Huge advances in device management

Tucked away in premises at Bedford Hospital’s site is an EBME department that has achieved a range of successes including improving patient safety, facilitating major cost savings, and assisting clinicians in trialling and procuring devices.

Particularly notable is the way in which the EBME team, under the leadership of its manager Stuart Norris, has participated in a Turnaround Process established by the Bedford Hospital NHS Trust to drive up efficiency and reduce expenditure wherever possible.

When, in 2006, the Turnaround Process was started, the EBME department quickly realised that continued focus on switching equipment maintenance and repair from external contracts to in-house activity would make a substantial contribution.

Proposals for this switching were put forward to the Trust, which, recognising the merit of “spending to save”, encouraged the fully resourced EBME department to implement its plans. The department team’s primary focus was to put forward ideas to rapidly achieve good recurring savings. Proposals for five EBME projects were put forward to the Trust’s Turnaround Process director, and all were approved.

The projects were to:

• Analyse and subsequently manage external maintenance contracts.

• Enable the switching, Trust-wide, to a different type of patient temperature reading device.

• Facilitate the introduction of blood salvaging equipment and arrange its maintenance.

• Design and implement an equipment library.

• Centralise the ordering and storage of consumables.

Four of the projects were completed within a target time of one year – the other, the establishing of the equipment library, was started and continues. The library arrangement is being progressively rolled out throughout the Trust.

Fully integrated

The EBME department is run, under contract, by EBME Ltd and the department’s activities are fully integrated into the Trust organisation under the umbrella of the Estates Management within the Directorate of Corporate Services.

EBME Ltd uses highly-developed systems for managing, maintaining and repairing medical devices. It provides continuous asset management, technical consultancy, cost control, cost reduction, and performance management.

The focus of the company is to assist organisations in the healthcare sector to follow a well-structured equipment management strategy, taking into account National Audit Office recommendations, required standards of clinical governance, and Department of Health guidance.

Before the EBME Ltd contract at Bedford commenced, medical device management was an activity shared by Trust staff concerned with administration, risk management and purchasing. “Although their medical devices were well maintained through external maintenance contracts, they didn’t have the specialist expertise that an EBME department could offer,” says Stuart Norris. “We have been able to provide a double benefit – improving the management of medical equipment and making cost reductions.”

Significant savings

The EBME team has made significant savings through cancelling or reducing third party maintenance contracts, ensuring Trust compliance with Standards for Better Health (S4BH) Standard C4b concerning the acquisition and use of medical devices, and has assisted the Trust reduce anti-litigation insurance costs by providing evidence of improved maintenance standards.

Sixty-four maintenance contracts were closely scrutinised, and the process of analysis resulted in 12 being cancelled and 13 revised – net annual savings of about £80,000 were predicted.

In the first phase, part of the 2006/2007 year, £41,000 was saved, training cost £30,000, additional staff resources cost £13,000 and test equipment cost £10,000. The overall cost was therefore £12,000.

In the second phase, the 2007/2008 full year, £159,000 was saved, £46,000 was spent on additional staff resources and £20,000 was allocated to a contingency fund for major breakdowns and service kits. The saving for the year, and annually recurring, was therefore £93,000 – it was acknowledged with satisfaction that the predicted net savings estimate of £80,000 had been well exceeded.

Notable was the way in which the switch was made to a different type of patient temperature reading device. Consumables necessary with the device that had been used entailed an annual expenditure of £40,000. The capital expenditure for the new devices was about the same figure, but no further spend on consumables was required – creating an impressive, ongoing, saving.

Cell salvage technology

The EBME department proposed the introduction of cell salvage technology to enable financial savings to be made with some surgical procedures. Cell salvage is now providing the Trust with a significant cost-saving benefits through lower use of blood products. Patients recover more quickly if they receive their own blood rather than donated blood during, and following, surgical procedures.

The equipment library’s role is being widely welcomed. It was ascertained that the Trust had, in many areas, too many items of equipment but that, often, frontline staff believed the equipment provision was inadequate. Items such as infusion devices “floated” from area to area, and were not easily located when needed – this tended to give the impression that simply not enough were available.

The establishing of the equipment library will measurably address the issue of ineffective deployment of equipment such as infusion devices, defibrillators, and monitoring equipment. Prior to the library being put in place, it was estimated about 60% of infusion devices were, at any one time, not being used. Stuart Norris comments: “It is difficult to quantify the savings of an equipment library. However, the library will certainly improve patient safety and can help speed up patient treatment.

“It will help us to know exactly where equipment is, how often it is in use, and how many devices we need. Also, if an alert on particular equipment is issued, we can immediately locate each relevant item and don’t have to carry out a sweep of the Trust’s premises. Any items of equipment which are damaged or faulty can be quickly dealt with.

“Users of equipment will no longer have to waste time locating equipment. One phone call to the library is all that is necessary – and the required device can be delivered five minutes later.”

He adds that the centralising of consumables, such as non-invasive blood pressure cuffs, ECG leads and pulse oximetry probes, is expected to yield annual savings of up to £20,000 through harnessing bulk purchasing power. Clinicians who are given assistance by the EBME team in trialling and procuring equipment, now realise the EBME role goes far beyond “fixing things”.

Ensuring compliance

The EBME department team has been working to ensure compliance with the S4BH Standard C4b. This is focused on medical devices and is concerned with evidence-based purchase, management and maintenance processes.

Put in place have been systems and processes for the acquisition and use of medical devices. These are updated as required to comply with MHRA safety notices, alerts and bulletins.

A clear policy has been developed and implemented to ensure that “single-use” medical devices are not reused. Established is a system of verbal and written notification of any damage to, or malfunction of, medical devices. All equipment is now labelled with an appropriate tag that contains all relevant details about the device, and that shows that the user has cleaned it appropriately before inspection or repair.

Modifications to medical devices are controlled as part of the department’s quality management system that satisfies ISO 9001:2000 criteria. Authorisation for modifications is given by the EBME manager.

The Trust has arrangements in place for the training of staff in the use of medical devices, and this training activity is subject to an annual audit. The EBME department’s training provides instruction to Trust staff, predominantly on infusion devices. Such training forms part of the induction process for personnel.

The EBME department is working steadily towards producing evidence that is required to help reduce anti-litigation insurance costs. An improvement in the Trust rating in this area indicates better patient care as well as achieving financial savings through lower insurance premium payments.

An accurate inventory of devices is held by the EBME department on a management database, and a rolling replacement programme for devices has been created.

All medical devices are properly maintained, and a history of maintenance and repair for each device is held on a database. Management reports are produced and reviewed, enabling the EBME department to establish clear objectives.

All proposed new equipment purchases are assessed by EBME and infection control departments to ensure they are standardised, fit for purpose, and easy to maintain and decontaminate.

Management information generated in all areas is channelled to the Trust’s Medical Devices Group and upward reported to the Trust’s Patient Safety Committee – monitoring of effectiveness of activities is thereby ensured.

Conclusion

An evaluation of equipment maintenance arrangements, especially for equipment in anaesthetics and patient ventilation, provided a clear case for maintenance and repair to be conducted “in house” and opened up ways for EBME staff to advance their careers.

The department restructuring and the expansion of maintenance responsibilities were assisted by the adopted quality management system meeting ISO 9001:2000 criteria. The system has been running for some four years, with improvements continually made. It is noticeable that the standard and reliability of medical equipment have been significantly improved. Unquestionably, the success of the EBME’s projects has been due to cohesive teamworking within the department, which has closely consulted with the Trust.

Currently, the department is looking at further areas of cost reduction, and expanding service provision into the area of radiology. Within this area, the department hopes to enter into “partnerships” with manufacturers who currently conduct maintenance and repair activities under contract. The intention is for EBME staff to receive appropriate training to carry out “first line” maintenance/repair of radiology equipment.

Phil Eagles, head of estates at the Trust, stated that it was clear the valuable work undertaken by EBME Ltd with the Trust had raised standards while also contributing to the cost-efficiency programme.

Award won
By demonstrating its outstanding progress, the EBME department at Bedford Hospital NHS Trust won, earlier in 2008, the UK’s first Clinical Engineering Team of the Year Award. The department, in its winning entry documentation, outlined how it had contributed to the Trust’s Turnaround Process and clearly showed the benefits of a programme of costeffective improvement projects for the maintenance of medical equipment. The Clinical Engineering Team of the Year Award scheme was launched by Welch Allyn, a leading manufacturer of frontline medical products and solutions, to reward clinical engineers for their significant and often underrecognised contribution to healthcare in the UK.

EBME departments are currently being encouraged to enter for the 2009 Clinical Engineering Team of the Year Award. Details about the entry criteria can be obtained by sending an e-mail to clinengteam@hsdcomm.com

Trust provides full range of services
Bedford Hospital NHS Trust provides a full range of acute hospital services and has a high-tech cancer centre – the MacMillan Primrose Unit. Other advanced departments include a cardiology suite opened in 2005 and an ultra-modern pathology laboratory completed in 2006.

The Trust emphasises how it is proud of its tradition of service, the high standards of which regularly secure the organisation local and national awards for care at both clinical and support levels. The Trust has a reputation for excellence in cleanliness, meeting waiting time targets, and in the way information is provided for patients.

Stuart Norris
Stuart Norris, EBME manager, served in the Royal Air Force for 12 years, initially as a ground electrical technician for four years and subsequently, after six months of intensive training, as a medical and dental equipment technician. After leaving the RAF, he managed the EBME department at East Surrey Hospital, Redhill, and went on to become the chief medical electronics officer at Wrightington, Wigan and Leigh NHS Trust. He took on his role at Bedford in July 2003.