By Nikhil Kanamala
The area of clinical engineering in hospitals is dynamic and must always be changing to meet technological advances. Clinical engineering departments in hospitals must strive to perform preventive maintenance and repairs to ensure safe medical equipment for patients. They must also be aware of the advances in health care, the growing population of patients, nurses and physicians who are becoming more technologically “savvy” and the dynamic economic forces that influence hospital administrative decision making. As a result, the area of clinical engineering in hospitals must shift away from the normal paradigm of being a technical service department toward becoming more integrated with the clinical staff on the floor. Clinical engineering must understand patient needs and work toward meeting the clinical requirements.
The advances in medical device interconnectivity and e-health means that clinical engineering departments must understand the importance of how medical devices interact, transfer patient data (which can be vital for diagnosis) and how medical devices work together as a system. For example, a patient monitor may only be useful for taking the vital signs of the patient. However, the interconnectivity of the patient monitor with the hospital central database and the monitor central server means that all the patient data across all the departments can be stored for diagnostic purposes. Solving an issue, therefore, moves away from just fixing the patient monitor but rather finding the problem in the over arching system. This also means that clinical engineering departments must train staff regarding basic IT skills so that they can establish close working relationships with IT.
It is also essential, for the sake of patient safety, that the clinical engineering staff must always be aware of the latest advances in technology and regulations affecting health care. Staff must always be aware of unsafe equipment parts such as batteries that are overdue for replacement or equipment that has been recalled by a manufacturer. Staff must then work together with regulatory bodies such as Health Canada or ECRI to address malpractice by vendors and to ensure that patients are being diagnosed with the safest possible equipment that has passed all regulatory standards.
Clinical engineering departments must also be aware of the economic forces affecting health care. After all, being a department in a hospital, clinical engineers must know how to work hand in glove with the finance department to manage medical equipment that is cost effective for the hospital. This means that it is important for clinical engineers to understand the return on investment (ROI), the total ownership cost and the cost benefit analysis. For example, if an expensive piece of equipment such as an X-ray has reached the end of its life cycle, but it works perfectly well and passes all safety and functional tests, it may be more practical to prolong the life of the X-ray rather than replace it. On the other hand, an inexpensive pulse oximeter that has reached the end of the life cycle can be disposed of and replaced as the cost of ownership is very low. Another example is to understand that when equipment is newly purchased, clinical engineering departments must prepare themselves financially to deal with a high ownership cost during the initial quarter of the lifecycle due to frequent repairs and recalls. However, as the product matures, clinical engineering departments can expect a lower ownership cost as the repairs and recalls would decline due to better education of the clinical staff using the equipment and manufacturers fixing the recalls.
One of the critical steps toward advancing the area of clinical engineering in hospitals is to build relationships with key stakeholders – that is the clinical staff on the floor by educating them on safely using the equipment, information technology by gaining IT skills for better communication, finance, risk management by consulting with them regarding any safety issues regarding equipment and the risk classification and materials management.
While the points stated above are important in advancing the area of clinical engineering, it can never be overemphasized that the vision of clinical engineers must align with the vision and purpose of the hospital where they are located. In most cases, it must be to promote service of equipment, quality of patient care and innovation.
Nikhil Kanamala, BMET, works in biomedical engineering at Northern Health, Bulkley Valley Health District.
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