Medical Equipment Maintenance Research Articles

Low-cost mobile dental unit for oral care service delivery in third world countries: from concept to operation

In this paper, we design and implement two low-cost dental units in order to remedy the difficulties of its accessibility for healthcare services in hospitals and the difficulties encountered with the maintenance of medical equipment. In developing countries, income is low and a huge amount of people do not have access to basic dental healthcare partly due to the cost involved in the purchase and maintenance of imported dental units. In the present work, two varieties of dental units were designed and built using electronic, pneumatic and hydraulic circuits. The first one is a dental cabinet with an electronic command board and without a chair. The second is made of hydraulic and pneumatic systems as command with a foldable chair and a stand. The pneumatic and hydraulic systems enable the dentist to operate the instruments by hand and/or foot. The mechanical design of the two dental units was done in Inventor software. Both equipment types were installed in three healthcare centres in Cameroon and their initial social impact was investigated.

The effectiveness of the neonatal diagnosis-related group scheme

The goal of this study is to investigate the effectiveness of the neonatal diagnosis-related group scheme in patients affected by respiratory distress syndrome. The variable costs of individual patients in the same group are examined. This study uses the data of infants (N = 243) hospitalized in the Neonatal Intensive Care Unit of the Gaslini Children’s Hospital in Italy in 2016. The care unit’s operating and management costs are employed to estimate the average cost per patient. Operating costs include those related to personnel, drugs, medical supplies, treatment tools, examinations, radiology, and laboratory services. Management costs relate to administration, maintenance, and depreciation cost of medical equipment. Cluster analysis and Tobit regression are employed, allowing for the assessment of the total cost per patient per day taking into account the main cost determinants: birth weight, gestational age, and discharge status. The findings highlight great variability in the costs for patients in the same diagnosis-related group, ranging from a minimum of €267 to a maximum of €265,669. This suggests the inefficiency of the diagnosis-related group system. Patients with very low birth weight incurred costs approximately twice the reimbursement set by the policy; a loss of €36,420 is estimated for every surviving baby with a birth weight lower than 1,170 grams. On the contrary, at term, newborns cost about €20,000 less than the diagnosis-related group reimbursement. The actual system benefits hospitals that mainly treat term infants with respiratory distress syndrome and penalizes hospitals taking care of very low birth weight patients. As a result, strategic behavior and “up-coding” might occur. We conduct a cluster analysis that suggests a birth weight adjustment to determine new fees that would be fairer than the current costs.

Exploration on the emergency support mode of hospital medical supplies under the epidemic of NCP/ 中华医院管理杂志

Since the outbreak of Novel Coronavirus Pneumonia(NCP), hospitals have taken the fight against the virus as its own responsibility, and keep standing in the front line of epidemic prevention and control. The continuous input of anti-epidemic forces in hospitals also brings challenges to the medical supplies support, including the management of protective supplies and the maintenance of medical equipment. In the face of increasing security pressure, the medical materials support team broke the game on multiple fronts. Firstly, the team implements active material procurement strategy, sets material distribution priority according to risk level, releases materials uniformly based on stock and use, and implements traceability management of donated materials to ensure material supply. Secondly, centralized allocation management of equipment, emergency installation, advanced maintenance and emergency maintenance work is effectively completed. Thirdly, disinfection strategies for items and equipment are developed safely and effectively with the aid of disinfection equipment functions. At last, personnel management and training have been strengthened. These measures have provided strong support for the orderly prevention and control of the epidemic. Key words: clinical medical engineering; New crown pneumonia; Medical material support; Medical equipment maintenance

Ultrasound as a harmful factor of working environment for health workers

Materials on the features of effect of ultrasound on the health of medical workers engaged in the maintenance of medical ultrasound equipment are presented. Main directions for optimizing working conditions of medical workers and preserving their health are proposed.

Equipment Maintenance in Primary and Secondary Healthcare, Punjab

Healthcare systems and, more specifically, public sector healthcare systems are complex hierarchical entities. Delivering quality healthcare services is a challenging task facing several key hurdles. Equipment maintenance and availability is one of the key issues since the non-functionality of medical equipment degrades service provision in public sector hospitals. In this case, we discuss the situation of primary and secondary healthcare services in Punjab, Pakistan, focusing on the current condition of equipment functionality and maintenance across thirty-six districts of Punjab. The healthcare sector in Punjab is organized in a tiered manner, with primary health care facilities providing basic medical services to the masses and secondary healthcare facilities providing referral and specialized services to the patients. Providing medical services requires an efficient network of medical professionals, adequate medical equipment, physical infrastructure and sufficient supply of medicines at all levels of the healthcare system. This case identifies and discusses the issue of non-functionality and maintenance of medical equipment in Punjab. Demand for medical equipment is generated on a central and district level, followed by a combination of central- and facility-level procurement. Maintenance of equipment is done by the facility without any standard operating procedures. The purpose of this case is to observe the current maintenance options in practice and to assess the impact of a decentralized maintenance system on the functionality status of biomedical equipment across districts. The objective is also to highlight the need for an efficient maintenance regime in accordance with the nature of the equipment to ensure cost and downtime minimization.

Maintenance and management of medical equipment

Equipment management; maintenance

Requerimientos funcionales para el diseño conceptual del sistema automatizado para la trazabilidad del mantenimiento equipos médicos

Currently, healthcare uses very complex medical equipment, particularly for life-support. Although medical equipment helps to improve care, it is not without risks; events can occur as a result of failures, malfunction or user error. The Department of Biomedical Engineering is responsible for the management of medical equipment in Hospitals to guarantee safety and quality in patient care; nursing is not involved in this process. This paper proposes a methodology to identify the functional requirements to design a computer system, called Nursing Medical Equipment System (NMES) to support the traceability of maintenance, training and monitoring of medical equipment; to comply with one of the fourpronged approach policy concerned to medical equipment use, issued by the World Health Organization. A survey was conducted among 24 nurses from Intensive Care Units of three hospitals, from this survey and additional information provided by the Department Biomedical Engineering, the software components were designed. The conceptual design was based on the unified modeling language methodology and a three-tier architecture (client-server model) was proposed for its implementation. NMES consists of the following modules: inventory, track work order, maintenance logbook, quick reference, and technovigilance. NMES supports nursing staff to get involved in the functioning status of medical equipment, raise awareness in the nursing staff regarding the importance of having technical support from the DBE in their daily work process, in order to contribute to the continuous improvement of care delivered to patients.

Criticality-based reliability-centered maintenance for healthcare

PurposeMedical technologies and assets are one of the main drivers of increasing healthcare cost. The rising number and complexity of medical equipment have forced hospitals to set up and regulate medical equipment management programs to ensure critical devices are safe and reliable. The purpose of this paper is to gain insights into maintenance management-related activities for medical equipment. The paper proposes applying a tailored reliability-centered maintenance (RCM) approach for maintenance activities selection for medical equipment. Such approach will support assets management teams in enhancing operation, decrease risk and cost, and ultimately improve health of patients served by these equipment.Design/methodology/approachThe traditional RCM approach will be used with a focus on criticality reduction. By criticality, the authors refer to the severity of failures and occurrence. The proposed method relies on the use of reliability growth analysis for opportunity identification followed by a thorough failure mode and effect analysis to investigate major failure modes and propose ways to reduce criticality. The effectiveness of the proposed method will be demonstrated using a case of one of the leading obstetric and gynecological hospitals in United Arab Emirates and in the Gulf Cooperation Council region.FindingsThe case examines the relationship between the current practice of planned preventive maintenance and the failure rates of the equipment during its life span. Although a rigorous preventive maintenance program is implemented in the hospital under study, some critical equipment show an increasing failure rates. The analysis highlights the inability of traditional time-driven preventive maintenance alone in preventing failures. Thus, a systematic RCM approach focused on criticality is more beneficial and more time and cost effective than traditional time-driven preventive maintenance practices.Practical implicationsThe study highlights the need for utilizing RCM approach with criticality as the most important prioritization criterion in healthcare. A proper RCM implementation will decrease criticality and minimize the risk of failure, accidents and possible loss of life. In addition to that, it will increase the availability of equipment, and reduce cost and time.Originality/valueThis paper proposes a maintenance methodology that can help healthcare management to improve availability and decrease the risk of critical medical equipment failures. Current practices in healthcare facilities have difficulty identifying the optimal maintenance strategy. Literature focused on medical maintenance approach selection is rather limited, and this paper will help in this discussion. In addition to that, the Association for the Advancement of Medical Instrumentation supports the initiative of adopting RCM on a large scale in healthcare. Therefore, this paper address the gap in the literature for medical equipment maintenance and the work is in line with the recommendation of leading healthcare association. The paper also presents statistical review of the total number of received maintenance work orders during one full year in the hospital under study. The analysis supports the need for more research to examine current practice and propose more effective maintenance approaches.

An index to prioritize the preventive maintenance of medical equipment

We propose an index to prioritize preventive maintenance for medical equipment. Our index considers seven variables: type of equipment, equipment function, maintenance requirements, calibration, equipment age, equipment location, and equipment hazards. We developed a mathematical model using these variables, and its result is interpreted as an index of equipment maintenance priority. The numerical output of the index was classified into three categories: high, medium, and low priority. We proposed our index model to technical staff at the Department of Biomedical Engineering of the National Institute of Respiratory Diseases in Mexico as a protocol for scheduling appropriate preventive maintenance for medical equipment during the year. The index was tested in a sample of 16 different medical equipment. Our model provides a guide to define the priority and the number of preventive maintenance routines required for medical equipment per year.

Evidence-based medical equipment management: a convenient implementation

Maintenance is a crucial subject in medical equipment life cycle management. Evidence-based maintenance consists of the continuous performance monitoring of equipment, starting from the evidence—the current state in terms of failure history—and improvement of its effectiveness by making the required changes. This process is very important for optimizing the use and allocation of the available resources by clinical engineering departments. Medical equipment maintenance is composed of two basic activities: scheduled maintenance and corrective maintenance. Both are needed for the management of the entire set of medical equipment in a hospital. Because the classification of maintenance service work orders reveals specific issues related to frequent problems and failures, specific codes have been applied to classify the corrective and scheduled maintenance work orders at Careggi University Hospital (Florence, Italy). In this study, a novel set of key performance indicators is also proposed for evaluating medical equipment maintenance performance. The purpose of this research is to combine these two evidence-based methods to assess every aspect of the maintenance process and provide an objective and standardized approach that will support and enhance clinical engineering activities. Starting from the evidence (i.e. failures), the results show that the combination of these two methods can provide a periodical cross-analysis of maintenance performance that indicates the most appropriate procedures.Graphical abstractThe left side shows a block diagram of the process needed to calculate the proposed set of KPIs, starting from technological, organizational and financial data. On the upper right it is shown an example of scheduled maintenance analysis for a specific class of equipment (legend in the article body). The bottom right part shows how the KPIs can be implemented in a business intelligence dashboard.

Determining the Priority of Medical Equipment Maintenance with Analytical Hierarchy Process

The best quality of services provided by health care facilities can be realized if medical devices are in a reliable and safe condition. A large number of medical devices and the use of various types of medical devices have been a problem for hospital management to decide the level of priority in carrying out medical equipment maintenance. The purpose of the maintenance is to increase their availability and to reduce maintenance costs. This study aims to show how to determine the priority level of medical device maintenance based on the calculation of the criticality scores of medical devices. The criticality scores are obtained based on the assessment of criteria, sub-criteria, and grade by using the method of Analytical Hierarchy Process (AHP). The devices with higher critical weight take higher priority for maintenance than devices with lower critical weight. The approach was applied for 20 medical devices at the Out Patient Department of Eye Hospital in Jakarta to describe how to prioritize the maintenance of medical devices.

Research on Quality Evaluation System of Ultrasound Diagnostic Equipment Maintenance

In order to improve the quality of medical equipment after-sales service quality and improve the quality of medical equipment maintenance, this paper discusses the establishment of an evaluation index system to evaluate the quality of ultrasonic diagnostic equipment. From the three aspects of maintenance results, maintenance process and maintenance coverage, the quality of the post-maintenance quality of hospital ultrasound diagnostic equipment manufacturers is objectively evaluated.

Is it Possible to Build a Profitable Maintenance Business in the Market of Heavy Medical Equipment in the B2G Segment?

The relevance of the study is defined by the dramatic situation associated with the new high-margin medical device market in Russian Federation. The study shows the industry practice of heavy medical equipment maintenance2 and challenges in shaping the business model in conditions of legislative and regulatory gaps, an objective deficit of qualified technical experts and the poor quality of maintenance at public healthcare. The relevance of the article is formed by the absence of formal and informal rules of market performance. There is no consentience neither in the legislative, executive and judicial authorities, nor among the healthcare managers, suppliers (including Company’s subsidiary in Russia) and consumers (healthcare sites) of complex medical equipment. The problem is also dramatized by the black-market spare parts supply in Russia and the trend to its validation by the authorities. It’s difficult to embrace the phenomenon, to define values and goals, and specify ethical and practical results. Low development of theoretical economy rules at the new market cause the uncertainty of business compliance in the Russian Federation. The purpose of the study is to identify the basic theoretical foundations at the emerging market of heavy medical equipment that have an impact on the development of this innovative sector of the economy. The research item is presented as a KeyKis and defined as follows: Is it possible to build a profitable maintenance business at the market of heavy medical equipment (HME) in the B2G segment and guarantee its high-quality in the situation of legislative loophole? The answers could serve as a basis for development the legislative provision and maintenance guidelines, as well for forming managerial and marketing strategies for the company. The research methods consist in examining this phenomenon in a particular challenging situation in time, space and interrelation of key participants of the emerging industry market, including public and private stakeholders, domestic and foreign businesses, responsible and irresponsible characters. The case study (KeyKis) is based on authoring tools of academic economy that are applied in practice: the product matrix, the market carotid (3-D economy model), the amplified marketing strategy matrix. The research results show the mutual influence of stakeholders on the new market branch of medical technologies and business development opportunities at the heavy medical equipment maintenance market in Russian Federation. The practical importance of the paper is to facilitate the definition of difficult economic situation, provide guidelines for strategic processing and apply these tools to practical management.

Contracting in Medical Equipment Maintenance Services: An Empirical Investigation

Maintenance service plans (MSPs) are contracts for the provision of maintenance by a service provider to an equipment operator. These plans can have different payment structures and risk allocations, which induce various types of incentives for agents in the service chain. How do such structures affect service performance and service chain value? We provide an empirical answer to this question by using unique panel data covering the sales and service records of more than 700 diagnostic body scanners. We exploit the presence of a standard warranty period and employ a matching approach to isolate the incentive effects of MSPs from the confounding effects of endogenous contract selection. We find that moving the equipment operator from a basic, pay-per-service plan to a fixed-fee, full-protection plan not only reduces reliability but also increases equipment service costs. Furthermore, that increase is driven by both the operator and the service provider. Our results indicate that incentive effects arising from MSPs leads to losses in service chain value, and we provide the first evidence that a basic pay-per-service plan—under which risk of equipment failure is borne by the operator—can improve performance and reduce costs. This paper was accepted by Gad Allon, operations management.

Influential factors on medical equipment maintenance management

PurposeEffective maintenance management of medical equipment is one of the major issues for quality of care and cost-effectiveness especially in modern hospitals. An effective medical equipment maintenance management (MEMM) consists of adequate planning, management and implementation. This is essential for providing good health services and saving scarce resources. Considering the importance of the subject, the purpose of this paper is to extract the influential factors on MEMM using a qualitative approach.Design/methodology/approachDocuments review and interviews were main methods for data collection. Semi structured interviews were conducted with a purposive sample of 14 clinical engineers with different degree of education and job levels. Interviews were voice recorded and transcribed verbatim. Qualitative data were analyzed using a content analysis approach (inductive and deductive) to identify the underlying themes and sub-themes.FindingsFactors influencing an effective and efficient MEMM system categorized in seven themes and 19 sub-themes emerged. The themes included: “resources,” “quality control,” “information bank,” “education,” “service,” “inspection and preventive maintenance” and “design and implementation.”Originality/valueThe proposed framework provides a basis for a comprehensive and accurate assessment of medical equipment maintenance. The findings of this study could be used to improve the profitability of healthcare facilities and the reliability of medical equipment.

A Conceptual Framework to determine Medical Equipment Maintenance in Hospital Using RCM Method

Maintenance services are performed to ensure the equipment is operating according to manufacturer standard and maintained at a desired level of quality. The implementation of maintenance services may prevent unexpected breakdown and disruption of operations in a hospital. However, there were numbers of cases reported on the frequent breakdown of medical equipment even though the maintenance program is in place and practised. Therefore, the reliability of the maintenance services was questioned especially when the breakdowns occurred after the maintenance services being performed. This paper proposes a conceptual framework to determine the accurate maintenance program for medical equipment in the hospital using Reliability Centred Maintenance (RCM) method. The recommendation from the RCM will assist to identify the root cause of the breakdown and minimize the number of breakdown for medical equipment in the hospital. RCM process is known as one of the most effective maintenance approaches to reduce the number of maintenance activities and hence minimizing the cost of maintenance incurred.

Investigating Repeat Service Calls

Service on demand (repair) is a regular part of medical equipment maintenance. Repair can be approached as a 1-time situation of finding the problem and fixing it, or it can be approached as an integral part of keeping the medical device environment in full functioning condition at managed cost. The latter requires an organized commitment to not only repair but also determine why repair was needed and what if anything could be done to reduce subsequent failures. This is particularly the case for repeat service calls over an unexpectedly short period.

Function of the national big data platform for medical and healthcare management in medical equipments management

Medical services, medical insurance institutions, medical administrations, pharmaceutical and medical device manufacturers, pharmaceutical and medical device research institutes, and health-related service providers produce large amounts of data in the operation, which constitute medical and healthcare big data. Medical and healthcare big data is the important basic strategic resource of a country. The construction of the national big data platform for medical and healthcare management is of great significance to the development of healthcare in China, and will bring new development and change. Medical devices and equipments are essential to the provision of quality services, the lack of safe and effective and functional medical equipments will affect the quality of healthcare services, affect the diagnosis and treatment of patients, and even threaten the healthy development of the entire health system. Application of IoT technology and big data technology, and with the help of the national big data platform for medical and healthcare management, can solve many problems existing in the supervision and evaluation of medical devices, medical device adverse event control, hospital medical equipment maintenance (such as maintenance, condition monitoring, accident retrospective, evaluation and scrap) and medical device acquisition process, so as to improve the management efficiency and management level of medical devices and improve the efficiency of medical equipment production enterprises in product registration, after-sale service and adverse events protection. This process has a realistic driving significance and long-term strategic significance to our medical system. In this paper, the problems in the management of medical equipment in China were analyzed, and the function of the national big data platform for medical and healthcare management in medical equipment management were introduced and analyzed. Key words: Healthcare big data; Medical equipment management; Medical equipment registration; Medical equipment supervision

Failure mode effects and criticality analysis of medical endoscopes

Objective To determine the important functional units of medical endoscopes and provide a theoretical basis for improving the maintenance and repair of hospital medical equipment. Methods The units of medical endoscopes were analyzed by the failure mode effects and criticality analysis (FMECA) method to determine the important functional unit. The maintenance methods of the important functional units were proposed and compared with those obtained by a medical equipment repair company. Results According to the risk priority number (RPN) score> 36, the important functional units of the medical endoscope were determined as electrical interface, water bottle interface, suction interface, housing, chain, pliers pipeline, water gas pipeline, jacket, charge coupled device (CCD) glass, guided beam glass and nozzles. These units require clinical operators to focus on and perform regular maintenances. Compared with the results obtained by the company, human factors were considered as a greater impact on the reliability of medical endoscopes. Conclusions For clinical operators, the operation training of medical endoscopes should be strengthened to avoid human-induced failures. Key words: Failure mode effects and criticality analysis; Medical endoscopes; Reliability

Review in Maintenance Strategies for Haemodialysis Machine in Healthcare Facilities

Hemodialysis machines are critical medical equipment in healthcare facilities for renal replacement therapy in form of dialysis treatment on solving chronic kidney diseases in Sub Sahara Africa. It is a vital machine which acts as human kidney by incorporating electromechanical controlled extracorporeal blood paths that leverage pumps and semi permeable dialyzer membranes to filter the patient’s blood. The biggest challenge to the biomedical engineers in most African hospitals is to maintain the manufacturer’s safety and performance specification of the haemodialysis equipment. There is a need for effective maintenance strategy for haemodialysis medical equipment in order to maintain the manufacturer’s set specification to meet clinical expectations and hence improve its reliability. The overall goal of the research paper is therefore to analyze the influence of different maintenance strategies and subsequently improve on the reliability of hemodialysis equipment in healthcare institutions in Kenya. The research will prioritize hemodialysis machine as critical medical equipment and use comprehensive secondary data to review and analyze the strategic maintenance applied in health institutions to optimize the best and cost effective strategic maintenance for the hemodialysis medical equipment. The ant colony optimization (ACO) algorithms may be less expert reliant and avoid uncertainty and ambiguity to determine the best strategic maintenance management to manage hemodialysis medical equipment in the hospitals. The results will provide an opportunity to technical engineers to develop a predictive and intelligent management system in the hospitals to minimize or remove the Mean Downtime (MDT) and Mean time to repair (MTTR) for a failed hemodialysis machines and improve the reliability of the hemodialysis machine.