Dr. Syed Amin Tabish,FRCP, FACP, FAMS, MD (AIIMS)

Equipment Planning

When and why to buy what from whom for how much!

Avoid: buying what you don’t need for a high price and at the wrong time

Buying the right equipment, for the lowest price, for the right reasons and at the right time.

ME Technology Technology to improve clinical

outcomes, reduce costs, and improve quality of life for patients

Major asset of the health care industry: Year 2001, total medical devices sales

volume ≈ THB 15 Billion “Health care compression” Increasingly important to manage

medical equipment to contain costs and improve quality and performance

Why Plan? A significant portion of

equipment (i.e. 25%-50%) that exists in developing countries cannot be used

Main causes: Lack of funds Improper management

“Preventative Medicine” approach

ME Planning Cycle

1.Planning- What? When?2.Assessment- Why? Who?3.Acquisition- How? Cost?4.Disposition- What? When?

Equipment Life Cycle

Installation Acceptance testing and approval

Clinical Use Planned Maintenance and Unplanned Maintenance (Corrective)

Decommissioning/Disposition

Equipment Planning Cycle

Equipment Planning What? When? Systematic approach to determine the hospital’s equipment needs

Need a complete, accurate and up-to-date medical equipment inventory Purchase Cost Purchase Date Equipment Type Department Name

•Prioritizing equipment needs and determining equipment replacement;•Identifying how and when maintenance is to be conducted and how much this costs;•Utilization records;•Maintenance and repair records;•Acceptance testing;•Ease in locating medical equipment; •Minimizing safety risks

Medical Equipment Inventory

i. Clinical Effectiveness

ii. Cost of Ownershipiii.Strategic medical

technology direction

iv.Client and Medical Staff Perception

Planning Considerations

Clinical Effectiveness Availability (MTBF) – how often it breaks

Downtime duration Age - over 7 years very difficult to

get parts from anywhere – thus may result in longer downtimes

Accuracy/Effectiveness of diagnosis and treatment

Speed of procedure Spare critical equipment for

emergency use

Cost of Ownership Consumables consumption (cost, volume and usage frequency)

Speed (faster studies = more patient throughput)

Medical Expenditure Limit- Cost of Maintenance and Repair versus Replace

2nd hand resale value/trade in price

Strategic Med Tech Direction Equipment standardization-

bundled consumables/service contracts/ ease of user training, etc

Technology lifecycle of the equipment

Latest medical technology- marketing value

Connectivity- internally and externally

Mobility and portability- multi-location

Patient and Medical Staff PerceptionAgeAppearanceTechnical look/feel

Advantages of PlanningFacilitates introduction of new technology

Standardization of equipment

Coordinated purchasing approach

Multiple site/facility service contract agreements

Equipment Assessment Why? Who? Collecting data for assessment

Lifecycle cost analysis Historical utilization and consumption

data Installation and construction needs Manufacturers profile/background On-site demonstration, clinical trials

and bench tests Upgrading current

technology-“forklift” upgrade Alternative technologies

Involve All key stakeholders Well documented, transparent and

accountable

Advantages of Assessment Select the correct

equipment to purchase All the hospital’s requirements will be met

Quicken the assessment process for the same equipment type

Equipment AcquisitionHow? Cost?

Manage the acquisition process Investigate best acquisition option

Refining quotations from equipment suppliers

Negotiating with suppliers

Acquisition Options Purchase Outright Operating Lease Finance Lease Vendor financing Rental (pay per use) Revenue sharing Group Purchase

Group Purchasing Central body that manages the

purchasing process for it’s members Scope: medical consumables and

medical supplies, pharmaceuticals, and medical equipment

HIGPA reported “Health care providers report they save between 10-15 % by channeling purchases through GPOs, totaling USD19-33.7 billion in savings for 2002”

10% savings on purchasing in Thailand will result in a savings of ≈ THB 1.5 billion per year

Equipment Disposition Final step, but also the 1st step- medical equipment planning & lifecycle

Identification of equipment that can no longer serve its primary purpose

Assessment of a secondary and/or tertiary purpose within the hospital

Balance of the need for NEW versus USED

Disposition OptionsRelocationTrade-InSellDonateDispose/Scrap

Advantages of Managing DispositionEnsure complete and effective use of equipment

Asset is formally removed from the accounting records by Finance and Accounting

Example of an Annual Medical Equipment Planning Process

Med Equip Planning Process1. Initial audit of existing medical

equipment in the hospital [January – February]

2.Conduct a medical technology assessment for new and emerging technologies to fit with current or desired clinical services [March-April]

3.Planning for replacement and selection of new technologies [May-June]

Med Equip Planning Process4. Prioritizing for technology acquisition [July – August]

5. Provide input to the capital budgeting process [September-October]

6. Implement equipment acquisition and monitor ongoing utilization [on-going]

7. Dispose of equipment [on-going]

Example Short Term Project Profile all medical equipment in the hospital with a purchase cost above B500,000

Analyze utilization, technology trends, hospital’s strategic and clinical directions

Project their replacement costs into a 5-year capital expenditure plan

Take Away Message Medical equipment inventory

Complete Accurate Up-to-date

Set-up a Medical Technology Advisory Committee

Develop medical technology strategic direction

Message (contd)

Develop in-house medical equipment planning, assessment, acquisition and disposition policies and procedures

Develop a 5-year major medical equipment capital budget

Key Points Bio Medical Equipment and its

increasing use on a daily basis has played a key role in the advances that have taken place in Medicine in recent years. We need to remind ourselves that widespread placement and use of Electro Medical equipment that we now take for granted is a relatively recent phenomenon.

Key Points

It is not that long ago that Medical Equipment was only seen in very small clusters and even then only in high acuity areas such as ICU, CCU, Theatre, etc. In the modern hospital every department now has a compliment of sophisticated Medical Devices.

Key Points Effective placement and safe use

of Medical Equipment does improve patient care and enhance workflows, and certainly improves efficiencies. There are challenges though and these include effective Care and Maintenance of Equipment, User Training on an on-going basis to ensure effective and safe use of the equipment and your role in the unlikely event that something unforeseen happens that could or did contribute to a patient injury.

Key Points

Medical equipment, fittings and fixtures layout follows the work flow and must separate the “dirty” and “clean” zones.

Key Points

Height of hospital equipment, shelving and layout should allow easy access to hospital staff of an average height. The same goes for all diagnostic units, which should be suitably adjustable to cater to all heights/sizes of patients

Key Points While a great majority of medical

equipment is easy to relocate through attached wheels, this is not the same for larger medical equipment units such as MRI’s, and CT scanners parts of which are bolted to the floor or wall. Access and egress are both important. So thought needs to be given not just to facilitate the initial arrival and installation of these large/oversize medical units before the last wall is built, but also how to remove the equipment when it needs servicing or decommissioning and replacement.

Key Points

It pays to consider if these big units can be dismantled into smaller modules and whether the equipment can pass through the corridor corners? Are any trolley options available? Is the door large enough to accommodate easy passage of these units? Does it need to go in a lift? If yes, are the service lifts large enough to cater to the size and weight?

Key Points

Over and above the size/movement aspects of large hospital equipment, building structure is another aspect to consider well before the construction starts. The hospital X-ray unit, for example needs steel in the ceilings to provide the ceiling tracks on which the X-Ray head is mounted. Slab deflection and vibration requirements should be established with the equipment providers.

Key Points

Continuing with the example of the X-Ray, the X-Ray table, the head on the gantry, the wall mounted bucky, the control console and the generator all need services and floor trunking dimensions and locations should be provided to the structural engineers to plan that before the concrete is poured. Otherwise cutting out the trunking will be an expensive and time consuming job.

Key Points

Special hospital equipment also gets installed in stages, such as the theatre pendant and lights; the suppliers normally issue the steel plate at the construction stage which should be bolted to the concrete ceiling. The rest of the services and pendant is built just before the false ceiling goes up.

Key Points

Most advanced lasers and radiation equipment require interlocking doors as a safety measure, which is automatically turned on before switching on the said units, in addition to the warning lights outside the room

the medical equipment professional's functions

Equipment Control & Asset Management

Equipment Inventories Work Order Management Data Quality Management Personnel Management Quality Assurance Patient Safety Risk Management Hospital Safety Programs

Functions (contd) Radiation Safety Medical Gas Systems In-Service Education & Training Accident Investigation Safe Medical Devices Act

(SMDA) of 1990 Health Insurance Portability

and Accountability Act (HIPAA) Careers in Facilities

Management Service Contracts

Equipment Control & Asset Management Every medical treatment facility

should have policies and processes on equipment control & asset management. Equipment control and asset management involves the management of medical devices within a facility and may be supported by automated information systems

Control (contd) Equipment control begins with the

receipt of a newly-acquired equipment item and continues through the item's entire life-cycle. Newly-acquired devices should be inspected by in-house or contracted biomedical equipment technicians (BMETs), who will establish an equipment control / asset number against which maintenance actions are recorded.

Once a number is established, the device is safety inspected and readied for delivery to clinical and treatment areas in the facility.

Work Order Management Work order management involves

systematic, measurable, and traceable methods to all acceptance/initial inspections, preventive maintenance, and calibrations, or repairs by generating scheduled and unscheduled work orders

Work order management includes all safety, preventive, calibration, test, and repair services performed on all such medical devices

Data Required

Accurate, comprehensive data is needed in any automated medical equipment management system.

The data needed to establish basic, accurate, maintainable automated records for medical equipment management includes: nomenclature, manufacturer, nameplate model, serial number, acquisition cost, condition code, and maintenance assessment.

Data Required

Other useful data could include: warranty, location, other contractor agencies, scheduled maintenance due dates, and intervals. These fields are vital to ensure appropriate maintenance is performed, equipment is accounted for, and devices are safe for use in patient care.

Data Required Nomenclature: It defines what the

device is, how, and the type of maintenance is to be performed. Common nomenclature systems are taken directly from the Emergency Care Research Institute (ECRI) Universal Medical Device Nomenclature System.

Manufacturer: This is the name of the company that received approval from the FDA to sell the device, also known as the Original Equipment Manufacturer (OEM)

Data Required

Nameplate model: The model number is typically located on the front/behind of the equipment or on the cover of the service manual and is provided by the OEM. E.g. Medtronic PhysioControl’s Lifepak 10 Defibrillator can actually be anyone of the following correct model numbers listed: 10-41, 10-43, 10 -47, 10-51, and 10-57.

Data Required Serial number: This is usually found on

the data plate as well, is a serialized number (could contain alpha characters) provided by the manufacturer. This number is crucial to device alerts and recalls.

Acquisition cost: The total purchased price for an individual item or system. This cost should include installation, shipping, and other associated costs. These numbers are crucial for budgeting, maintenance expenditures, and depreciation reporting.

Data Required

Condition code: This code is mainly used when an item is turned in and should be changed when there are major changes to the device that could effect whether or not an item should be salvaged, destroyed, or used by another Medical Treatment Facility.

Maintenance assessment: This assessment must be validated every time a BMET performs any kind of maintenance on Equip

Quality Assurance

Quality Assurance is a way of identifying an item of supply or equipment as being defective. A good quality control/engineering program improves quality of work and lessens the risk of staff/patient injuries/death.

Patient safety

Safety of our patients/staff is paramount to the success of the organizations mission.

Risk Management Avoid the likelihood of equipment related

risks, minimize liability of mishaps and incidents, and stay compliant with regulatory reporting requirements.

The best practice is to using a rating system for every equipment type. For example, a risk-rating system might rate defibrillators as considered high risk, general-purpose infusion pumps as medium risk, electronic thermometers as low risk, and otoscopes as no significant risk. This system could be setup using Microsoft Excel or Access program for a managers or technicians quick reference.

Risk Management (contd)

User error, equipment abuse, no problem/fault found occurrences must be tracked to assist risk management personnel in determining whether additional clinical staff training must be performed.

Hospital safety Program

Safety includes a range of hazards including mishaps, injuries on the job, and patient care hazards.

The most common safety mishaps are "needle-sticks" (staff accidentally stick themselves with a needle) or patient injury during care.

Ensure all staff and patients are safe within the facility.

It’s everyone’s responsibility!

FUNDAMENTALS

Medical equipment is subject to damage and wear.

Regular maintenance and evaluation are necessary to assure that equipment delivers the expected performance within

specified parameters.

Equipment Maintenance Preventive Maintenance (PM) –

Medical equipment is subject to effective periodic maintenance

Service Contracts/Warranty – Manufacturers or a third party may cover specific ME under contract. This equipment is repaired and maintained by the

outside source. Upon receipt of their documentation, hospital reviews it and, if acceptable, enters it into the equipment management program history

Maintenance

Repairs - Clinical Engineering staff perform in-house repairs .

Manufacturers and other outside vendors conduct repairs of specific contracted

devices

Scheduled Maintenance Hospital defines intervals for inspecting,

testing, and maintaining appropriate equipment on the inventory (that is, those pieces of equipment on the inventory benefiting from scheduled activities to minimize the clinical and physical risks) that are based upon criteria such as manufacturers’ recommendations, risk levels, and current hospital

experience. All equipment included in the program is

inspected and tested prior to its initial use and at set intervals, commonly referred to as preventive maintenance