We've been challenged with producing some cost saving ideas and I'm wondering if anyone has any ideas that we could share?
One thing I'm considering is knocking the 6 monthly endotoxin/TVC sample on the head in our community which costs us in the region of approx. £5k
I'm not sure what benefit we are getting from a token 6 monthly sample. All the machines have two diasafe filters which i have seen give zero CFU and TVC from raw tap water never mind RO water. We would continue to sample for metals etc.
Doing this will also save us sometimes on the minimum £95 charge that ALS enforce as we can hold on to the metals samples for a few days at least to gather enough samples to take us over the minimum charge. If we only send one TVC/Endo sample together with the mandatory suite test then we are losing around £30 a time because of the minimum charge.
As with any test, it is only as good as the moment it is tested - it could fail the day after and stay like that for 6 months. Taking the samples monthly in-centre still seems valid to me due to the length of ringmains snaking through the hospital wards and the number of patients connected to the plant at any one time.
Anyone any thoughts?
Manchester University NHS Foundation Trust
Have you ever calculated how much you save by using second hand parts ?
We saved about £15k over a couple of years re-using non critical parts from old machines.
We don't have contracts on any pre-treatment stuff like softeners or GACs as they are pretty easy to work on generally and much cheaper to do ourselves ( although we only have about 50% success rebuilding Fleck softener heads - we have the proper tools now so we'll see).
Am thinking of downgrading our main plant particle filters from Hytrex type to a cheaper one - but that isn't a big saving as we only use about 40 a year.
One of our consultants did a review of dialyser use and we found about 30 patients who, after reactions to polysulfone membranes, had been put on the most expensive dialyser available and didn't need to be. We may save about £40k by switching to a cheaper, non polysulfone dialyser for these patients.
Do you pay a licence fee for an asset management programme ? We developed our own which is great. Of course there is a risk as there is no support if our developer leaves.
Depending on what you do, there may be room for cost reductions for home installations. There seems to be a very wide range of costs.
We don't do any in centre machine sampling and rely solely on the endotoxin filters. I'm not sure if this is standard practice everywhere these days though as its clearly stated in the RA guidelines that there is no requirement.
We do take 6 monthly chemical samples form HHD ROs. Its only £45 for the mandatory, but I think like you say its probably not giving any great assurances. I'd have thought that the permeate conductivity would rise and (possibly!) hit the alarm point in time if chemical elements were passing. We had a meeting with ALS earlier this year and they scrapped the minimum fee for us!
Chris - We've always recycled our parts where we can but I've no idea how we can quantify the savings accurately as least.
We have a contract for our water plants however it's up to us if we get the company out to do any repairs - we've repaired leaking ABS in the past however we've since upgraded to steel so it should now be maintenance free. One thing I wish I knew how to do was rebed the GAC and the softeners. That's about the only bit of pre-treatment repairs that we usually get.
I'm pretty sure our particulate filters couldn't get much cheaper - we're paying around £4 for a 20" one. That sound comparable?
For non-polysulfone dialysers we currently use the Nipro range although there is already some argument between the medics that some patients are put on these unnecessarily. I'm unsure how the prices of the non-polysulfone ones differ so will look into that.
We recently looked at our home installations to see if we could make them cheaper so have trimmed them down as far as we can while still providing elements that we consider can't be compromised. A different manager may think differently though!
Steve - Our current sampling regime is one visit every 6 months to home patients to do the ALS mandatory suite and a TVC/Endo test. It's the TVC/Endo test that I'm debating on dropping due to historical trend data we have combined with the scientific rationale that I've convinced myself of :-)
In-centre we still sample TVC/Endo monthly and metals quarterly and I couldn't see that changing at the moment.
Matt - Will be interesting to price the two options together - currently we buy our service kits in bulk to obtain a discount. We know we're going to use them over a year so makes sense.
Thanks for the replies guys
Manchester University NHS Foundation Trust
Probably minimal savings but we use equipment annual microbiology samples to cover our ring return (clearly only viable if you have equipment without point of use filters). Not sure what ALS or others charge for endotoxin but we do in-house with Cape Cod Pyrosate at around £10 per sample so a lot cheaper than PTS but still gives us a fairly quick result if needed.
Alternative suppliers for plant filtration.
Third party for plant servicing (we haven't taken this step yet)
Not sure how many blood pressure cuffs you get through but others can be obtained much cheaper than equipment suppliers.