There is only one hospital in Union County, Oregon; a county that covers 2,038 square miles and has more than 25,000 residents. The county’s main economic driver is farming and it offers hunting, fishing and camping for leisure. The hospital that serves the residents of the county is Grande Ronde Hospital (GRH). The hospital’s doors were opened for the first time in 1908. A new facility replaced the aging one in 1966. Additional construction in 1982 and 1992 extended the hospital’s footprint and offerings.
A small group of HTM professionals oversees the maintenance and repair of the hospital’s medical equipment.
“Our department consists of a combined clinical and facilities engineering group of 18 people,” says J. Michael Shepherd, BS, CBET, Biomedical Equipment Technician II.
“Of that group, there are three biomeds; myself, Leroy Shelman, and Stephen Jeffery. Our department manager, Elaine La Rochelle, is the Director of Facilities here at GRH and is a Certified Healthcare Facilities Manager,” Shepherd explains.
The department is responsible for equipment at the main campus and several satellite locations.
“In addition to the main hospital, we also provide service for our affiliated clinics,” Shepherd says. “These clinics include our regional medical clinic, regional medical plaza, children’s clinic, women’s clinic, sleep clinic, and hospice.”
As a smaller group of HTM professionals, circumstances require that the group be generalists and very flexible. The biomeds who make up the small contingent do have their areas of expertise.
“Being a small critical access hospital, we cannot afford to specialize too strictly,” Shepherd offers. “The needs of the job requires us to be able to overlap each other in most areas. That being said, there are some things that primarily go to one or another of us due to greater familiarity or training.”
“Leroy focuses on ECG, lab, and radiology. Steve focuses on anesthesia, thermometry and patient monitoring. My focus areas are patient monitoring/telemetry, ventilation and infusion,” Shepherd says.
The biomeds try as much as possible to provide in-house service on equipment for the convenience of the clinical staff.
“When an OEM or third-party service contract is required, it is normally the responsibility of the department to renew,” Shepherd says. “We provide oversight and coordination for service scheduling, however, in order to minimize impact on clinical care.”
Shepherd says that all three of the department’s biomeds are members of the Oregon Biomedical Association. Because of a reciprocation agreement, they are also considered members of the Washington Biomedical Association.
“In addition, I am also a member of the Intermountain Clinical Instrumentation Society as well as AAMI,” he says.
Beyond the Routine
The department has been involved in some special projects, both related to medical equipment and representing the HTM profession itself.
“Most recently, we were involved in the implementation of the Philips IntelliBridge Enterprise, allowing data from our vital signs monitors to be integrated into the EMR system,” Shepherd says. “Prior to that, we moved to an enterprise server for our infusion system.”
With the ever-evolving relationship and handoffs between CE and IT, the team at Grande Ronde has it figured out.
“We are separate departments, but have a fairly good working relationship with IT. Given the network intensive nature of modern medical systems means that collaboration is necessary from planning, through implementation, and finally to active use,” Shepherd says.
“There were two issues that we have had to address recently; both are incidences where the worlds of HTM and Information Technology interface,” he explains.
“The first was a problem with placeholder SSN issues,” Shepherd says. “When a patient, without a Social Security number is admitted, a placeholder of all zeroes is entered, as our ADT system requires SSNs. Our OB TraceVue system does not require Social Security numbers however, and when a patient is imported into the system, the all zero number is seen as a conflict, since it had been attached to the first patient to use the number.”
“With IT we stripped the SSN off of the ADT data on import into the OB system, then reattached the number on export to the medical records system with discharge of the patient.”
The team at Grande Ronde also used its problem-solving skills to solve another technology conundrum.
“Another issue was working between IT and Philips medical with regards to interfacing our vital signs monitors to the EMR,” Shepherd recalls. “The data moved between the two systems by way of the Clinical Data Interface, and had a great deal of issues getting the data across. Both sides were convinced that the problem was on the other side, and our unique position between the world of the clinical and the networking world let us see the problem with more detachment to let us find the message formatting issue that was preventing successful communications.”
Also, Shepherd has represented his team as he has become very involved with the alarm management task force at Grande Ronde. The task force was created in response to the Joint Commission National Patient Safety Goal of reducing alarm fatigue.
“HTM was considered a vital member of the team as we have the greatest knowledge as to the types of alarms that can be produced by different systems, which alarms are configurable, and the degree to which they can be configured,” he says. “I have been working with the nursing managers to identify the largest sources of alarm fatigue in each care unit so that we can address response.”
In a variety of ways, HTM professionals across the country have found ways to let the next generation of biomeds know about the profession. Many have found ways to bring about more public awareness of what biomeds do.
“This [past] spring was the first year that clinical engineering was asked to present at our hospital’s annual community health fair,” Shepherd says.
He ran a booth for the day, demonstrating a small selection of equipment to raise awareness about the HTM profession.
“I had a patient monitor, an oscilloscope, and a therapeutic ultrasound,” he says. “I used water on the ultrasound head to show the energy output. Kids especially found that cool, but most people seem to like an active display. It allowed me to explain the principles of ultrasound and the differences between therapeutic and diagnostic ultrasound, as well as how we troubleshoot and repair them. A large number of people were interested in how to enter the profession.”
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