There is a city in Illinois where you can be assured that things won’t be erratic; it’s Normal, Illinois. The city is home to Advocate BroMenn Medical Center, a 221-bed not-for-profit hospital. Including its predecessor hospitals, Advocate BroMenn is more than a 100 years old. A heart center was added in 2003 and a major addition was added to the main hospital in 2012.
Keeping the health system’s 6,695 pieces of medical equipment up and running smoothly is the Advocate BroMenn Medical Center Clinical Engineering Department. The four-man department includes Site Manager Roger Kyrouac, Radiology II and shop lead Gary Ofenloch, Biomed III Tony Messier and Biomed II Kane Lim.
The department has always been in-house and was originally started in 1983 by Rob Koppenhoefer.
The team was originally composed of four members with one eventually rising to the role of vice president of Support Operations. Another left and established the tech support team for State Farm Insurance and another was Roger Kyrouac, the department’s current manager. The biomed hired to replace the member of the team who left is now the director of facilities.
“Clinical Engineering maintains a five-year capital plan and collaborates with appropriate leaders to update periodically throughout the year as part of our customer rounding,” Kyrouac says.
The department may be small, but they are still involved in project planning, medical equipment evaluations and procurement, regardless of the source. They repair and maintain an inventory of equipment with an acquisition cost of $40,754,246.
“All medical equipment entering our system, regardless of ownership, is checked and added to our database as appropriate with clinical engineering involvement; coordination, installation and/or assistance as appropriate,” Kyrouac adds.
“We utilize the TMS database from Four Rivers to primarily track devices, work requests and cost; several other data points secondary; [and] techs indirectly through usage of the database,” he adds.
In addition to the main hospital, the clinical engineering crew takes care of a 26-bed critical access hospital and 19 physician offices/clinics.
Collaboration and dealings with information systems and facilities is very cordial and the departments support each other. Integration with the information systems department is very good.
“We meet regularly and as needed; collaborate on all medical equipment related projects, procurements and service models; serve as each other’s wingman; have lunch together on a regular basis; and have developed strong professional relationships,” Kyrouac says.
Service contracts go through a multi-point evaluation before getting a thumbs up or thumb down.
Quotes first come to Kyrouac to evaluate. He then determines the service model to employ. Because of the department’s small size and the “remote status to the rest the system,” the determination is based on the service and technical demands of the device(s), the existing in-house skills and availability, manufacturer T&M versus contract options and optional third-party service(s).
“The analysis is discussed with the owner department leader(s),” Kyrouac says. “If a contract is deemed beneficial, the request, analysis and quote are forwarded to my director and support center team for approval and processing.”
“Clinical Engineering is an active member and resource on the Capital Approval Committee, the Construction/Projects Team [and the] Physical Environment Committee,” he adds.
Deciding on the Best Approach
“Change is the only constant and our shop has seen our share; right-sizing, down-sizing and re-engineering to name a few. We have been part of two mergers, the first with another local hospital in 1985, which allowed us to grow substantially. The second with the Advocate Healthcare System in Chicagoland,” Kyrouac says.
Kyrouac says that because the two health systems had such “common philosophies,” the department has had very few growing pains.
“We are now positioned very well to move forward against the headwinds of health care reform. We are very blessed to be part of a much larger group of skilled, knowledgeable, creative and insightful leaders and technicians. We are engaged in several strategic plans to enhance our ability to better serve our health care ministry,” he says.
Certainly, the department has done its share of holding the bottom line for its employer. Total annual budget to acquisition cost is an impressive 4.94 percent.
The team is involved with a new surgical and patient care expansion project at a facility in Eureka, Illinois. They have been instrumental in the equipment selection process. The project is a critical access hospital that is 30 miles away from the main site.
“There are two phases so far that I have had a great number of hours involved in and that is the equipment planning. We went through the initial equipment planning two years ago where we just set up some general guidelines,” Kyrouac says.
“Then, this spring, we had a series of some very lengthy and comprehensive meetings where we had some vendors present a couple of times and we worked out more details. Those were pretty intense, not getting through all the details, but planning the exact types of devices and where we wanted them and how we wanted them to work within our structure,” he adds.
The department will have yet another go-around to finalize on vendor selection.
Part of a Cooperative Team
The BroMenn system has gathered enough experience to provide equipment guidelines based on the project model, but the department has a lot of input into workflow. This helps with the spatial concept versus the layout displayed in the prints.
“Our construction leads are very good at that kind of thing as well,” Kyrouac says. “I unite the clinical piece to the construction piece. I can provide that additional liaison piece to our clinical folks.”
They also recently completed a large monitoring expansion project to assure sufficient CO2 monitoring capabilities for new protocols. The project did not come without challenges.
“One challenge was fully understanding, from both clinical and clinical engineering standpoints, how the roll-up of devices is going to impact the patient care,” Kyrouac says. “If all you want to do is CO2 monitoring, then there are not many devices out there that you are going to find stand-alone and to get a monitor that has the full functionality of CO2. You are also getting multiple parameters that you’re not going to be using.”
Kyrouac says that working with the vendors, to find the best fit and workflows for all areas, is a challenge that the department has tackled. The monitors, at the different locations, must tie into the EMR.
In addition to working with vendors, Kyrouac says that the department is very fortunate to have a “very strong, positive working relationship with facilities, information systems and construction.” He says that it is so collaborative that the lines are often transparent.
“Leading up to and after installation, facilities, IS and clinical engineering at our site are focused on what is the best possible service solution for this device or system,” Kyrouac says. More often or not, it is a collaborative thing. It is not whose bucket does it go into. It is; who is going to lead and then the others play supportive roles.”
The Advocate BroMenn clinical engineering team helps to make the whole model work.
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