Clinical Engineering Best Practices: Improve Patient Care and Control Costs 

As we developed our training seminar on clinical equipment maintenance and management best practices for the County Commissioners Association of Pennsylvania, it occurred to our team that other healthcare clients might like to see a short synopsis of best practices. While these concepts are not revolutionary, it often helps to compare your facility’s clinical equipment procedures with industry best practices.

The best place to start an analysis is maintenance and management. We identified five distinct areas for all clinical equipment management programs: policies and procedures (or equipment management plan), inventory identification and management, inspection and preventative maintenance, equipment repairs, and quality assurance. Implementing best practices in these five categories will lead to improved care, increased regulatory compliance, and a healthier bottom line.

Clinical Equipment Policies and Procedures

Policy and procedure documents create a blueprint on which to base your clinical equipment program. These serve as a written management plan describing the processes for managing the effective, safe, and reliable operation of clinical equipment. Policies and procedures are not static. They change as your organization grows and regulations change.

The components of these documents vary based on the specific needs of your patient care facility. For example, an acute care hospital will have different policies and procedures than a nursing home facility. In all cases, guidelines need to be established for issues such as: the selection of medical equipment, risk criteria, inspection and preventive maintenance strategies, processes for acting on recalls, processes for reporting equipment related incidents, emergency procedures, and regulatory compliance strategies.

Inventory Identification and Management

Inventory management is a very challenging and often overlooked issue facing clinical equipment managers. Understanding where equipment is located, how it is serviced, the age of each unit, and what is covered under warranty are just a few important items. Making a separate inventory of clinical equipment is wise, because the data needed to manage these assets is typically not included on the facilities plant ledger or other types of capital equipment lists.

The default inclusion criteria for clinical equipment inventories is simply to include all patient care equipment. However, this can be inefficient if low risk, non-critical items are included. It usually makes sense to develop specific criteria for determining which items should be included in the program. The criteria should be based on risk factors associated with the equipment and consistent with maintenance strategies, inspection frequencies and service levels. By selecting assets based on their clinical and physical risks, low risk items can be eliminated. This increases the efficiency of the program, allowing greater focus on items of greater concern.

Inspection and Preventive Maintenance

Inspection and maintenance of clinical equipment is often the most visible aspect of clinical equipment management. Identify appropriate inspection and maintenance strategies for all clinical equipment on the inventory to achieve effective, safe, and reliable operation. Include intervals for inspecting, testing, and maintaining selected equipment.

Different maintenance strategies can be deployed based on the unique attributes of the clinical assets and the staff. Interval-based inspections are the most common and are based on a pre-defined calendar schedule determined on risk. Other types of inspection procedures include metered maintenance, based on equipment usage, predictive maintenance, based on failure algorithms, and corrective-only maintenance, which simply entails fixing machinery when it fails. Corrective maintenance should not be the primary maintenance strategy for medium and high risk equipment.

Documentation of inspection and preventive maintenance is an important, but sometimes overlooked process, in the management of clinical equipment. A patient care organization can be performing inspections and preventive maintenance exactly as planned, but without proper documentation, regulatory agencies will find significant fault in the processes. A centralized database of inspection and preventive maintenance activities is essential.

Clinical Equipment Repairs

Though you may perform and document inspections and maintenance as planned, it is inevitable that some equipment will experience failure. Healthcare organizations need to identify and implement processes to handle equipment failures. The repair plan should included procedures outlining when and how to perform emergency clinical interventions. Additionally, make sure there is access to backup equipment and easy access to contact information for equipment repair services.

Equipment users need to understand the appropriate procedures to inform the repair staff of a problem. Designate a central contact to document the problem, quarantine faulty equipment, schedule repairs, and return the asset to service once the repair is complete. You want to ensure that  none of these steps is overlooked, as overall efficiency will be diminished and patient care may suffer.

Quality Assurance

The clinical equipment QA program supports the healthcare institution’s mission to provide a safe environment for patients/residents and care providers. A good QA program measures both quantitatively and qualitatively the best practices outlined in the previous four sections. It must be customized for each organization’s unique management plan.

Establish clear and measurable goals for categories you choose to measure. For example, you may set an inspection/preventive maintenance compliance rate for the clinical assets on your inventory list. Measuring your progress on a monthly basis will give you a good idea if you are meeting expectations.

QA programs should also be designed to help organizations analyze repair and inspection data to identify failures and general trends in asset management. Feedback regarding clinical equipment management can be relayed to physicians and nurses so they may improve the quality and safety of their medical device usage. Surveying physicians and other users on their perception of clinical equipment availability and operations is one example of an appropriate qualitative QA program.

Planning and Executing are Equally Important

Efficient clinical equipment maintenance and management is a process, not a one-time effort. The ultimate goal is to ensure quality care, but a properly executed management plan can actually help reduce costs as well. While the best practices outlined above are not revolutionary, the execution of those them is often challenging.

Success starts with well thought out policies and procedures documents as blueprints; then, each subsequent area must be addressed with equal dedication. If there is a chink in the preverbal chain, both quality care and cost efficiency diminish.