JMIR Publications

ABSTRACT

Background:

Despite various logistical innovations in recent years, the management of reusable medical devices still accounts for substantial healthcare costs.

Objective:

This study evaluates the outsourcing of reusable medical devices and the implementation of an online portal for ordering the devices within a large chain-wide healthcare provider in the Netherlands. A first objective is to establish if this intervention leads to improved device utilization, better management of devices, higher compliance with safety and hygiene standards, and eventually to lower costs and a higher quality of care. Secondly, we aim to identify and explain the challenges that occur when implementing this intervention within the care provider under study and the broader healthcare system in the Netherlands.

Methods:

Using on-site stocktaking and data from information systems, we analyzed the utilization of different types of devices before and after the intervention. Wheelchairs and anti-pressure ulcer mattresses were used as exemplary types of devices for comparison purposes. Effects on management and compliance were established by means of a survey, focusing on ordering and delivery time, as well as satisfaction with the ordering process, safety and hygiene certification and effects on the care delivery process. Qualitative data in the form of observations, documentation, and interviews was used to further explain the effects and identify challenges related to implementing improved device management in the studied chain-wide healthcare provider context.

Results:

Wheelchairs, which were previously owned by the care provider and are now rented, showed a reduction in utilization of 1,000 days per month. The utilization of anti-pressure ulcer mattresses, which were already outsourced at most care locations before the intervention, gradually increased over time, which could be explained by the care burden of patients. The online portal did not reduce the average duration a device is used. 51 nurses responded to the survey. In terms of device management, reported ordering and delivery time improved with 3.1 minutes and 0.5 days, respectively. User experience of the portal was generally rated high: 1.7 (scale 1-5). Improved compliance with safety and hygiene standards showed a perceived improvement of 1.9 (scale 1-5). No clear positive effect was observed on costs and quality of care.

Conclusions:

This paper shows that outsourcing of medical device management can reduce device utilization. When combined with an online portal for ordering devices, it can also improve device management and compliance with safety and hygiene standards. In our study, there were still various ordering routes and multiple stakeholders involved in managing devices, complicating the measurement of improved performance, and thereby hampering structural improvement. Combined with a lack of transparency on costs and quality, this provides barriers to achieving structural and larger scale implementation and improvements.