Hospitals have embraced clinical studies that indicate that early intervention yields significantly better outcomes, and now use external defibrillators throughout the hospital, not just in the ICU/CCU.
However, what it takes to keep these life-saving devices in a state of readiness and its associated costs is often overlooked. To gain a better understanding, E3 Consultants of Philadelphia, Penn., did a survey of five hospitals, and determined the annual effort and cost of maintaining defibrillator readiness in the hospital. The findings are enlightening.
The survey consistently revealed that four activities are employed to ensure defibrillators will be ready when a code situation arises. These four methods are: 1.) user defibrillator checks, 2.) preventative maintenance, 3.) prompt service and repair, and 4.) regular battery maintenance and replacement. Each activity plays a critical role in ensuring the readiness of a defibrillator. Also, E3 Consultants noted that while defibrillator technology has significantly evolved over the past 20 years, the means for testing to ensure code readiness has remained the same.
To gather data pertaining to the time and cost associated with each of the readiness activities, a questionnaire was developed and distributed to the hospitals involved in the study. The data collected was then used to calculate the annual time spent on each of the four readiness activities at each of the five hospitals surveyed. The average annual salary for an LPN and an RN in 2007 was used as the basis for this calculation. Added to this was the time involved in conducting daily defibrillator checks.
The bottom line revealed that the user defibrillator check consumes between 27 to 146 hours of nursing time per defibrillator per year. That translates to an average of 73 hours per defibrillator per year. Charged at the total annual cost, the surveyed hospitals spend $2,363 per defibrillator per year.
These survey results clearly identified an area for improvement in maximizing both time and investment. When defibrillators were first manufactured, they had functional limitations that hospital staffing had to live with. Now 20 years later, there is an opportunity to leverage the progress that has been made by purchasing defibrillators that automatically check and report their state of readiness. These defibrillators will turn themselves on, perform the pre-determined tests and email the results to the BioMed/Clinical engineering department to verify that they pass all manufacturer’s therapy related functional test parameters.
In the area of battery maintenance, the average annual time spent on battery maintenance and replacement activities is 0.3 hrs. per defibrillator.
The driving factor of battery care and maintenance is the cost of the replacement battery and the battery replacement interval. The less expensive the battery is, and the longer it can be kept in service, the lower the cost will be for this readiness activity.
It was also observed that although the manufacturer-recommended battery replacement interval was four years at four of the surveyed hospitals, most did not foresee waiting the full four years to replace the battery. They estimated they would likely replace them after 2–2.5 years of service. Extending the replacement interval to four years cut the battery maintenance and replacement costs approximately in half.
In summary, this information shows that a significant amount of hospital staff effort and cost is required to ensure the readiness of a single piece of equipment that, in many cases, is rarely used and rarely fails. It was also noted that while defibrillator technology has advanced significantly over the last 20 years, the means to maintain them has not. From the data presented and information obtained from defibrillator manufacturers, there are means of streamlining these processes to help drive down effort and cost while not sacrificing safety.
For one, the ZOLL R Series® defibrillator is equipped with extensive readiness test capabilities, which allow the unit to periodically check the key components like the state of the battery, whether the unit is plugged in and charging, and whether it is capable of discharging. It is also equipped with readiness indicators that are designed to alert the operator when the device is NOT in a state of readiness. With the addition of readiness tests and indicators, the time spent on the user defibrillator check is reduced from 1-3 times/day to once/week, thus significantly reducing the overall effort and cost of ownership.