This can be a very difficult question to answer for many facilities. All too often it is a question that isn't asked at all. So how is this determined? This is ultimately based on the financial and technical needs of a facility. Here are a few points of consideration to help you make an informed decision.Financial Considerations:Regular maintenance costs. Even in the best-case scenario your equipment comes with a cost associated with wear due to usage. Angulation adjustments and bending rubber replacements are the most common "normal wear" issues for flexible endoscopes while rigid endoscopes commonly experience deteriorated seals and scratched lenses. No matter what, sensitive devices such as endoscopes will require regular maintenance to keep them in proper working order so don't make the mistake of thinking that by getting new equipment you won't have any associated maintenance costs.Look at your budget. Different facilities handle expenditures in different ways. New equipment may count against a general budget, departmental budget, specified new equipment budget, or possibly no budget in the worst case scenario. If your facility separates a new equipment budget versus a repair budget this decision can get easier. Ultimately budgets can prove to be the deciding factor when considering new equipment. Sometimes the bean-counters can be convinced to shift budgets around to accommodate for dire circumstances but this should probably be your starting point for making your decision.Do repairs or maintenance cost more than the device is worth? This is an easy one. If the cost of a one-time repair is more than an aging piece of equipment is worth then it is time to cut your losses and look at alternatives. Even if you can't afford to outright purchase a new scope there are often options for leasing or trade-in incentives offered by manufacturers which are worth looking into.Look at potential future repair costs.As equipment ages it will inevitably become more expensive to maintain. Parts availability and even technical expertise can become a factor in old equipment. If you are at the break-even point for repair costs this year chances are pretty good that you will be upside down the following year if nothing changes.Is your old scope simply unreliable?Sometimes you can be unfortunate enough to encounter a "trouble scope" (to be detailed later) where no matter what you do the scope is constantly malfunctioning in some manner. This leads to a lack of confidence in the scope and can result in cancelled appointments and lost revenue.Do annual repairs or maintenance cost more than a new device? You should ask your repair company for an annual report detailing the cost of all repairs performed on your scope over the previous 12 months. If the cost of maintenance for a scope in any 12 month period is in excess of the cost of a new scope then you have a good chance that you will benefit from purchasing a new scope.Technical Considerations:Maintaining existing equipment. If you have an honest and knowledgeable service provider they may be able to help extend the life of your old equipment and keep it in good shape. In many cases regularly performed maintenance can add years of life to your equipment. On the other hand, the exact opposite can happen if your scopes receive infrequent, ill-performed repairs from a disreputable service provider. This is one of the major factors which can have a substantial effect on the longevity of your scopes and it should be carefully considered.Requirements and new procedures (limitations of old technology). Medical technology is rapidly advancing. New procedures are constantly being developed and devices are being updated and improved on a regular basis to make procedures easier on patients and medical staff. Your old scopes may still be in acceptable condition but it is possible that they just aren't up to current standards. Sometimes equipment must be upgraded at regular intervals to stay relevant. Using a 10 year old endoscope and expecting it to perform like a new one isn't realistic; just like expecting a 10 year old computer to function like a new one isn't realistic. Yes, the device may perform the same basic function but it most likely isn't as efficient or effective. New scopes versus more scopes. Sometimes simply replacing old scopes with new ones will not be a remedy for your situation. If your facility does not have enough scopes to support the caseload then you will only end up with premature wear on your new equipment. Equipment manufacturers and reputable service providers can help you determine if your facility has enough scopes to handle your average number of procedures.What about safety? Minor failures on scopes are one thing but catastrophic failures can cause injury and undue suffering to your patients. Improperly maintained scopes in particular put your patients at more risk. There is an unfortunate temptation to use "slightly" damaged scopes when case loads are high and scope supply is low but the flaws in this way of thinking cannot be overstated. If a scope cannot be consistently maintained due to age or frequency of repair it is the facility's responsibility to replace the scope with a functional device.The trouble scope. The dreaded "trouble scope" is a scope that seems to be cursed in some manner because the perception is that it is breaking more than any other scope and because of that stigma it typically gets mishandled more and it becomes an endless cycle of break, repair, break, repair, break. Sometimes this is a simply the result of different systems failing in consecutive order on an aging device. Other times this is only a result of human psychology. Either way this can be an extremely frustrating situation which must be accounted for in your decision making process.Warranty coverage on a new device. This is a factor that is commonly overlooked when purchasing a new device. Make sure that you read and understand the warranty policy on any new device you are considering. You should pay attention to any exclusions and "fine print" that you may find. It is important to know these terms in order to avoid any possible misunderstandings or conflicts in the case of a potential warranty claim. There are many other factors which can affect whether or not you should go ahead and tackle the cost of new equipment. Each situation is different and you should take an individual approach to making your decision but if you take into account the considerations listed out here you will have a much better grasp on your situation.
