By K. Richard Douglas
On the first Saturday in May, the eyes of the nation are upon one legendary horse track and race that takes place at the storied Churchill Downs. The grandstand is packed, and the infield is standing room only, as the thoroughbred horses take to the track. Mint juleps and extravagant hats are as plentiful at the Kentucky Derby as the “poke” that dots the landscape in eastern Kentucky. This event draws the nation’s attention to the city of Louisville every spring.
On a local level though, while the Kentucky Derby offers a brief economic impact, health care needs are ongoing. This is where Norton Healthcare’s mission is felt. It is a mission that finds its roots in a faith-based heritage with volunteers and contributions for the establishment of the original hospitals coming from the Episcopal Church, the Presbyterian Church, the United Methodist Church, the United Church of Christ and the Roman Catholic Church.
Today, the health care system, that originated in the post-Civil War period, serves patients in Kentucky and Indiana through five large hospitals, 13 Norton Immediate Care Centers and more than 800 employed medical provider offices.
The system’s clinical engineering department handles the equipment at these sites by relying on more than 40 team members. The department includes technicians, specialists, administrative support, management, and an executive. Several members of the group are CBETs and one person is a CHTM.
“The entire CE operation is a system function with centralized leadership on the main campus and distributed team leads for each campus. There are two divisions within CE, each with a director,” explains Neil Feldmeier, MBA, director of Biomedical Engineering.
Feldmeier says that one division is Biomedical Engineering, which services general biomedical equipment and is responsible for CMMS administration and AEM program design. The second is Imaging and Ancillary Services, which services LINAC and imaging equipment and is also responsible for medical device systems security and equipment disposition/reallocation.
The System Director of Clinical Engineering is Scott Skinner, MBA, FACHE, CHTM, CMRP. Doug Elmore is the director of Imaging and Ancillary Services.
“The executive, who reports into the system CIO, is akin to a ‘chief medical equipment officer’ and has overall responsibility for CE operations along with capital assessment and planning responsibilities,” Skinner says.
The CE directors and executive manage all service contracts.
“CE drives a very strong in-source strategy which is supported by senior leadership, including significant investments in proper service schools, tools, and test equipment,” Skinner adds. “Our goal is to be able to perform all maintenance within the department and not just at a ‘first call’ capacity. Since 2009, CE has in-sourced anesthesia machines, sterilizers/washers, linear accelerators (LINAC), beds, ventilators, and miscellaneous laboratory devices, among other things.”
The entire group employs one unified CMMS. Administration of CMMS, including data analytics, is performed by a coordinator who is a CBET. That person also is responsible for regulatory reporting and tracking alerts and recalls, according to Feldmeier.
Achieving Key Metrics
The department stays busy with special projects. Security and cost savings have been priorities.
“We have coordinated the design of multiple physiological monitoring systems in association with multi-million dollar facility renovations. CE is pivotal to driving system-wide equipment standardization through a Clinical Equipment Replacement Plan (CERP). CE leads the organization’s alarm management project to meet The Joint Commissions’s National Patient Safety Goal,” Feldmeier says.
He also says that the department recently stood up a medical device cybersecurity function, with a dedicated Medical Device Systems Security Analyst position, and is the strategic owner of ongoing medical device IT risk assessment and mitigation. The security analyst evaluates and works to mitigate risks on existing and incoming medical equipment. Feldmeier says that this position is also a liaison between CE/IT and focuses on cybersecurity vulnerabilities.
Other initiatives the team has tackled since 2009 include improving key quality metrics from 40 percent to 100 percent and passing two full surveys from The Joint Commission with zero clinical engineering-related findings. They have also initiated equipment standardization processes and realized over $5.5 million in capital savings.
Skinner says that the department has also “in-sourced or renegotiated service contracts resulting in over $600,000 in annual savings and has facilitated — with medical directors and other key stakeholders — the development of a long-term physiological monitoring strategy for a children’s Level I trauma/teaching hospital.”
Additionally, the team developed and directed a system project that replaced 1,100 beds at four hospitals and secured funding, and coordinated project management, for major sterile processing equipment upgrades. Those upgrades included, but were not limited to, IUSS units system-wide; instrument washers, cart washers, and steam sterilizers for the flagship hospital; and hydrogen peroxide plasma sterilizers system-wide.
They also secured funding and coordinated vendor selection for an OR light replacement initiative system-wide.
Setting a Standard
“CE participates in all hospital daily safety briefings (DSBs); this activity has been published as a best practice in BI&T,” Feldmeier says. “An example of something we’ve mentioned at a DSB is an incorrect internal defibrillator paddle configuration. This catch prevented a possible adverse patient event and was lauded as a ‘Good Catch’ and published in an employee newsletter.”
The previously mentioned CERP allows the department to evaluate system-wide clinical equipment needs and work to replace technology that is obsolete or in need of replacement to obtain the latest standard of care.
“CE actually manages multi-million dollar annual funding of this program and coordinates all equipment purchases,” Skinner says. “This program was written up in BI&T and CE received a ‘Best Practice Award’ in 2011 from AAMI in recognition of what CERP has accomplished.”
With their innovative focus, team members have not only shared their experience through AAMI, but are active outside their facilities as well.
“Key team members are AAMI members. Everyone in CE is a member of the Kentucky Association for Medical Instrumentation (KAMI),” Feldmeier says. “The CE executive is board-certified as a Fellow of the American College of Healthcare Executives and is a Certified Materials and Resource Professional (CMRP). Conferences attended by various persons annually include AAMI, ACHE, RSNA, Archimedes Medical Device Security, and HIMSS.”
In a system with 1,837 licensed beds and more than 42,000 CE supported devices/systems, the CE department at Norton Healthcare handles a big task and still finds time to innovate and find savings.
