THEATRE E F F ICI ENCY
can put the patient at risk, cost theatre time or cause stress and frustration to the staff.
The rigid endoscope: impact on theatre efficiency With the high reliance on rigid endoscopes in many procedures and the positive impact they can have on both patient outcomes and contribution to theatre efficiency, what is the impact when this important device fails? The rigid endoscope has capabilities to help deliver exceptional results for both surgeon and patient and its performance in use is outstanding. However, it is a complex medical device and this needs to be remembered as it travels around the hospital environment.
Rigid endoscopes are used in many common procedures allowing the surgeon to view internal organs with great clarity. The rigid endoscope is also used as a carrier for surgical devices to cut, ligate and dissect, for example in biopsy.
In use, the rigid scope can be placed under extreme torsion and leverage in an effort to adopt the desired angle of vision for the user. This puts critical parts of the scope at risk of damage leading to defective parts. This is not a reflection on the device but on the demands under which it is used. The rigid scope is an assembly of parts – from the eye piece to the scope tip, made up of a lens assembly, a light post and the lens train, which is a series of glass rod lenses spaced at set intervals. An objective lens for image capture is at the tip of the scope and a light fibre array carries light to the scope tip. This assembly of glass rods and lenses means the rigid scope should be treated with care and respect at all times.
As with all endoscopic devices, it will be constantly exposed to decontamination and sterilisation cycles as it moves on its routine from CSSD/TSSU to operating theatres and back to CSSD/TSSU. In the vast majority of cases, this cycle of use and
cleaning continues without detriment to the scope. However, when an issue arises with the scope, it significantly impacts on the surgeon, patient and operating theatre efficiencies. The surgeon’s field of vision is only as good as the rigid scope can deliver. If a surgeon starts a procedure with a scope that has a lens defect or degradation of the adhesive or moisture in the optical system this will have a major impact on the procedure from various perspectives. In regular day-to-day use, a rigid endoscope will return to the CSSD/TSSU for decontamination and sterilising before being packed ready for further operating theatre use. Unless the hospital has invested in a full endoscopic testing system as used by the OEMs and third-party maintenance providers, the first time a defect will be identified is in theatre, when in the hands of the surgeon. So, how does this impact the efficiency of the operating theatre? Firstly, from the surgeon’s perspective the procedure cannot continue without a clear view of the site. The procedure is now on hold, the patient is still receiving anaesthesia, the theatre team are on hold. This can lead to stress and frustration for the whole team. Is there a replacement sterilised rigid scope of the same type available close to the operating
theatre? If not, how long will a replacement device take to arrive in theatre, ready to use? If the correct scope is not available, is the procedure to be cancelled?
All of the above can impact the efficiency of the operating theatre and the safety of the patient. Costs involved can include: lExtended theatre time at £9-£20 per minute (based on previously stated costs).
lThe cost of an extra sterilised device (equal to approximately 3.5 hours according to Medical Device Regulation in EU MDR).
lThe cost of a cancelled procedure and a patient remaining on the waiting list.
Now multiply this cost by the number of times faulty scopes arrive in theatre over a year… This could be a simple saving to make, with little additional work in the CSSD/TSSU department, who, unfortunately, are often put under pressure to rectify the situation. For the patient, the risk of extended anaesthesia time, while an alternative scope is provided, is evident. There is also the stress and frustration and possible additional medication or pain if the procedure is cancelled.
How do you stop this issue recurring in the future? The decontamination and sterilisation department in the hospital is the central recipient for a rigid scope tray, which will contain the scope and its required additional instruments. In some cases, the service will be managed by a third-party decontamination and sterilisation provider. The point where a defective scope can be identified prior to return to theatre use is at this point in the rigid scope work cycle. If a surgeon has identified a defective scope, then the hospital’s policy for repair or replace will be instigated and the scope dealt with. Often this is a case for replacement either under a supply contract or by purchase of an additional scope. However, the rigid scope is a complex device and can be damaged at any time between theatre and CCSD/TSSU. Accidental damage can occur in theatre if a scope is
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