantly harm to those patients, as well as their partners, but it also caused significant reputational damage to the hospital.
As these examples highlight, cleaning devices does not always mean that they are truly clean. The reality is that even when staff follow manufacturer recommendations for cleaning, contaminants can still exist deep in the equipment because cleaning protocols aren’t always sufficient, devices aren’t cleaned in a timely fashion or they simply weren’t designed with optimal cleaning in mind. All of this applies to the devices themselves, but also to external components and ancillary equipment, such as light sources, which can also carry bacteria and often are not cleaned regularly or adequately.
It isn’t hard to imagine that if reprocessing doesn’t get a reusable device truly clean—or if potential sources of contamination, such as handles or even plug-in light sources, are overlooked when considering potential risk factors and developing institutional decontamination protocols—devices, their components and even the seemingly benign items you see in an exam room, all can easily become vehicles for cross contamination.
By comparison, when a product is opened, used on a single patient and then thrown out, the risk of cross contamination from one patient to another drops to almost zero. So making this simple change from reusable to single-use enables organizations to minimize cross contamination, maximize infection control and focus on what’s really important: delivering high-quality care to patients.
Convenience and Care
Providers in the ED are already strapped for time, and with the second annual open-enrollment season for healthcare insurance coverage under the ACA about to kick-off in November, it’s likely that load is about to get even heavier, so anything that can make their jobs easier should be welcome.
As we discussed above, disposable vaginal speculum requiring a reusable external light source need to be reprocessed, located, assembled, and charged, for each pelvic exam, then broken down and cleaned after the procedure. For a patient in need of urgent evaluation or an immediate procedure, the single-use speculum also means less time waiting. A single-use device, especially those with built-in light sources, eliminate all of this prep and post exam work and allow clinicians to deliver great care in less time.
As this article has outlined, for hospitals looking to increase resource utilization and cut costs while also reducing the risk of cross contamination and enhancing the experience for providers and patients alike, medical devices that are designed for single-use offer a high ROI that should put them high on the list for any healthcare organizations, and for acute care environments in particular.
Douglas H. McConnell, M.D., F.A.C.S., is Medical Director at OBP Medical, the leading global developer of single-use, self-contained, illuminating medical devices. Trained at Stanford University and the University of California at Los Angeles (UCLA) School of Medicine, Dr. McConnell is board certified in Thoracic Surgery and currently serves as Director of Cardiac Surgery at Shasta Regional Medical Center, a 246-bed acute care, medical and surgical facility in Northern California.