By Jim Fedele
Hospital-based biomed shops are often under a lot of scrutiny to save labor and find ways to be more efficient. One area that insidiously erodes labor is the support of offsite office practices. For us, and I would imagine other facilities, we have a hospital entity that recruits and manages physicians’ practices to support our hospital-based operations. This entity provides operational support to the physician practice in the form of IT systems, supply contracts, capital equipment needs, repair services, insurances, etc. We include these practices in our management program as if they are a hospital-based department, however I am rethinking that strategy due to some good growth in recruitment that is now taxing our labor resources. I am wondering how other biomed programs manage these differently.
We are charged with supporting these practices for equipment repair services, in general, we simply get a call to add a practice to our inventory. We are not usually consulted until after the deal is done. In most cases, the equipment is relatively minor, dated and in fair condition. However lately, we have added some specialty clinics that have had many expensive issues with their equipment. In most cases we don’t know the age, condition or service history of any of the equipment we are adding from these office practices and clinics. In general, the equipment is minor, like otoscopes, thermometers, scales, and possibly an EKG machine and hyfrecator. However, the specialty clinics we recently added had flexible scopes and video equipment. Most of it is very old and in need of repair. Which creates some unique budgeting issues when we normally develop budgets around run rate, and these are new expenses. My point is that the way the office practices repair services are managed before they join us is very different once they are part of us.
Another issue we contend with is the managing entity of these office practices also adds, removes and redistributes equipment without informing us. This causes us to spend a lot of time looking for that equipment trying to match it against a PM list. Between the driving time to and from these practices and the effort needed to find the equipment it feels like a lot of wasted time.
As I step back and look at the situation, I feel like I should consider a different equipment management approach. The equipment we are managing doesn’t really get preventative maintenance, we are merely doing functional tests. We are not performing tasks that extend the life of the device. Before we took over the service duties at the practice, they were likely running a run-to-fail model because of the service costs. Also, the office practice is doing preliminary diagnostic work, they basically prequalify patients for the more comprehensive and accurate testing they would get from a hospital or specialty service. Some do minor procedures, but these are generally low-risk procedures that do not rely heavily on medical equipment. I am thinking that an annual sweep of the practice might work better.
Sweeps could save time as we would not be chasing an equipment list and looking for specific equipment. We could schedule the sweeps after the practice closes, inspect the entire space, and document the equipment that was found and inspected and move on. This would at least save some time from trying to find everything that is on a PM inspection list.
Another idea I had is to just put them on a run-to-fail schedule. Don’t schedule anything and fix things when they are broken. However, there may be issues with regulatory compliance. And, in general, there isn’t an appetite to try this because people fear litigation and don’t believe it is safe. Even though before we took over that is likely what was occurring.
I am sure there isn’t a one-size-fits-all solution, I know some places have a field service team. Also there are third-party companies that sell inspection services to office practices. With our present growth and expanding geographical distance (some of our practices are two hours away), we will soon need to add labor if we keep our current plan. I am interested in how you manage the equipment, what are your considerations when deciding how to service these outside entities? As always, I am interested in your thoughts and opinions.
Jim Fedele, CBET, is the senior director of clinical engineering for UPMC. He magazines six Susquehanna Health hospitals. He has 30 years of HTM experience and has worked for multiple service organizations. The views expressed here are those of the author and do not necessarily represent or reflect the views of TechNation or MD Publishing.