Costs associated with a fibrescope inventory: what role forthe disposable scope?
A Norris, P Wakeling, M Wiles, R McCahon, M Bennett
Introduction
Disposable intubating fibrescopes have recently been introduced to the UK at an initial cost of between £200 and £300
per item. Informal trialling of these devices at our hospital suggested that they performed satisfactorily, however thecost seemed high. We decided to look at our numbers of fibre‐optic intubations and the costs and governance concerns
associated with maintaining, repairing and replacing our existing devices.
MethodWe checked our inventory of devices. In a twelve‐month period we prospectively collected data on
all fibreoptic intubations performed on the site.
We also looked at manufacturers’ repair records
for costs and nature of damage to ourfibrescopes, together with records where these
could be obtained, from the Medical Equipment
Service Unit and the theatres finance team.
Figure 1 Storage and retrieval of fibrescopes from drying cupboard.
Fibrescopes are sterilised every 72 hours.
Results
In 2009 on our campus we had 11 fibrescopes, of which four were paediatric. They were from a variety ofmanufacturers. It proved very difficult to obtain details of costs, and records were incomplete. Repair contracts forsome of the devices totalled more than £4000. Detailed breakdown of repairs was only available for the fibrescopesfrom Karl‐Storz. Most problems related to the angulating tip, with leaks, tears and damaged vertebrae. There were also
examples of severe damage to the shaft and eyepiece/camera. In five out of seven episodes the damage wasconsidered too extensive to repair and scopes were replaced under the customer arrangement, but not before costs of~£12,000 were incurred. Four new scopes were ordered in that year at a cost of £32000. For the last four years wehave, on average ordered two new devices to replace stock and increase supply as demand has grown and followingchanges to sterilization requirements. Our estimate therefore was around £32,000 In 2008‐9 we recorded performanceof 141 fibreoptic intubations. If all of these had been performed using disposable instruments at £200 each the cost
would have been £28,000Discussion
Fibrescopes are expensive and notoriously easy todamage. Our hospital has over 30 operating theatres anda large staff body with a high turnover. Despite the factthat the majority of damage is easily avoided, the problem
of repeatedly damaged scopes has resisted all ourattempts at training. Our cost estimates are incomplete,and even the direct costs are certain to be greater than
we have identified here. Additionally, they do not start toaddress sterile service concerns, storage requirements, Figure 2 Plug & Play set‐up of Ambu®aScope™versus usual
record keeping and quality control of infection [1]; see set‐up for fibreoptic intubation
Figure 1.
Remote sites need to have access to difficult intubation For these reasons our department has decided to invest inequipment, but the cost of keeping traditional fibrescopes disposable instruments especially for use outside the corein all these areas is excessive if they are rarely or never elective areas to supplement our standard instruments.
used. The occasional user of a fibrescope is often faced The price of disposable devices will probably fall. In thewith equipment that fails to work as well as it should, and meantime departments should identify the real costs ofthey may lack the skills to troubleshoot fibrescopes and fibreoptic intubation.
camera stacks; see Figure 2.
Reference
1.Pujol E, Lopez A, Valero R. Use of the Ambu®aScope™ in 10 patients with predicteddifficult intubation. Anaesthesia 2010; 65: 1037 – 1040.