By K. Richard Douglas
Pediatric hospitals in large urban areas often have a very large potential patient population, inclusive of the city and surrounding suburbs.
The North Central Texas city of Fort Worth is a prime example of a major city with a number of bedroom communities surrounding it. The former pre-Civil War army outpost has gone from hosting cowboys and cattle drives to museums and nightlife.
Serving the pediatric population of this vibrant city and its growing metro area is Cook Children’s Health Care System.
“We have two hospitals; 425-beds and a 105-beds, six urgent care centers and over 35 clinics in our Dodson multi-specialty building and throughout the community,” says Leo Velasquez, operations manager of clinical engineering and central equipment.
The large HTM department, which is comprised of two groups, also includes Director Sal Cruz. Like Velasquez, Cruz oversees the combined department that includes clinical engineering and central equipment.
In addition to Cruz and Velasquez, Rebecca Vega is contract and asset manager. Catina Hendrix is the group’s work control technician/dispatcher.
“Clinical engineering takes care of all medical equipment, all nurse calls, all beds, stretchers and cribs, all patient TVs and all patient room gaming systems,” Velasquez says.
He says that clinical engineering consists of four specialized team areas: the general biomed team consists of one BMET 3, three BMET 2s (one takes care of laboratory, one takes care of respiratory and one is the networking/monitoring specialist) and four BMET 1s.
The department’s imaging team has an imaging tech 3 and an imaging tech 2. The department’s surgery team resides in the surgical suites and consists of one senior surgery BMET, one surgery BMET 2 and a surgery BMET 1.
“We also have four full-time contractors that take care of central equipment assets (IV pumps, bili lights, SCD units and standalone monitors, and – since COVID started – about 200 powered air purifying respirators [PAPR] units) and one part-time contractor to service and administer our RTLS system,” Velasquez says.
He says that central equipment is the department that makes sure that all clinical areas have enough equipment to care for patients. They run three shifts 24/7.
The group also has one lead equipment distribution tech and 12 equipment distribution techs (four per shift). Their duties include cleaning and disinfecting movable medical equipment, assuring that PAR levels are maintained in clinical areas; acting as runners for special equipment pickup and delivery between departments and the sterile processing department. They also order special needs rental equipment for patients.
The central equipment team assists with finding medical equipment that is due for PMs.
Contributing to a Groundbreaking Surgery
The two teams that comprise HTM have tackled a number of projects in recent years, including assistance in a complex operation and challenges presented by the COVID-19 pandemic.
“Over the last several years, our clinical engineering/HTM department has been involved in large organization-wide projects that really showcased our value to the hospital,” Velasquez says.
He says that for 2020 and 2021, the hospital was deeply affected by the national shortage of PAPR products.
“We were unable to get more of the air hoods for the 3M PAPR units we had since all respirators were on,” Velasquez says.
He says that the biomed team designed and built an ultraviolet C (UV-C) room with racks and shelves that was modeled after one built by the University of Nebraska. It was capable of disinfecting PAPR hood and N-95 mask from viral and bacterial contamination.
This operation was 24/7 for one and a half years.
A new hospital, wing or OR is always a big project for HTM. In 2022, the team at Cook Children’s assisted in the preparation to open a new hospital in Prosper, Texas, 50 miles north of the main Fort Worth hospital.
“Our department, and especially our director Sal Cruz, were instrumental in many aspects of selecting, sourcing and installing the equipment into the hospital, even with severe supply chain issues, we were able to make sure that the hospital was able to open on time,” Velasquez says.
In 2023, Cook Children’s was the first hospital in North Texas to separate conjoined twins. The HTM team was instrumental in converting the single OR suite used into a double room that two surgical teams used to care for the separated twins, according to Velasquez.
Senior Surgery Biomedical Equipment Technician Jay Burton, CBET, became a part of the setup team.
“Earlier this year, Dr. Yamout approached the lead wanting assistance in setting up a second anesthesia machine in the OR in order to accommodate newly separated twins. Our OR suites are not designed to have two patients and all the devices needed to support them, so we had to come up with a plan,” he says.
Burton explains that the goal was to get two anesthesia machines working independently of each other, as well as getting two independent EPIC work stations functioning, all of this was needed to fit in an acceptable footprint to allow the required staff enough space to attend to each patient. Power, light, medical gasses and IT integration were issues that the HTM team addressed.
“The first anesthesia machine was easy because it, and the accompanying EPIC, was already established in the suite. In order to install the second anesthesia machine, we had to experiment with many different gas connectors, air connectors and hose configurations in order to find the right combination in order to fit all the needs of the staff,” Burton says.
EPIC was also needed on the second anesthesia machine. Because with only one EPIC assigned per room, they had to “borrow” a room number and add it the suite the procedure was being performed in. In order to accomplish this, they had to go to the IT closet and jump the communication cable to a communications port in proximity to the second anesthesia machine.
“After some testing and a couple of ‘dry runs,’ it was decided by all that our plan was sound and going to work. The conjoined twins were successfully separated,” Burton adds. “We did also open up a new medical office building to house our hospital associated clinics. Currently, we are now working on a project to make our central sterile processing Department compliant with new standards of critical water for sterilization (AAMI Standard ST108),” Velasquez says.
Team members have pursued certification and are involved in the local HTM community.
“We have six team members that are AAMI certified. We do have several techs that attend the local HTMA-NTX meetings/meet and greets,” Velasquez says.
The diverse skill sets of the HTM professionals with Cook Children’s keep children in north Texas healthy.