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Evidence-Based Maintenance: Part I: Measuring Maintenance Effectiveness With Failure Codes

Wang, Binseng ScD, CCE; Fedele, Jim AAS, CBET; Pridgen, Bob; Williams, Allan AAS, CBET; Rui, Torgeir Siv.Ing; Barnett, Leonard AABM; Granade, Chad AAS; Helfrich, Robert BS, MBA; Stephenson, Bobby; Lesueur, Dana AA, BSBA; Huffman, Timothy BSBA, CBET; Wakefield, John R. CBET; Hertzler, Lawrence W. BSEE, MBA, PE, CCE; Poplin, Brian DHA, FACHE, CBET

doi: 10.1097/JCE.0b013e3181e6231e
FEATURE ARTICLES

Although medical equipment maintenance has been well planned and executed for more than 30 years, very few studies have been conducted to measure and evaluate its effectiveness in terms of reliability and seriousness of failures. The lack of factual evidence limits the ability of clinical engineering (CE) professionals to revise maintenance strategy and improve the effectiveness of their work, as well as focus on the equipment and tasks that could provide the highest return for their limited resources. Using a small set of failures codes, data were collected from 8 hospitals for a period of up to 24 months, covering more than 40,000 pieces of equipment. Careful analysis of more than 62,000 work orders collected showed that the failures found for each type of equipment within a single hospital tend to converge to a stable pattern with less than 100 work orders. Furthermore, failure patterns obtained from different hospitals for the same equipment type seem to be within statistical variation of each other, although these hospitals may use different brands and models of equipment, in addition to obvious differences in user care and training, utilization intensity, and other environmental factors. The failure data collected were used to determine the probability of failure that will be used in subsequent papers of this series to compare different maintenance strategies adopted at different hospitals, as well as to determine additional opportunities for CE professionals to contribute to enhance patient safety beyond increasing equipment reliability through maintenance.

Although medical equipment maintenance has been well planned and executed for more than 30 years, very few studies have been conducted to measure and evaluate its effectiveness in terms of reliability and seriousness of failures. The lack of factual evidence limits the ability of clinical engineering (CE) professionals to revise maintenance strategy and improve the effectiveness of their work, as well as focus on the equipment and tasks that could provide the highest return for their limited resources. Using a small set of failures codes, data were collected from 8 hospitals for a period of up to 24 months, covering more than 40,000 pieces of equipment. Careful analysis of more than 62,000 work orders collected showed that the failures found for each type of equipment within a single hospital tend to converge to a stable pattern with less than 100 work orders. Furthermore, failure patterns obtained from different hospitals for the same equipment type seem to be within statistical variation of each other, although these hospitals may use different brands and models of equipment, in addition to obvious differences in user care and training, utilization intensity, and other environmental factors. The failure data collected were used to determine the probability of failure that will be used in subsequent papers of this series to compare different maintenance strategies adopted at different hospitals, as well as to determine additional opportunities for CE professionals to contribute to enhance patient safety beyond increasing equipment reliability through maintenance.

From ARAMARK Healthcare's Clinical Technology Services, Charlotte, North Carolina.

Corresponding author: Binseng Wang, ARAMARK Healthcare's Clinical Technology Services (CTS), 10510 Twin Lakes Pkwy, Charlotte, NC 28269 (wang-binseng@aramark.com).

Binseng Wang, ScD, CCE, is vice president, Performance Management and Regulatory Compliance, with ARAMARK Healthcare's CTS. He began his career in Brazil, working in academia, hospitals, and a large health system. In the United States, he was a visiting scientist at the National Institutes of Health and a vice president at MEDIQ. He earned a doctorate from MIT and certifications as CCE and ISO 9001 auditor. He has been elected fellow by ACCE and AIMBE.

Jim Fedele, AAS, CBET, is the CTS technology manager at Susquehanna Health System. He began his career in 1990 as an entry-level technician, became certified as CBET in 1992, and joined ARAMARK in 2004. Jim chairs many committees for the client and is the chair of the Quality and Standards Committee for ARAMARK Healthcare's CTS.

Bob Pridgen, was the CTS technology manager at South Georgia Medical Center, Valdosta Georgia. He is currently director of clinical engineering at Biomedical Equipment Solutions Today, Tallahassee, Florida.

Allan Williams, AAS, CBET, is the CTS supervisor at South Georgia Medical Center. He began his career as a technician in 1980 at Gilmore Memorial Hospital in Amory, Mississippi, and joined Service master in 1984 at Golden Triangle Medical Center, Columbus, Mississippi, as a technician and was later promoted to manager. He attended Itawamba Junior College and completed 11/2 years in prepharmacy before graduating with an AAS degree in electronics. Allan earned certification as CBET in 1984.

Torgeir Rui, Siv.Ing, is a consulting quantitative analyst with ARAMARK Healthcare's CTS. He has experience in the healthcare, energy, and automotive industries. He holds a master of science degree equivalent (Sivilingeniør) in industrial mathematics from Norwegian University of Science & Technology.

Leonard Barnett, AABM, is the CTS technology manager at South Shore Hospital in Weymouth, Massachusetts, since 2004. He spent 29 years servicing x-ray, computed tomography, and magnetic resonance imaging equipment. He was promoted to service supervisor and later as area service manager with Siemens Medical. He earned his associate's degree in business management from Northeastern University. He joined ARAMARK in 2003 to manage the imaging service in the Caritas hospital system.

Chad Granade, AAS, is the CTS technology manager at Phoebe Putney Memorial Hospital in Albany, Georgia. He began his career in 1995 and has filled the roles of both biomedical equipment technician and imaging service engineer. He holds an AAS degree and is expecting his BSEd in workforce education in the summer of 2010. Chad was also privileged to serve as both vice president and president of the North Carolina Biomedical Association.

Robert Helfrich, BS, MBA, is the CTS technology manager at Catholic Health East-St Mary's Hospital. He began his career as a technician and has held positions in both hospital systems and the healthcare service industry over the past 20 years. He holds a BS in biomedical engineering technology and an MBA from Temple University.

Bobby Stephenson, is the CTS technology manager at Conway Medical Center, South Carolina, where he has been for the last 14 years. He began his career in the US Army as a biomedical technician and has more than 30 years of work experience with various third-party service providers. He is a board member of South Carolina Biomedical Association.

Dana Lesueur, AA, BSBA, is the CTS technology manager at Enloe Medical Center in Chico, California. He began his career as a Biomedical Engineer in the Air Force and worked as an imaging and laboratory service technician for ARAMARK before being promoted to the current manager position. He holds an associate's degree in biomedical engineering and bachelor's degree in business administrative management.

Timothy Huffman, BSBA, CBET, is a district manager with ARAMARK Healthcare's CTS. Prior to present role, he was the CTS technology manager at Clarian North Medical Center in Carmel, Indiana. He began his career as a biomedical technician with the US Army and earned a BSBA at the Indiana Wesleyan University. He is a certified biomedical equipment technician.

John R. Wakefield, CBET, is the CTS technology manager at South Georgia Medical Center in Valdosta, Georgia. He began his career in the US Air Force as an electronic warfare technician and later as a biomedical equipment technician and has held positions in field service management and medical equipment management. He is a certified biomedical equipment technician.

Lawrence W. Hertzler, BSEE, MBA, PE, CCE, is vice president, Clinical Engineering, with ARAMARK Healthcare's CTS. He began his career as a technician and has held various management positions in hospital systems and the healthcare service industry. He holds a BSEE from Purdue University and an MBA from Washington University's Olin School of Business. He is a registered professional engineer and a certified clinical engineer.

Brian Poplin, DHA, FACHE, CBET, is senior vice president of Clinical Technology Services for ARAMARK Healthcare. He joined the company in 1994 as a technician and has progressed through the organization. A CBET trained in the US Air Force, he completed a BS in business administration and MS in management from Indiana Wesleyan University. Additionally, he holds a doctorate in health administration and policy from the Medical University of South Carolina and is an ACHE fellow with board certification in healthcare management.

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