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Evidence-Based Maintenance: Part III, Enhancing Patient Safety Using Failure Code Analysis

Wang, Binseng ScD, CCE; Fedele, Jim AAS, CBET; Pridgen, Bob; 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

Journal of Clinical Engineering: April-June 2011 - Volume 36 - Issue 2 - p 72-84
doi: 10.1097/JCE.0b013e318214313c
FEATURE ARTICLES
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During the early years of clinical engineering (CE), CE professionals in the United States devoted a significant portion of their resources to detect failures through inspections (incoming and scheduled) and prevent failures through periodic parts replacement, lubrication, and other tasks (preventive maintenance), with the goal of reducing patient risks. With the rapid evolution of technology in the last 3 decades that increased medical equipment reliability, it is unclear whether CE professionals should continue to focus their attention on equipment failure detection and prevention or broaden their scope to enhance further patient safety. Using scheduled and unscheduled maintenance data collected for almost 2 years from 8 hospitals and a standardized failure classification method, 22 equipment types were analyzed in terms of actions that CE can undertake to improve safety: directly, indirectly, or in the future. For each of these 3 CE action groups, the risk associated with the use of equipment was estimated from the respective failure probability and severity of harm. The results show that, for most equipment types, CE professionals have reached the saturation point of what they can do to reduce risks, although some redirection of their attention from certain equipment types to others would optimize the use of limited resources. On the other hand, plenty of opportunities exist in helping the users and other allied health professionals to reduce risks significantly through further training, better communication, and better selection in future acquisitions.

During the early years of clinical engineering (CE), CE professionals in the United States devoted a significant portion of their resources to detect failures through inspections (incoming and scheduled) and prevent failures through periodic parts replacement, lubrication, and other tasks (preventive maintenance), with the goal of reducing patient risks. With the rapid evolution of technology in the last 3 decades that increased medical equipment reliability, it is unclear whether CE professionals should continue to focus their attention on equipment failure detection and prevention or broaden their scope to enhance further patient safety. Using scheduled and unscheduled maintenance data collected for almost 2 years from 8 hospitals and a standardized failure classification method, 22 equipment types were analyzed in terms of actions that CE can undertake to improve safety: directly, indirectly, or in the future. For each of these 3 CE action groups, the risk associated with the use of equipment was estimated from the respective failure probability and severity of harm. The results show that, for most equipment types, CE professionals have reached the saturation point of what they can do to reduce risks, although some redirection of their attention from certain equipment types to others would optimize the use of limited resources. On the other hand, plenty of opportunities exist in helping the users and other allied health professionals to reduce risks significantly through further training, better communication, and better selection in future acquisitions.

From the 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 Parkway, Charlotte, NC 28269 (wang-binseng@aramark.com).

Binseng Wang, ScD, CCE, is vice president of Performance Management and Regulatory Compliance at 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 Massachusetts Institute of Technology and certifications as a certified clinical engineer and ISO 9001 auditor. He has been elected fellow by the American College of Clinical Engineering and the American Institute of Medical and Biological Engineering. He is the recipient of 2010 Association for the Advancement of Medical Instrumentation Clinical/Biomedical Engineering Achievement Award.

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 a certified biomedical equipment technician (CBET) in 1992, and joined ARAMARK in 2004. Jim chairs many committees for the client and is a former 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 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 1 1/2 years in prepharmacy before graduating with an Associate in Arts and Sciences (AAS) degree in electronics. Allan earned certification as a CBET in 1984.

Torgeir Rui, Siv.Ing, is a 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 (Sivilingenioer) in industrial mathematics from the Norwegian University of Science and Technology.

Leonard Barnett, AABM, has been the CTS technology manager at South Shore Hospital in Weymouth, Massachusetts, since 2004. He spent 29 years servicing radiography, 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 a Bachelor of Science in Education (BSEd) in workforce education. 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 bachelor of science degree in biomedical engineering technology and a master of business administration degree 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. He is a board member of the South Carolina Biomedical Association.

Dana Lesueur, AA, BSBA, is a CTS technology manager with ARAMARK. Before this present role, he was 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 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. Before this 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 bachelor of science degree in business administration at the Indiana Wesleyan University. He is a CBET.

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 CBET.

Lawrence W. Hertzler, BSEE, MBA, PE, CCE, is vice president of clinical engineering at 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 Bachelor of Science in Electrical Engineering (BSEE) from Purdue University and a master of business administration degree 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 executive 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 earned a bachelor of science degree in business administration and a master of science in management degree from Indiana Wesleyan University. In addition, he holds a doctorate in health administration and policy from the Medical University of South Carolina and is an American College of Healthcare Executives Fellow with board certification in healthcare management.

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