Medical Equipment Layout Design in Hospital Facility Planning

The following are few examples of problems faced by Hospital authority while commissioning the new facilities wherever medical Equipment is involved.
 The new EMG system installed in Neurology Department was not able to perform test properly due to continuous artifacts as dedicated ground/earthling was missing.
 The brick walls of Mammography unit was found less than 9 inch & doors were not lead lined as it is mandatory to have same wherever X-Ray based equipment are used.
 The total six numbers of electrical sockets were provided per cubicle new cardiac Intensive care unit. It was found insufficient while in use on certain patients.
 The heater coil of Steam autoclave was repeatedly failing due to pH level of incoming water not within prescribed specification by service provider.
 MRI scanner getting aborted frequently due to increased temperature in equipment room against prescribed specification by service provider.
This is more common in Hospital’s where the inputs from Clinical Engineering Department are missing during facility planning stage. This may result in rework in the particular facility. The hospital should actively involve In House Clinical Engineers during any new/renovation of facilities construction.
The Clinical Engineer should review the following checklist after understanding requirement from Equipment supplier before providing inputs to Hospital project planning dept.
1. The patient factor:
a. Space for patient movement through trolley, Wheelchair into Equipment room.
b. Patient positioning during test with reference to interfacing of equipment with patient& also ensuring that patient privacy are maintained during testing.
c. Availability of services like medical gases, Nurse Call bell, Crash Cart with Defibrillator inside the equipment room.
2. The equipment electro-mechanical factor:
Exact location of equipment based on dimension of room, equipment footprint, location of periphery equipment and housing of cables.
a. Type (i.e., single phase or 3 phases, Raw/UPS / DG back up) & Number electrical points needed for equipment and periphery equipment based on power consumption of equipment.
b. Equipment grounding specification like need of dedicated grounding or hospital grounding.
c. Air-conditioning details to be provided based on heat dissipated in equipment operating temperature & % humidity level accepted by equipment.
d. Specific consideration like Piped Medical Gas System, dedicated computer network cable, exhaust fan, drainage duct, plumbing lines etc depending on type of equipment.
e. Government Statutory requirement with respect to equipment.
3. The material factor:
a. Provision in room to keep equipment accessories like patient electrode, probes, transducers, instruction & service manuals, spare parts.
b. Provision to keep essential drugs, medicines etc.
4. The Human factor:
a. Sitting positioning of equipment technician, nursing staff during patient test on equipment.
5. The Equipment maintenance factor:
a. Provision for keeping space in equipment room to carry out routine calibration by technician, preventive and breakdown service by manufacture service engineer.
6. The building factor:
a. Weight bearing capacity of building structure with reference to dimension and weight of equipment.
b. Interior of room like type of flooring, ceiling, lighting etc.
c. Compliance of equipment room as per government bodies regulation.
d. Routing of Equipment from landing at Hospital till arrival at designated room.
7. The change factor:
a. Includes provision flexibility in layout design considering possible up gradation of equipment.
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The systematic planning of all medical equipment area by Clinical Engineering Department in consultation with service provider & facility engineering will help Hospital project planning & execution team to reduce blunders during execution stage. This will help hospital to save cost in rework on account of change in MEP plan when equipment arrives to hospital site.

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Prelude-Quality for Hospitals

I will go one step back and want to evaluate whether our approach is correct to our quality journey. The most important step towards quality is to have a commitment from the top management and fixing the goal. This should be captured in the documents (policies, protocols & SOPs) in an appropriate manner. The preparation of the document should not be merely for fulfilling the accreditation criteria but should be followed sincerely. The main challenge is to change the mind-set of the hospital staff towards quality system and it’s the time consuming process which needs to be initiated from the first group of employees. Quality systems is not burden or to identify fault but to improvise and provide the best to the patients.

When we talk about manufacturing industries, the emphasis is on spending more time on planning so that the implementation would be with minimum defect. But in hospital setup we never follow this concept. All quality related activities get initiated after completing the hospital building and starting operations.

In today’s scenario the approach is very different. First a hospital starts operations and while working identify issues and these issues are addressed with temporary fix. Such fix gets routine, thus inspires the management to build a system. Remember such system which is inspired by temporary solutions will always fail. When it start impacting other areas and no way-out get identified, the management starts aggressively focusing on quality systems. This process of self-exploration leads to loss of valuable time and thus impacts the hospital services and financials. Admission & discharge process, OPD processes & infection control, Emergency response are such issue which are never a focus while building an infrastructure or even preparing and following SOPs.

The best approach is to incorporate Quality concept at the beginning of the project. We can’t dissociate it from business plan. By amalgamating efficient processes design and quality systems together, we can optimize cost and can build appropriate infrastructure for patients. This requires to be run from top and to be included in the vision.