In February 2008, L & D dept. head was very upset with all of us. She presented tracking record and performance issues of fetal transducers - Toco & Ultrasound (Fetal Heart) that shocked everyone. She pointed out that she had been complaining about it for last 4 years and was keeping a track record for almost last 2 years. Most of us had not paid serious attention to such complaints as we were informed by the repair service company that the physical damages were due to rough handling. While there always was some breakage due to mishandling, the tracking data presented in the meeting clearly indicated poor quality repairs, repeated failures and overall poor performance. Though the repair cost per transducer was very low, due to repeated repairs, the amount paid per unit turned out to be more than that of a new transducer from the original manufacturer - that too in less than a year.

Our director ordered us to replace the repaired transducers with new ones from the original manufacturer. The purchasing department came up with a price quote that was close to quarter million dollars. The warranty offered was about a year and the management became concerned over the high cost of the replacement as well as recurring repair costs. Was there another alternative - a vendor for quality repairs?

Back to square one. We started using a different company for our fetal transducer repairs. This boomeranged when a patient had complications during labor. Her relatives threatened to sue us for the poor quality of monitoring devices. Perhaps the dude was a techie and had noticed the problem. We started testing each repaired item before putting it into use. It was time consuming and stressful, plus we were short staffed due to the economic situation. The number of PMs performed per month made us stay late every day. We were not happy with the quality of repairs. We changed the vendor and a month passed but the same problem of poor quality of repairs persisted. We changed the vendor again but the problem continued. By the end of the year, we had used 6 new vendors with no improvement in the situation.

In December 2008, the management decided to replace at least 20% transducers with new ones from the original manufacturer. This was based on the testing records and our recommendations. Meanwhile we had found a company that charged more but assured guaranteed performance and a 2-year warranty, but the purchasing department shot down the price quote, as it was higher.

In the beginning of 2009, the issue was discussed again in the meeting for department budgets and the L & D head presented a print out of the blog that talked about our problem. The company recommended by the blogger was the one that was shot down by our purchasing department! Our director checked out the blog and asked us to try out their services. The company, which was in Georgia repaired a few transducers. We were amazed with the quality of their work. L & D too, has been extremely happy with their performance for last 9 months. We are not blamed any more! Nor do we blame nurses for poor handling!

The new vendor made sense to us when he pointed out some of the inherent problems with particular models and simple remedies that reduced cost as well as down time. Last Monday, we were informed by this vendor that all our rebuilt fetal ultrasound transducers M1356A had warranty not only for 2 years as a whole unit but also for 5 years on crystal bonding, which is a very common problem (rattling). As an experiment, we dropped the rebuilt transducer from second floor and the crystal did not come off! The belt buckle got slightly bent but the transducer worked just fine! In regular usage, since the drop would be at the most from 6 -7 ft., we were sure of the quality of repairs.

We hope the following blog link will help you. We shall be happy to share our experience with you. The key is precise tracking and unbiased analysis. The approval of the vendor should be strictly based on the quality of work and not on their word.

http://www.avalontoco.blogspot.com/

http://www.blogger.com/profile/16724840114237900492

We mostly have old HP fetal monitors. HP is bought over by Philips and latest fetal monitors from Philips are Avalon series with triplets monitoring capability. The Avalon fetal monitors can be configured with the wireless transducers M2725A, M2726A or with cable transducers model M2734A, M2735A and M2736A. Avalon series fetal monitors are excellent but the cost of transducers is in the range of $1400 and hence it is not economical from service point of view. We have been using following transducer models.

 

HP/Philips Toco Transducer M1355A

HP/Philips Ultrasound Transducer M1356A

GE/Corometrics Toco Transducer 2260

GE/Corometrics Trimline Toco Transducer 2260EAX

GE/Corometrics Nautilus Toco Transducer 2264 LAX/HAX/AAX

GE/Corometrics Ultrasound Transducer 5700 HAX

GE/Corometrics US Transducer 5700 LAX

 

However rugged the design, transducers do fail and show wear and tear based on usage and handling. We find HP transducers M1355A and M1356A most reliable compared to Corometrics Trimline Toco 2260 EAX and Nautilus 2264 HAX/LAX.  GE/Corometrics Nautilus Ultrasound 5700 original transducers give intermittent problems even after short term usage. Once the cable is replaced with a high flexibility quality cable, they work well. Failures in HP/Philips transducers are very low provided they are original from HP or Philips and not compatibles.  

All the Biomeds being technically qualified and experienced, should take a closer look at the repaired transducers, compare with the original and open (disassemble) them if problems are noticed, to make thorough check. Some of the repair service companies deliberately break some internal walls of the original transducer top cases as their replacement bottom cases (NON OEM) do not fit due to dimensional mismatch. The replacement casings are manufactured using cheap raw materials and processes to reduce cost. Sometimes we get deceived by the bright colors and looks. If we open it up after 5-6 months of usage, we get a big head ache. Many of these transducers do not have the metal inserts for top-bottom fitting, the screws and internal metal parts are rusted, being made out of cheap material other than standard Stainless Steel. The old gages are re-used by gluing some strain gage foils that do not conform to the OEM specifications. You would be lucky if you can dismantle the repaired or compatible Corometrics 2260 box style transducer without damaging it. The Aluminum stand-offs come off as they are threaded directly into the plastic (no metal insert used in bottom casings) and cannot be re-assembled without heavy gluing. The gage plate is so rusted - if sent to the lab, you would find a bacterial colony! Is it not scary?

It is our moral responsibility to ensure that patients are given quality treatment. Purchasing Managers can be convinced if the performance testing, routine check and tracking is well documented. Cheapest is not always the best. The quality and pricing are to be compared with what OEMs offer and not with the cheap stuff available in town. It is a mistake to negotiate or bargain with the quality conscious vendor. Comparison has to be between apple and apple. The fact of the life is that a Mercedes cannot be bought at the price of the lowest priced car in the market. 

End users i.e. the nurses are most important and their feedback is always precious to minimize the recurring cost and obtain high up time of the equipment. During emergency situations, the patient's comfort and life are the priorities and hence the equipment or the accessories like transducers get least attention. If quality stuff is used, damages due to such incidents are not that significant compared to a poor quality product. It is unfair (of sales people from some service companies) to keep blaming the end users (nursing staff), neglecting their repeated appeals about poor performance and continuing to procure the services of the cheapest vendors, taking their word for granted. It is in our interest to train the end users in proper and safe handling. Working hand in hand with the L & D staff not only improves overall quality but is also a pleasure. Finally, we are the way we think and if we choose to accept the sales pitch (from marketing people of cheap-price-cheap-quality service companies) that the end users are solely responsible, then facts can never be unveiled. In today's economic situation, it is better to focus on quality that yields significant savings on long-term basis.