Machine replacement plan

[Ian Wilde]

Just wondering about the good old machine lifetime replacement plan...

I can remember the suggestions of 7 years before a machine should be considered for replacement.  

Now I believe the common census is more like 10 years?

However, providing that the machine is still well supported by whichever company it is made by why not just keep it going until it is no longer supported by the manufacturer?

An unreliable fleet would obviously cause problems if it meant a loss of dialysis to patients but with a good service regime in place I would imagine that the machines are no more problematic than new machines?  Most faults should be picked up during the machine's self test anyway so they could be swapped for a spare before a patient is even near it.

Just wondering what people's thoughts are especially when there seems to be little money knocking around for brand new equipment.  Is it scaremongering that forces us to change our machines or have people actually consulted their own facts and figures to see if the machines are actually less reliable?

Below is a table of machine data from one of our satellite units showing age of machines against money spent on them (spare parts only, no tech time or service kits included).  22 machines, unit open 6 days a week, 3 shifts a day.



Age wise some might say they are coming to the end of their careers but as a cost to the department, since having some serious investment during year 6 they are now no more costly than when they were 3-4 years old.  

We'll have an even better idea in 12-24 months of course but I'd be interested to hear what people have to say on the subject or what your own machine replacement plans are?

[Chris Bates]

Hi Ian,
After about 2 years and several capital bids and business cases we now have what is effectively a 7 year rolling replacement programme for 92 machines. (Not including machines at our 2 satellites run in partnership with the private sector).
We anticipate savings of approx 40k p.a. on spares to begin with as the new machines have a 3 year parts warranty. We are immediately replacing > 40 4008 machines aged 10-14 years, many with >60k hours.
We did a comparison and the 4008s were out of action approximately 20 times (!) as much as the 5008s.

The main push for this was an incident, which highlighted the excessive movement of machines due to breakdowns. Our director of nursing was very supportive and I can't believe we would have got this without her input.
Next year we will start replacing our oldest 5008s which will be 8 years old. These machines are still reliable but I think they might start to get expensive by the time they are 10 years old.
The business case was approved with costs based on 5 year leases, as I was told we wouldn't get 7 year leases any more. However we have managed to get 7 year leases which spreads the cost nicely.
All our machines in all units will now be able to be connected to the Fresenius TDMS/TMON system which will greatly improve our audit trail.

I believe there are other unit out there with rolling replacement programmes but I don't know how common it is.

Chris

[Ian Wilde]

Cheers for the reply Chris - you've certainly got some machines with spaceship miles on there!

I think you'll probably find that you are in the lucky minority to have a replacement program in place.

I can see how the warranty on new machines can ease the spare parts cost burden for a few years but what I'm trying to figure out is if it is better to spend ~£100k on 7 or 8 new machines or put that £100k into spare parts.  Even at Fresenius prices that's still going to buy me quite a lot of stock!

I'm just in the middle of crunching the numbers for our main hub machines to comare to our satellite figures above to see if there's any correlation.

I'll post the results when they're in.

[fraser gilmour]

We've had a rolling capital program in place now for all trust assets that's been running for a few years. Our finance dept. tends to favour outright purchase over lease agreements and our HD machines are set to depreciate fully over 7 years, RO's and chairs are set at 10. I asked for these terms knowing that they would be the earliest we could replace but would more than likely have to wait. We have equipment on the program overdue for three years now but have money ring-fenced for next financial year. We have also waited till consumables contracts are due to be signed to get some extra leverage.
One other factor I would consider is the ongoing improvements in software and hardware you will benefit from when replacing at more regular intervals.

Ian, are you able to pull these maintenance spend figures from a service database, or do they come from accounts? I'd love to have that info at my fingertips but we have no good way of identifying it

[Ian Wilde]

Hi Fraser,

Luckily for us our own in-house database has all these facts and figures available for extraction.

I have only got experience with the 5008 machine to go off but I know that software is relatively easy to upgrade as the years go by with them if required. Over the last 8 years I have seen certain parts for them modified some for better some for worse.  Apart from a warranty aspect the fight between buying new or just carrying on replacing parts is a tough one.

I suppose that when patient dialysis time starts to be compromised due to breakdowns then you have a problem but by then it could be too late to get funding for more equipment.  All I can see here in Manchester is that after 8 years this has yet to happen.  Could be luck, could be that they are well looked after, could be that they are just a good machine?  Its a toughie!

[Gerry Boyle]

Hi,
We have a 10 year rolling replacement program that makes it really easy for the accountants, we replace 10% of our fleet every year.   We currently have AK200 Ultra S and 5008 machines on this program; our ARTIS are a special case as they have accumulated much fewer runtime hours so we'll probably need to keep them in service for a greater number of years.

However by increasing the lifetime we are working outwith the latest RA guidelines that suggest 7-10 years and/or 25,000-40,000hrs (see below).  

Manufacturers in EU are required to support equipment for 10 years beyond the last date of manufacture.   The only problem I could foresee with extending lifetime beyond 10 years, apart from reliability, is if the machine is no longer manufactured and at 10 years beyond that date you might have a lot of equipment that you would then need to finance their replacement.

We also finance the purchase of equipment from capital expenditure and not leasing; what are the relative benefits?

Gerry






Renal Association Guidelines on Haemodialysis Equipment

Guideline 2.3 - HD: Haemodialysis equipment and disposables
We suggest that machines should be replaced after between seven and ten years’ service or after completing between 25,000 and 40,000 hours of use for haemodialysis, depending upon an assessment of machine condition. (2C)

[Chris Bates]

Thanks for the info Gerry - I missed that in the guidelines.
I have been looking for something official on lifetimes for ages.
Our machines will all have about 40k hours by the time they are 7 years old, so it looks like out new 7 year programme is about right. (assuming finance don't change their minds next year when I want some more machines.)
Regards
Chris