Before finalizing a CT scanner purchase, hospitals must ensure proper planning and consideration has gone into locating and maintaining the new system, according to an Oct. 17 webinar presented by the ECRI Institute.
Robert Maliff, MBA, director of the applied solutions group for ECRI, said the first choice to be made is where a new scanner will be located, as radiation oncology, surgery, critical care and emergency departments all may house the CT system. “If the radiology department is not adjacent to the emergency department (ED) physically within the hospital, it’s always a challenge to get those patients that present to the ED to a CT scanner.”
Departments outside of radiology may use a CT scanner, but that doesn’t mean the department was designed to accommodate the technology, warned Maliff. A radiology department is likely designed with radiation shielding for scanners, but often times this is not the case in the other areas of the hospital and this should be investigated early on as structural upgrades will need to be included in the budget if the scanner is sited outside of radiology.
Effective utilization analysis is also critical; otherwise a hospital could install a million dollar piece of equipment being used only twice a day. Maliff said this analysis should include the types of studies most likely to be performed. Routine diagnostic scans might only take 15 minutes, but biopsies and pediatric patients could take significantly longer, throwing a wrench into scheduling and utilization estimates.
Trauma cases present another kind of challenge, as they obviously require quick access to a scanner. Some hospitals anticipate this by padding the schedule with an open slot every couple hours, according to Maliff, allowing for scans to be moved around when a trauma patient presents.
Post-installation, the other major factor a hospital must consider is maintenance. According to Maliff, annual service contract costs could add 6.3 percent to 9.5 percent of the original acquisition cost each year, and while tube coverage might be the first expense to spring to mind, there are many maintenance costs that must be considered.
Providers should be aware of the fine print regarding labor hour limits and overage charges for extensive scanner use. Travel time for service reps—especially those heading to make repairs at rural locations—might translate into a bill for hours of service even if the actual repair took only minutes.
Negotiating service contracts at the point of purchase gives providers the most leverage, advised Maliff. He suggested being aggressive and asking for monthly or quarterly calculations of uptime guarantees—rather than yearly—as this will favor the hospital rather than give the vendor too much leeway.
There is always the option to have a CT service team in-house, added Maliff, though this option doesn’t work as well at facilities that have scanners from a number of different vendors. “[It’s a] great way to go if you have a base of similar equipment so you can go to one vendor's training program and get trained on a few models and do a lot of service up front so you don’t have to call the service vendor in all the time.”