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A practical guide to instrument selection.

As important as any protocol in the laboratory is one that keeps track of the current state of in-house instrumentation, reveals costly obsolescence, and identifies the best replacements for outdated systems.

We will describe such a protocol. It promotes further automation, and the advantages of automation are well known--lower unit costs, reduced labor requirements, improved turnaround time, and increased productivity.

The most effective instrument choices will maximize employee performance, net income for the institution, and the quality of patient care. Impact on the institution as a whole must be kept in mind because the laboratory is competing with other departments for capital funds.

Toward a proper allocation of limited resources, our instrument replacement and selection guide consists of four areas of activity. We first evaluate present instruments and systems, then assess obsolescence in these instruments and systems, evaluate available technology and related services, and weigh the alternatives to select the best possible new instruments. Let's look at the procedures in each area of activity.

* Evaluate present instruments and systems. Base this evaluation on a qualitative assessment of the system's technology and a quantitative assessment of long-term performance, as recorded in the istrument log. All instrumentation should have a log card. Small items costing $5,000 or less may be grouped, but those costing more should have individual log cards. A prototype card appears in Figure 1.

Whenever possible, record log card data on the laboratory computer, although the system works equally well on alphabetized index cards. Either way, the goal is to gather data and keep it handy to expedite purchasing decisions. Updated log cards provide a cumulative cost picture: If they reveal an excessive outlay of time and money to maintain a particular instrument, for example, it's probably time to switch to another system.

For a comprehensive profile, log cards should include the following information: the instrument's name and its institutional number (if one is assigned): manufacturer model and serial numbers; purchase price; installation date; phone number for service calls; breakdowns (date and time of each incident); service requests and responses (date and time); total hours required to complete repairs; problems and solutions; repair costs; each date and time the instrument was back in use; total hours of downtime; and any relevant comments.

With most types of instrumentation, maintenance costs and problems in obtaining service are crucial factors. Downtime and breakdown frequency are also primary concerns. By recording all these data in one place, the log card system can help us identify instruments that chronically malfunction.

Comments on the card offer a chronological record of any unusual incidents. For example, noting that this is the fourth time an analyzer has broken down in a single month, or the sixth time the same relay has gone out, makes it easy to pinpoint persistent problems. The alternative is the spend time tracking down individual service reports.

If your laboratory instruments are processed through the institution's biomedical engineering department, it is helpful to assign them a number immediately upon arrival. This number can then be used to access the information on the log card.

A system of separate log cards facilitates the retrieval of information, manually or by computer, in chronological order. These data enable us to analyze the frequency of different problems and project the life span of replacement components. Shorter-lived components can then be stockpiled in the laboratory.

The problem and solution columns on the card serve as a guide to troubleshooting and on-site repairs. Downtime and repair cost data are invaluable criteria in deciding whether to replace or maintain a faltering instrument.

For smaller devices, each could have a card showing its number and the other descriptive details in section A of Figure 1. The actual log (section B) would group all these devices as problems occur, identifying the particular instruments by their numbers.

Log cards merely store information. The data become useful when periodically analyzed--at least once a year, more often if indicated. For example, every laboratory should perform a comprehensive service audit before renewing or negotiating a service contract. It takes only a few minutes and should generally cover the following factors: the time it took for the technical representative to respond, the total number of hours spent on-site, the cost of the visit, and any problems occuring after the visit.

Audit results are invaluable when discussing the quality and cost of servicing with suppliers. Some manufacturers welcome the feedback as a measure of how well they are meeting user needs.

The audit also makes it possible to evaluate whether you need a service contract at all. An istrument may be so reliable that it's wasteful to spend several thousand dollars to guarantee a year's worth of repairs. On the other hand, a firm may offer such a comprehensive contract--and have such a solid track record for meeting service obligations--that it would be foolish not to purchase the contract.

* Assess obsolescence of instrumentation. It has been said that the path of progress is marked by the junkyards of earlier decades. A good instrument can last for years, and circumstances can occasionally justify its continued operation even though it may be less efficient than the latest model. Certain blood gas analyzers are a classic example. The radiometer models have been around for more than a decade and still work quite well. Because they are easy to operate and repair, technologists aren't afraid to use them, as they might be with fancy electronic gadgetry.

No matter how trusty an old instrument seems to be, however, we cannot become complacent about obsolescence. Nor can we risk losing clinician goodwill because service suffers from a constantly malfunctioning instrument. Frequent downtime also erodes staff morale, and laboratorians are likely to begin coveting the sophisticated instruments in the institution down the road.

All instruments reach retirement age eventually. There are three telltale signs that the time has come. The first is when the system becomes unsafe because of mechanical wear due to age or excessive us. On this point, keep in mind that metal fatigue is not easily detected, and outside consultation may be neccessary. The second warning sign is when the system has been superseded by one offering increased sensitivity, in-depth factory training is desirable to master troubleshooting and maintenance procedures.

If the manufacturer does hold sessions at a training center, each laboratory is usually limited to sending one or two representatives. Whenever possible, hold one space in reserve; you may need to train a future replacement, particularly since a newly trained operator becomes more marketable and may be hired away by another laboratory. Also schedule an in-service session as soon as a trainee returns, so everyone can benefit.

If a laboratory is located far from a manufacturer's service center, obtaining needed parts and repairs can turn into a major headache. In Canada, for example, most instrument firms are based in Toronto--nearly 4,000 miles from our laboratory. It's often faster to arrange an international service call from the company's California office, reducing the trip to a mere 1,500 miles.

Annual service contracts are especially worth considering for key instruments, such as those handling a large test volume or special procedures. Have the manufacturer spell out every detail; vague terms often lead to vague service.

If a hospital has a biomedical engineer, this person should definitely examine the contract. If not, it's a good idea to consult technologists who routinely use the instrument. Sales representatives can also help point out which parts are likely to require more attention.

Finally, according to a number of manufacturers' representatives, it's possible to estimate the annual cost of service contracts as follows: Expect to pay 10 per cent of the purchase price for instruments costing up to $100,000 and 15 per cent for those costing more. If an annual contract markedly exceeds this figure, ask the manufacturer why.

When choices are narrowed to the most promising-looking instruments, survey the laboratorians in your area who use them. A few phone calls can quickly establish a track record for both instrument and manufacturer. The supplier should be willing to provide a list of local customers.

In surveying users, concentrate on 1) performance as experienced by labs versus what the manufacturer claims, 2) downtime during and after the warranty period, 3) servicing response time during and after the warranty period, 4) parts availability for minor inhouse repairs, and 5) whether the user would buy this particular instrument or a similar one again (if not, why not?).

* Weigh the alternatives and decide. Some of the factors reviewed will become arguments for or against a particular instrument, and others will suggest the probable consequences of choosing one alternative over another.

But what if two instruments appear equally appealing, perhaps for very different reasons? Let the manufacturer's reputation and track record in the field serve as tie-breaker. Referring to annual reports and other sources, note the number of years the compnay has been in business; its dollar value; the number and types of instruments sold; geographic distribution--national and international--of products; and the manufacturer's ranking, if it appears at all, among the Fortune 500 companies or some similar listing.

Cost alone should not be the final overriding factor. An established reputation for excellence may well justify a firm's higher prices. Reputation indicates the likely level of trouble-free operation, or built-in obsolescence, you'll encounter.

To sum up, unless an instrument fails suddenly an dramatically, the information required to justify its replacement can usually be obtained in a timely, systematic manner from the log cards. With this data base, a competent analysis takes only a few minutes. Preparation jof the laboratory's annual budget provides an ideal opportunity to review instrument performance since the outcome may rearrange capital spending priorities during the coming fiscal year.

The selection steps outlined here may seem excessive, but they're not if the log cards have been kept up to date. Most of the decision-making data are readily available from in-house records and the vendor. Be wary of doing business with a firm unable or unwilling to offer this information.

The effort invested in surveying users is definitely well spent. It may prevent you from buying a laboratory lemon, and it is invaluable in negotiating certain purchase or service conditions.

High technology is now a way of life for most health care institutions, yet many decision makers fail to consider instrument acquisitions in the broader human context of the lab. We can select the best instrumentation on the market, but its introduction to the laboratory still calls for time and care. We must calm staff fears of job loss, and provide training to minimize anxiety over automation in general.

Remember, too, that hospital administrators are businessmen, not scientists. When we press them to replace instrumentation, they need our help to ask the right questions--and make the choices that will serve the institution best.

Success depends on how well we evaluate our needs and the options available to fulfill them.
COPYRIGHT 1984 Nelson Publishing
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1984 Gale, Cengage Learning. All rights reserved.

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Author:Khan, Mohamad K.
Publication:Medical Laboratory Observer
Date:Aug 1, 1984
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