Maintaining Safety and Sustainability in EP

Francisco J. Pérez Gil, MD
Centro Cardiovascular Hospital San Lucas
Ponce, Puerto Rico

Francisco J. Pérez Gil, MD
Centro Cardiovascular Hospital San Lucas
Ponce, Puerto Rico

In an era of shrinking reimbursements from insurance companies and increasing costs, it’s becoming more important than ever to find innovative solutions to provide optimal patient care and remain profitable. In my experience as a cardiac physician, one of the most effective ways to foster patient safety while remaining fiscally sustainable is using a third-party reprocessor for single-use medical devices (SUDs).

My practice at the EP lab of Centro Cardiovascular Hospital San Lucas in Ponce, Puerto Rico has been running a successful SUD reprocessing program since opening in 2008. In 2011, the lab saved more than $152,000 through reprocessing, and is on track to increase savings for 2012 — all with no adverse impact on patient care. 

Reprocessing Beginnings

I began using reprocessed EP catheters during my residency at the University of Maryland and continued using them while practicing at Virginia Commonwealth University. My experiences working with leading physicians showed me the two-fold benefit of using a third-party reprocessor: the devices are as reliable and as safe as those of original manufacturers (OMs), at approximately half the cost.

As a physician, what made me believe in reprocessing was the strict regulatory guidelines requiring FDA 510(k) clearance to assure devices are substantially equivalent to OM devices. I am uncompromising in my dedication to patient safety, and reprocessed SUDs have always supported my vision for delivering top-quality care in the most sustainable way. Johns Hopkins researchers recommend that reprocessed devices have a reliable safety record of excellence similar to that of new equipment.1,2

The Association of Medical Device Reprocessors (AMDR) found that third-party reprocessing programs are employed safely at 100 percent of U.S. News & World Report “Honor Roll” hospitals.3 However, the same study found only 50 percent of U.S. hospitals have implemented reprocessing programs.3 This data reveals that half of U.S. hospitals are missing significant opportunities for supporting financial and environmental sustainability goals. 

Back to the Island

I enjoyed working on the east coast of the U.S., but I eventually decided to return home to Puerto Rico. I wanted to give back to the island and people who had given me so much. So, in 2008, I founded the EP lab at Centro Cardiovascular Hospital San Lucas. We are located in an area with nearly 2.5 million people, and we have the only dedicated EP lab in Puerto Rico. In 2012 we performed 1,300 cases in the lab, including 400 ablations, mostly implants.

Practicing medicine on an island — let alone starting a lab — comes with challenges. First, the distance from the U.S. mainland translates into higher shipping costs for some medical supplies. Second, the insurance reimbursements we receive are often less in Puerto Rico than in the continental U.S. for equivalent services. These two challenges necessitate implementing measures that can deliver maximum value at the lowest possible cost, while maintaining patient safety as the top priority.

My time in the continental U.S. enabled me to learn about the science and technology behind modern third-party reprocessing, and I leveraged these experiences successfully upon launching my practice in Puerto Rico.

Getting Others to Believe

Even with my positive experience in using reprocessed devices on the mainland, I encountered a common — and very dangerous — misconception at the new hospital. Colleagues believed reprocessing referred to in-house sterilization or cleaning, not an exacting process done by a third-party vendor and subject to strict FDA oversight.

The savings potential of reprocessed devices was too great to let this opportunity pass by due to misinformation. I was determined to educate my hospital staff as to why we needed to implement a reprocessing program. By working closely with our vendor, Stryker Sustainability Solutions, the EP lab staff and hospital administrators were able to receive specific information on reprocessing science and technology, the stringent FDA oversight, and the vast potential cost savings. In addition, the reprocessor was available to answer any questions and make sure all parties were confident moving forward.

By working closely with our representative, we were able to get buy-in from several key hospital administrators. In the end, all parties realized the cost savings and quality care possible by using reprocessed devices was too great to ignore. Our staff could feel the shared dedication and passion for sustainability while ensuring patient safety.

Reprocessing Takes Hold

After deciding to begin a reprocessing program, we worked with our representative to educate EP lab staff on the reprocessing cycles of the various catheters we use, from when the original device arrives to when it is collected, reprocessed, and returned to the hospital.

Our vendor collected all used EP catheters, regardless of reprocessing clearance, to minimize our waste and handling costs and limit disruptions to staff. The lab can be a high-stress environment, and we didn’t want to have staff spending time deciding whether or not specific catheters could be reprocessed.

Watching the Bottom Line

When the lab opened in 2008, we saw immediate results from the reprocessing program, and at year’s end, we saved more than $143,000. Since 2008, we have steadily improved our results, and in 2011, we saved $151,000.

Tallying the savings with the purchase and disposal of reprocessed devices, our lab is 20 percent more profitable than we would be if only using original medical devices — all without any additional capital investment. I am not aware of another initiative with a savings potential that rivals reprocessing. In the end, it comes down to our use of reprocessed SUDs, which allows us to operate a safe, profitable, and cutting-edge hospital.

Environmental Impact

Puerto Rico is at the forefront of the ecotourism movement and, as such, is committed to environmentally sustainable efforts. We are on a small island with limited room to dispose of waste.

By using reprocessed devices, we have significantly limited the amount of waste we put back into our ecosystem. In 2008, our reprocessing program enabled us to reduce our waste by 587 lbs. Since then, we have improved by 21 percent, diverting 751 lbs. from landfills in 2011.

Using Those Savings

Of course, none of these savings, economic or environmental, would matter if we had quality of care issues. In the end, patient safety has to be the primary concern.

Other healthcare professionals are discovering what my first-hand experience has shown me: using reprocessed devices does not negatively impact the quality of care patients receive. During my time using reprocessed devices, I have not had a single defective catheter.

I maintain the use of reprocessed devices makes us a safer hospital. The reason is simple: the savings generated are reinvested in quality-care initiatives including hiring more staff and providing continuing education opportunities. As a physician, this is more important to me than paying extra for original equipment that is no safer or more effective than a reprocessed device.

The Future of Reprocessing

Though we experienced initial reluctance from some staff at the hospital, third-party reprocessing is now a fully integrated process in our EP lab. It enables us to be an effective, profitable, and cutting-edge facility. But there is more we can do.

Given the success of the program in our lab, it is not surprising that the use of reprocessed devices is beginning to spread to other areas — both in our hospital and other hospitals we interact with. After all, success breeds intrigue.

I am passionate about truly sustainable healthcare, and, as such, often speak with others on the benefits of reprocessing — both at other departments within the hospital as well as at other hospitals. I share with them our detailed savings results, and the numbers are compelling. To date, I have convinced three other hospitals to begin reprocessing programs of their own. It’s a start, but for each department or hospital starting a program, there are more that haven’t yet made the change.

The use of reprocessed SUDs in our lab has made us financially sound. We are able to serve more patients, at lower costs, while delivering the same top-quality care. For us, sustainability doesn’t simply refer to green initiatives, it also refers to smart financial decisions, resource management and quality of care improvements.

Many hospitals are pursuing these sustainable practices and becoming more financially secure. However, more hospitals could consider making this move to help preserve the strength and longevity of our healthcare system. Take the time to research what reprocessing could do for your lab, and learn how it could make your lab into a more profitable and sustainable facility.


  1. Desmon, Stephanie. “Going green in the hospital will save money, reduce waste.” Johns Hopkins University - The Gazette. The JHU Gazette, 1 Mar. 2010. Web. 13 Aug. 2012. <>.
  2. Kwakye G, Pronovost PJ, Makary MA. Commentary: A call to go green in health care by reprocessing medical equipment. Acad Med 2010;85:398-400.
  3. Updated Press Release: Reprocessing Industry Overwhelmingly Supported by U.S. News & World Report’s 2011-12 Honor Roll Hospitals. Association of Medical Device Reprocessors, 28 Sept. 2011. Web. 13 Aug. 2012. <’s-2011-12-honor-roll-hospitals-2/>.