While compassion and understanding are common traits of those who enter the healthcare field, there are few better examples of this in the biomed segment than can be found in a very specialized shop that is part of Intermountain Healthcare in Utah.
There are also few better examples of where a biomedical engineer has more direct contact with patients, while addressing their quality of life, than the Intermountain Homecare Home Medical Equipment Specialty Wheelchair Shop.
Intermountain Healthcare is a Utah-based not-for-profit system of 23 hospitals, 170 clinics, a medical group with 2,300 employed physicians as well as a health insurance company and other services.
The custom wheelchair shop consists of schedulers, inventory coordinators, seating specialists and clinical engineers who work in consultation with physical therapists. The shop is managed by Bryon Cheney and is part of the medical equipment branch of Intermountain Homecare.
The shop includes five clinical engineers who focus on building new chairs and repairing existing chairs. These clinical engineers report to Dustin Smith, MBA, who is Intermountain’s director of central support, clinical engineering.
“Intermountain’s shop is one of the largest custom wheelchair shops in the Intermountain West. Many patients from neighboring states are willing to make the trip to Utah to ensure their family member has a chair built just for them that will enhance their long-term quality of life. Intermountain has been exploring the possibility of having two wheelchair engineers travel throughout Utah to repair and adjust chairs as needed so patients don’t have to drive to South Jordan,” Smith says.
The shop provides custom new build chairs and maintains and repairs existing chairs.
“A lot of planning and critical thinking is needed to provide these complex chairs and mobility for the patient, including little things most don’t even consider. For example, a child might need a chair that would allow them to elevate enough to turn a light switch on and off, or to be close to the ground to play with other children,” Smith says.
He points out that most traditional chairs wouldn’t have this function, but by customizing each chair, a child can have the freedom to be a kid. The biomed and seating specialists work together to create a plan to allow the patient the best possible quality of life.
Smith explains that great care is taken to fit each chair to a patient’s needs.
“Some chairs are simple, while others have complex components that allow paralyzed patients more mobility and interaction with the world around them. From expensive components such as head arrays and eye movement technology to the simplest models, the wheelchair shop treats every chair and every patient as unique,” Smith adds.
Smith says that the clinical engineers on the team come from varied backgrounds and previously served on other teams within the Intermountain system.
“This caring bunch of individuals brings strong mechanical acumen and familiarity with electronics to their jobs. Their goal is to make sure each chair enhances the life of the patient who’s in it. They’re often commended for their excellent bedside manner and kindness in working with patients and their families,” he says.
It requires a combination of the skills that many biomeds possess along with a specialized skill set that has been developed through experience.
“Each chair is a unique environment for the patient. Some repairs are simple fixes that general biomeds could perform, but the scope of simple versus complex is where these engineers shine. As they work only on equipment from the wheelchair shop, they’re comfortable and nimble in finding solutions very quickly,” Smith explains.
He says that in some cases, when a patient is awaiting parts for their chair, an appropriate loaner chair needs to be improvised. The biomeds are a valuable team that make these interim loaners as capable as possible for the patients during their waits.
“Because each loaner is not just for the patient’s mobility, but is also the environment they spend significant time in, the engineers are very thoughtful of the importance of these chairs to the patient’s life. Through compassionate discussions with their patients, the engineers obtain important insights about the patients that might be otherwise be overlooked,” Smith says.
“Recently, an engineer was working on a repair on a patient’s chair while conversing with the patient. Together they discussed the inconsistent wear on the wheels of his chair. Through this dialogue the engineer was able to understand the environment in which the patient was living and make improvements to add stability to the wheels. This personal connection is vital to the team’s success,” Smith adds.
The biomeds in the shop are flexible and able to assist in other areas where needed.
“Due to their wide variety of knowledge and experience, these biomeds have the flexibility to assist in other areas of the homecare system, whether it be in setting up a hospital bed, repairing other home medical equipment, or working in the fulfillment center to get equipment to patients,” Smith says.
The close interaction between team-members and patients allows the clinical engineers and their colleagues to meet the patient’s unique needs.
“This team watches their patients grow and thrive. They have one patient who received her first chair at age two. Her insurance provider required proof the young girl could operate the chair. The team went into action to design a course for her to maneuver through. The training and test worked — she received authorization for her very own chair. This process also allowed her to become engaged and excited about her chair,” Smith remembers.
He adds that over the last seven years, her chair changed several times to meet her needs. Her chair opened up possibilities she’d never had before. She was able to play with other children on the floor thanks to the hydraulic lift that lowers her seat to floor level. It allowed her freedom to participate in many activities she couldn’t be part of before.
“When her chair was in for repairs, she was devastated she couldn’t play soccer with her loaner chair. After getting her chair back, she was so happy, she sent the biomeds a picture of her playing soccer with her team,” Smith says.
Occasionally, challenges aren’t always related to a particular design or patient. Sometimes inventory management requires creative thinking.
“As with many complicated pieces of equipment, custom wheelchairs have a fairly lengthy authorization process. In response, Intermountain Homecare’s customer wheelchair shop starts procurement while awaiting the authorizations, which has tremendously decreased wait times,” Smith says.
One possible consequence is that when an authorization isn’t obtained, restocking fees result from returning parts that weren’t authorized. To prevent those charges, some components weren’t returned, which caused the inventory to bloat,” Smith explains.
He says that in these cases, the team went into action: They reduced the parts inventory by roughly 30 percent in the last six months and contracts are being reviewed to eliminate or reduce restocking fees from their top six suppliers — which in turn makes a big difference in the profitability of the wheelchair shop.
In some cases, high-tech solutions must be integrated into the construction of a chair.
“Our wheelchair shop has supported one patient since he was two. He’s completely paralyzed except for eye movements and a slight tilt of his head. For the past 17 years, the team has customized his chair as his skill level increased to improve his quality of life. Through a joint effort with the engineers and seating specialists, this patient was fit with a head array in his early teens, which allows him to rock his head a quarter-inch to the side to communicate with his onboard computer. He began to write and create artwork in various computer programs. As he grew more accomplished, he was fitted with a retina sensor to give him more detailed control. He’s now attending college,” Smith says.
With great compassion, and a specialized skill set, the clinical engineers and their colleagues in the Intermountain Homecare Home Medical Equipment Specialty Wheelchair Shop improve lives one wheelchair at a time.
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