Reusable vs disposable nasopharyngolaryngoscopes: Cost analysis and resident survey

Disinfection of flexible fibre-optic endoscopes out-of-hours: confidential telephone survey of ENT units in England - 20 years on

BACKGROUND

Flexible upper aerodigestive endoscopy is often performed in the emergency setting. To prevent nosocomial infection on-call clinicians must have access to decontaminated endoscopes.

METHODS

A telephone survey of 104 ENT units in England replicated previous cycles conducted 10 and 20 years ago. The on-call clinician was asked about decontamination practices, training and cross-cover.

RESULTS

Seventy-one clinicians participated of which 68 had an endoscope available out-of-hours. Twenty-five (36.8 per cent) used single-use endoscopes. Twenty-three (51.1 per cent) of the 45 clinicians using re-usable endoscopes decontaminated them themselves, an increase from 43.3 per cent in 2013 and from 35.1 per cent in 2002. Overall 91.2 per cent had safe practices, up from 68.7 per cent in 2013 and 48 per cent in 2002. One hundred per cent had been trained in decontamination, compared to 37.3 per cent in 2013 and 12.1 per cent in 2002. On-call clinicians from the ENT department increased to 91.5 per cent, compared to 63 per cent in 2013.

CONCLUSION

There has been a dramatic increase in patient safety, underpinned by the introduction of single-use endoscopes, increased training and reduced cross-cover.

Single-use versus reusable rhinolaryngoscopes for inpatient otorhinolaryngology consults: Resident and patient experience

Objectives

Single-use rhinolaryngoscopes were brought to market in 2019 as an alternative to traditional reusable scopes and have garnered interest across settings given portability and potential cost advantages. While single-use was previously evaluated compared to traditional devices, the overall impact to the consult experience for both users and patients has not been captured.

Methods

Eighteen residents performed consults with both single-use and reusable rhinolaryngoscope systems on alternating weeks. A five-question cumulative survey administered across three assessment points over a 12-week period using a five-point rating system to rate favorability. Residents and patients also completed four-point scale surveys following procedure(s) to capture the consult experience. Statistical analyses were performed to measure significance differences between survey responses between the two systems.

Results

Single-use rhinolaryngoscopes received higher overall ratings compared with reusables across each metric captured including overall consult time (4.3 vs. 2.2, p < .001), multiscope consults (4.4 vs. 3.1, p < .001), patient communication (4.6 vs. 2.1, p < .001), teaching opportunities (4.6 vs. 2.1, p < .001), and overall ease of use (4.7 vs. 2.6, p < .001). Residents rated single-use higher than reusable after each procedure in terms of ease of use (1.07 vs. 2.68, p < .001) and visual clarity (1.27 vs. 1.89, p = .003), while patients rated single-use higher for understanding of illness (3.9 vs. 3.1, p < .001) and understanding of treatment rationale (3.9 vs. 3.1, p < .001).

Conclusion

Resident and patient experience feedback favored single-use rhinolaryngoscopes compared to reusable scope technology across multiple surveyed measurables. Single-use rhinolaryngoscopes provide a viable tool for otorhinolaryngologist and other clinicians to perform rhinolaryngoscopy consults.

Level of Evidence

4.

Disposable versus reusable fibre-optic nasendoscopes: a national survey of UK ENT surgical trainees and a single-centre cost-analysis

BACKGROUND

This study primarily assessed ENT surgical trainees' preferences for the qualities of disposable and reusable fibre-optic nasendoscopes. Secondary aims included eliciting trainees' views on ENT surgery and climate change, and creating a single-centre per-use cost analysis for disposable and reusable fibre-optic nasendoscopes.

METHODS

A cross-sectional study was formulated. An online survey consisting of multiple-choice and Likert-scale questions was distributed nationally. Cost analysis was performed using 2021-2022 data from the host institution.

RESULTS

Twenty-four trainees responded. Data on disposable fibre-optic nasendoscopes showed no difference in overall satisfaction (p = 0.244). Reusable fibre-optic nasendoscopes had a lower cost per use compared with disposable nasendoscopes at 5 years (4.7 per cent reduction) and 10 years (7.1 per cent reduction). Of the trainees, 79.2 per cent were supportive of climate-friendly initiatives within ENT surgery, and 25 per cent felt supported by their departments.

CONCLUSION

Trainees' satisfaction with disposable and reusable fibre-optic nasendoscopes is similar. Cost analysis favours reusable fibre-optic nasendoscopes in the long term at the host institution. Empowering departments and trainees to pursue climate-friendly initiatives should be encouraged.

Disposable laryngoscope intubation to reduce equipment failure in an emergency out of OR setting - a quality control case study

BACKGROUND

Reusable laryngoscopes have been reported to be superior to disposable laryngoscopes with plastic blades during emergent intubations. Surprisingly, at our institution a quality reporting system revealed a high number of equipment failures with reusable laryngoscopes in an emergency out-of-OR (operating room) setting. As recent studies indicated an improved quality of disposable laryngoscopes, we hypothesized that a thoroughly evaluated disposable laryngoscope would result in less equipment failure in an emergency out-of-OR setting.

METHODS

To perform a more standardized and time efficient analysis, four distinct disposable laryngoscope blade/handle configurations were trialed during standard intubations (n = 4 × 30) in the OR by experienced anesthesia providers who completed a 6-question, Likert-scale/open-ended survey for product evaluation. The 'best' disposable blade was implemented in an emergency out-of-OR setting and equipment failure rates were monitored over a 3-year period.

RESULTS

Different disposable laryngoscopes were equal regarding sturdiness, illumination and airway visualization. The laryngoscope with the highest overall score was significantly higher scored than the laryngoscope with the lowest overall score. All disposable laryngoscopes were more cost effective than the reusable ones, and the top scored laryngoscope demonstrated the highest 5-year cost-saving ($210 K). Implementation of the top scored disposable laryngoscope into an emergency out-of-OR setting reduced the equipment failure incidence from high 20s to 0.

CONCLUSION

Disposable laryngoscopes are cost effective and superior to reusable laryngoscopes in an emergency out-of-OR setting. We demonstrate that the implementation of a disposable laryngoscope in the emergency out-of-OR setting resulted in a near elimination of equipment related quality submissions which ultimately enhances patient safety.

A cost comparison between reusable flexible and disposable laryngoscopes

OBJECTIVES

To compare the costs of disposable laryngoscopes to reusable scopes in outpatient and inpatient settings.

METHODS

The total variable and fixed costs involved in flexible scope reprocessing were collected from two general otolaryngology clinics, a pediatric otolaryngology clinic, and a children's hospital. Variable costs of disposable materials and labor were collected from 65 scope reprocessing events to identify the cost of reprocessing. Fixed costs of scope maintenance, monitors, video towers, and storage equipment were collected from financial records. Fixed and variable costs were analyzed to identify the cost per scope event. The costs were then compared to a theoretical model where disposable scopes were used to meet the volume demands of each clinic and children's hospital setting. The model of disposable scopes was generated after obtaining volume costs specific to each setting from a disposable scope company.

RESULTS

The average cost of a reusable scope model per scope event was $66.02 ± 4.49 at the three clinics and $130.66 at the children's hospital. The average cost of the disposable scope model per scope event was $152.55 ± 0.55 in the three clinics and $172.61 in the children's hospital. The cost differences were $86.53 ± 3.96 and $41.95 respectively.

CONCLUSIONS

In an outpatient clinic, reusable scopes are less expensive than a disposable scope model. In children's hospital inpatient setting, the difference in costs between disposable and reusable scopes is lower. When considering other non-economic factors, disposable scopes may be a feasible option, especially in the children's hospital setting.

New Medical Device and Therapeutic Approvals in Otolaryngology: State of the Art Review 2020

Objectives

To evaluate new drugs and devices relevant to otolaryngology–head and neck surgery that were approved by the US Food and Drug Administration (FDA) in 2020.

Data Sources

Publicly available device and therapeutic approvals from ENT (ear, nose, and throat), anesthesia, neurology (neurosurgery), and plastic and general surgery FDA committees.

Review Methods

Members of the American Academy of Otolaryngology–Head and Neck Surgery’s Medical Devices and Drugs Committee reviewed new therapeutics and medical devices from a query of the FDA’s device and therapeutic approvals. Two independent reviewers assessed the drug’s or device’s relevance to otolaryngology, classified to subspecialty field, with a critical review of available scientific literature.

Conclusions

The Medical Devices and Drugs Committee reviewed 53 new therapeutics and 1094 devices (89 ENT, 140 anesthesia, 511 plastic and general surgery, and 354 neurology) approved in 2020. Ten drugs and 17 devices were considered relevant to the otolaryngology community. Rhinology saw significant improvements around image guidance systems; indications for cochlear implantation expanded; several new monoclonal therapeutics were added to head and neck oncology’s armamentarium; and several new approvals appeared for facial plastics surgery, pediatric otolaryngology, and comprehensive otolaryngology.

Implications for Practice

New technologies and pharmaceuticals offer the promise of improving how we care for otolaryngology patients. However, judicious introduction of innovations into practice requires a nuanced understanding of safety, advantages, and limitations. Working knowledge of new drugs and medical devices approved for the market helps clinicians tailor patient care accordingly.