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.
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!
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.
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.
In this digital era, the common man is getting more educated day by day and it would not be a surprise if many more patients start suing hospitals for poor quality monitoring equipment. It is always better to be pro-active.
Averon Bionics has announced that they now have the repair capability for latest Philips Avalon Wireless fetal transducers M2725A, M2726A, M2734A, M2735A and M2736A. Please check out following web link.