AMBU: THE SINGLE-USE ENDOSCOPY LEADER

The coronavirus pandemic may be showing signs of coming under control, but healthcare providers are steeling for another big challenge: managing the substantial backlog expected to occur as patients resume elective procedures.

Eliminating that backlog could take nearly two years, according to a McKinsey & Company study — and that’s assuming hospitals can ramp up surgical volumes higher than pre-COVID levels. More likely, providers will use a combination of tactics, from scheduling procedures on weekends to redesigning “clinical operations to become significantly more efficient,” McKinsey writes.

One strategy will be to eliminate, where possible, processes that are time- and resource-intensive. Using single-use scopes instead of reusable scopes, for example, could facilitate higher volumes while at the same time reducing reprocessing costs.

Even as the pandemic eases, near-term healthcare will have its own burdens to bear — in particular, staff shortages and limited capacity — that may inhibit providers from significant scale-ups.

In terms of capacity, “it’s getting better all the time, but it’s a long way back to normal,” says Monish Rajpal, a managing director and partner at L.E.K. Consulting in New York. Many smaller hospitals continue to play catch up, he says, while larger systems lead the recovery.

“You do need a multipronged strategy, not just for dealing with the backlog,” Rajpal says. “You want to make sure that all patients who need surgical care are being brought into the fold — new ones and backlog ones.”

Holistic Strategies to Manage Backlogs Include Workflow Improvements

One in seven households were unable to obtain an elective procedure or surgery in 2020, according to a survey by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health. For providers, that translated to an average decline of approximately 35 percent in inpatient and outpatient operating room surgeries between March and July 2020, according to McKinsey’s survey of executives at 25 large U.S. hospital systems.

An August 2020 paper in the Annals of Surgery, which estimated a backlog of almost 5 million cases, emphasized that the problem goes well beyond volume. Delayed care is almost certain to increase both disease severity and costs of care — the latter an additional burden for hospitals and ambulatory surgical centers (ASCs) reeling from the pandemic’s financial impacts.

Accordingly, hospitals and ASCs should leverage every opportunity to make procedures more efficient and cost-effective, without compromising standards of care. As they do so, experts emphasize the need to develop comprehensive, well-planned strategies.

“While there are many good reasons to ramp back up quickly, it is important that speed does not overtake strategy,” notes an article in the Harvard Business Review.

Implementing flexible single-use endoscopes is one tactic that would eliminate costly, inefficient reprocessing so that providers can repurpose associated resources. Such a strategy aligns with McKinsey’s recommendation to “reimagine operating room and inpatient throughput to transform operational efficiency.”

Research has shown that endoscope reprocessing is neither efficient nor, in many cases, effective. A 2018 paper in Chest that studied high-level disinfection of bronchoscopes found that 58 percent of “patient-ready” reusable bronchoscopes were contaminated with bacteria or mold, and two of three sites studied displayed significant breaches of control standards.

The paper’s lead author, Cori Ofstead — an epidemiologist with more than two decades research experience — has also partnered with the International Association of Healthcare Central Service Material Management to analyze reprocessing procedures. In their 2018 research, 70 percent of sterile processing professionals said they were under pressure to reprocess scopes faster, and 34 percent said it was not possible to follow manufacturers’ recommended procedures.

In early 2020, the American Society for Gastrointestinal Endoscopy’s Infection Control Summit reviewed endoscope disinfection and reprocessing and recommended, among other solutions, expanded use of single-use duodenoscopes. When the COVID-19 pandemic began to surge in mid-March 2020, the American Association for Bronchology and Interventional Pulmonology released guidelines recommending that, if bronchoscopy is warranted during testing or treatment, physicians should use a disposable bronchoscope to protect patients and staff.

Single-Use Endoscopy Adds Value Amid Staff, Budget Constraints

In McKinsey’s study, providers cited workforce shortages as the top barrier to increasing surgical volumes. Many hospitals anticipate an employee shortfall in the wake of the pandemic, resulting from layoffs, COVID-19 burnout, the closure of private practices, and interruptions in medical education.

Where possible, minimizing the use of lengthy procedures such as endoscope reprocessing — which can comprise 50 to 100 complex steps and take two hours or more to complete — can help mitigate the effects of reduced staff. Single-use endoscopes also address the business need to reduce costs as providers seek to regain their financial footing post-pandemic. In addition to requiring fewer human resources, single-use endoscopes eliminate the need for reprocessing materials such as brushes, sponges, towels and PPE.

“COVID and the recovery from COVID, including the need to deal with the backlog, is a good reminder that there are more efficiencies that hospitals can focus on from workflow, procedure and patient perspectives,” says Rajpal.

As healthcare providers strive to manage the backlog, many will deploy multiple strategies to do so. In the process, they may see the most gains from solutions that are sustainable now and in the future.