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Evidence-Based Maintenance: Part II: Comparing Maintenance Strategies Using Failure Codes

Wang, Binseng ScD, CCE; Fedele, Jim AAS, CBET; Pridgen, Bob CBET; Williams, Allan AAS, CBET; Rui, Torgeir Siv.Ing; Barnett, Leonard AABM; Granade, Chad AAS, BSEd; 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.0b013e3181f6b80b
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Almost since the beginning of clinical engineering as a profession, the need for scheduled maintenance (mostly safety and performance inspections) and its appropriate frequency have been debated extensively but could not be resolved conclusively because of the lack of comparable data. The combination of regulatory requirements typically based on manufacturers' recommendations and concern for patient safety discouraged experimentation by clinical engineering professionals and thus limited the possibility of comparisons within the same organization. Lateral comparisons among different hospitals have been difficult because of different computerized maintenance management systems, failure classification, and reluctance to share information. Using a small set of standardized failure codes, more than 62,000 work orders were classified by dozens of biomedical technicians at 8 hospitals for almost 2 years. These data were used to compare different maintenance strategies adopted for 7 types of medical equipment commonly encountered in acute-care hospitals. No prominent differences were found among the data collected from hospitals that adopted different maintenance frequencies, statistical sampling, and even run-to-failure strategies. Most of the small differences were comparable to the SDs calculated from the data for each maintenance strategy. These results suggest that it is justifiable to adopt a less resource-demanding maintenance strategy for most equipment types, except for the scheduled replacement of wearable parts that was outside the scope of this study.

Almost since the beginning of clinical engineering as a profession, the need for scheduled maintenance (mostly safety and performance inspections) and its appropriate frequency have been debated extensively but could not be resolved conclusively because of the lack of comparable data. The combination of regulatory requirements typically based on manufacturers' recommendations and concern for patient safety discouraged experimentation by clinical engineering professionals and thus limited the possibility of comparisons within the same organization. Lateral comparisons among different hospitals have been difficult because of different computerized maintenance management systems, failure classification, and reluctance to share information. Using a small set of standardized failure codes, more than 62,000 work orders were classified by dozens of biomedical technicians at 8 hospitals for almost 2 years. These data were used to compare different maintenance strategies adopted for 7 types of medical equipment commonly encountered in acute-care hospitals. No prominent differences were found among the data collected from hospitals that adopted different maintenance frequencies, statistical sampling, and even run-to-failure strategies. Most of the small differences were comparable to the SDs calculated from the data for each maintenance strategy. These results suggest that it is justifiable to adopt a less resource-demanding maintenance strategy for most equipment types, except for the scheduled replacement of wearable parts that was outside the scope if this study.

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

Corresponding author: Binseng Wang, ScD, CCE, 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 certified clinical engineer (CCE) and ISO 9001 auditor. He has been elected fellow by American College of Clinical Engineering and American Institute for Medical and Biological Engineering.

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 certified biomedical equipment technician (CBET) in 1992, and joined ARAMARK in 2004. He chairs many committees for the client and is the chair of the Quality and Standards Committee for ARAMARK Healthcare's CTS.

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

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 Servicemaster 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 1½ years in prepharmacy before graduating with an AAS degree in electronics. He 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 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, BSEd, 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. He 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, Conway, 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.

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 atClarian NorthMedical Center in Carmel, Indiana. He began his career as a biomedical technicianwith the US Army and earned a BSBA at the Indiana Wesleyan University. He is a CBET.

John R.Wakefield, CBET, is the CTS technology manager at South GeorgiaMedical Center in Valdosta.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 CBET.

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 variousmanagement 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 CCE.

Brian Poplin, DHA, FACHE, CBET, is senior vice president of CTS 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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