The Other Side 11:
Interview with an Anaesthetist
Dr Jasmeet Soar is a Consultant in Anaesthetist and Intensive Care Medicine at Southmead Hospital, North Bristol NHS Trust. On Target talked to him about purchasing equipment in this key specialist area of secondary care.
1. What types of healthcare products do you purchase? What factors influence your purchasing decisions?
Over the past eight years I have been involved in the purchase of anaesthetic machines, patient monitoring equipment for operating theatres, recovery areas and the ICU, intensive care unit ventilators, defibrillators and infusion pumps and a variety of other devices.
Anaesthetists use a lot of different devices in their everyday work, and like most doctors always want the latest piece of new kit. The biggest factor that decides whether a piece of equipment is purchased is the cost. Those funding the cost prefer to buy the cheapest option that is clinically acceptable. Those using the equipment usually want to buy the one that is clinically the best for their patients. A happy balance needs to be struck.
It is vital that new devices are trialled, a range of opinions is sought, and a formal procurement process is used to purchase equipment. After all, in the NHS we are spending taxpayers’ money. Usually if the pot of money has been identified, a good procurement process will enable purchasers to buy more items of equipment than was originally planned.
In my experience of sitting on equipment committees, anaesthetists are fairly savvy when it comes to equipment compared with other doctors. They work hands-on with a wide range of equipment and devices on a daily basis in a number of settings. Understanding how equipment and devices work are a key part of anaesthetic examinations. Indeed, I would not be keen on buying something if I were not familiar with the principles of how it worked. It also has to be fairly intuitive in terms of which buttons to press or knobs to turn to make it work.
Equipment is usually purchased either through haphazard replacement as things break down or as part of a planned replacement programme. At North Bristol, we have a planned replacement programme based on knowing when current items will reach the end of their useful lifespan. The planned approach seems to ensure the best deals in terms of costs and servicing.
Purchasing of innovative equipment is always a big problem. Usually there is little in the way of good evidence and a lack of NICE approval or a Health Technology Assessment to support its use. These items usually only get in if there is a consultant with persuasive powers championing their cause. If they are purchased, the funding often comes from charitable sources.
Ideally, when we buy something we want to standardise to one particular type of equipment (e.g. anaesthetic machine, monitor). This means that training is easier and staff are familiar with using it. Having a hotch-potch of equipment that carries out the same function is not safe in my view.
2. What aspects of medical device sales and marketing do you find helpful? What aspects do you find unhelpful?
I find it useful to meet company sales representatives face to face to find out about the equipment. The biggest problem is usually agreeing on a time to meet. Sales representatives seem to have larger and larger patches, so some have travelled a long
way to see me. I often find it embarrassing when I end up being late because my list has overrun, or I can only give them a very short amount of my time.
I usually do not like it when representatives turn up unannounced to see me. A greater use of e-mail to send information on products would be useful for me, as it would enable me to tell the representative whether it was worth their time seeing me or not.
One of my biggest bugbears is compatibility between equipment in anaesthesia and in intensive care.
3. Is there anything in particular that sales and marketing professionals could do to meet your needs better?
In my experience, very few of the manufacturers ever provide as much support as they promised once you have purchased equipment from them.
4. What impact has the challenge of infection control had on your approach to purchasing?
The biggest impact of infection issues has been that more and more items have become single-use. For example, we now have disposable laryngoscope blades. Also, non-single use items have to be traceable, i.e. we need to know which piece of kit (e.g. laryngeal mask airway) was used on which patient. Single-use items are often not as good as the original multi-use item that they replace.
5. How are current changes in hospital practice affecting your medical equipment needs?
Procurement in many areas has now moved to groups of hospitals. Hospitals pooling together to buy equipment and devices should, in theory, cut costs. The downside is that individual clinicians have less say in what they get to use. This is happening more and more, especially for devices such as intravenous cannulae and syringes.
NICE guidelines about the use of ultrasound for central venous access have increased the use of ultrasound by anaesthetists in both theatre and ICU. As anaesthetists have become more expert in the use of ultrasound and start using it for other indications, e.g. nerve blocks or cardiac echocardiography, the demand for better ultrasound machines has increased.
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