Dr.Rawat ,Medical superintendent of multispecialty Hospital had tough time with financial head Mr.Swamy for seeking approval of spare part for Gastroscopy as total maintenance budget had exceeded the yearly projected budget. We face this kind of situation in most of the hospital.
One of the important cost head in hospital annual budget is on repair & maintenance. The challenge as medical administrator faces is lack of control on medical equipment maintenance cost .Even though the annual Operational budget is given to management, most of the time it is based on gut feeling of Biomedical engineering manager (also referred as clinical engineering manager) .There are forecasting techniques in statistics to address this issue but no attempt is been done to analyze the nature of complaints & there correlation with spare & accessory replacement.
Downtime is the period of time during which equipment is not in a condition to perform intended function.
The maintenance cost index is the ratio of total maintenance cost and equipment capital cost. The maintenance cost is the summation of cost incurred on equipment spares, repair and annual maintenance cost.
The Hospital Biomedical Manager should always ensure to have lower downtime for all medical equipment without increase of maintenance cost index. The historical data on medical equipment provides lot of insight to hospital team to address the issue on maintenance cost.
The following case study conducted in one of the leading tertiary care hospital in western part of India.The data analysis is carried out to know percentage of complaints related to each block of medical equipment as explained below.
The typical medical equipment consists of following blocks:
Stimulus: In many measurements, the response to some form of external stimulus is required. The stimulus may be visual (e.g. a flashlight), auditory (e.g. a tone) or direct electrical stimulation.
The Transducer: The transducer is a device capable of converting one form of energy to another. In medical equipment the transducer may measure temperature, pressure, flow, or any other variable that can be found in the body, but its output is always an electrical signal.
Signal-conditioning: The part of the instrumentation system that amplifies, modifies, or in any other way changes the electrical output of the transducer is called signal-conditioning equipment.
Display: The display equipment may include monitor or chart recorder to view the desired signal.
Recording, Data processing, and Transmission: This is used to record the measured information (e.g. Floppy disk, magnetic disk) for possible use later or to transmit it from one location to another in hospital.
Control devices: This usually consists of feedback loop in which the output from the signal condition or display equipment is used to control the operation of the system in some way.
The data on spare part replaced in non-operational equipment is collected for one year from equipment maintenance tracker software from multispecilality Hospital. The data analysis is carried out to know percentage of complaints related to each block of medical equipment. Based on the analysis, maintenance strategy was prepared by team of Biomedical Engineers & presented to hospital management.
The following are the important conclusions drawn from the above case study.
(1) The equipment failure due to electronic part is double than due to mechanical parts failure. In some of the area wherein equipment were nonfunctional had issues related to stable power & temperature. The matter was addressed with engineering team.
(2) The mechanical parts failure (like compressor unit in ventilator, gear assembly in film processor, motor unit in saw) can be reduced by identifying major mechanical parts for each medical equipment & prepare check list of same. In some equipment the preventive maintenance schedule was skipped. The Biomedical manager was asked to closely monitor PM schedule vs executed.
(3) In electronic parts of medical equipment, the transducers are highly susceptible for failure due to the fact that they do come in contact with patient and are handled by nursing staff & technician. Making nursing staff & technician understand the Do’s & Don’ts of equipment & routine calibration of transducers can reduce these failures. The continual training program should be prepared, coordinated & implemented by Biomedical Engineers.
(4) The electronic failures in other section can be reduced by regular routine preventive maintenance servicing of equipment as per standard checklist given in the service manual of medical equipment. The few examples of failure of electronic parts are failure of preamplifier section in ECG machine, motherboard in syringe pump, pressure transducer in patient monitor, hardiest of computer section of MRI etc.
(5) The Biomedical manager & medical administrator got clear views on which all area’s the biomedical engineering team can focus like user training ,adhering to preventive maintenance schedule, ensuring proper environment for equipment to function etc. The operational budget was done considering these factors into account.
It is suggested to perform similar analysis in your hospital to understand which all issue related to medical equipment to be addressed so that maintenance cost can be monitored and controled & maintenance budget can be properly forecasted.