By K. Richard Douglas
In March of 2020, northern Italy was experiencing complete devastation; the hospitals in Bergamo and Lombardy were overflowing with very sick patients, and the death toll was staggering. During that one month in Bergamo, 5,700 people lost their lives to COVID-19.
Historically, the novel coronavirus pandemic has proven to be the deadliest challenge to the health care systems of countries worldwide since the Spanish Flu pandemic of 1918. That deadly pandemic was at a time when the medical community had few therapeutic tools in its arsenal and 20 to 50 million people died worldwide. In the U.S., the toll was overwhelming with 675,000 deaths resulting from the virus.
Unlike 1918, the ability to bring video news coverage in real time through news broadcasts, or through social media, has made the impact of the coronavirus pandemic very real for people around the world.
The COVID-19 pandemic has already been fatal for more than 5 million people who have died from the highly transmissible virus, and more likely an estimated 12 million, which represents “excess deaths” compared to prior years. The Economist has compiled data which suggests 16.8 million worldwide COVID-19 fatalities.
The sheer magnitude of the epidemic has overwhelmed health care professionals at times with ICU capacity challenged in hospitals around the world. Clinical and support staff have faced surges of very sick patients, staffing shortages, severe restrictions on patient contact, PPE shortages and transmission mitigation protocols.
Healthcare technology management (HTM) staff have witnessed protocol changes and additions as well as special projects and challenges with the frustration that an original equipment manufacturer (OEM) field engineer may be curtailed by restrictions on access.
Sudden Changes
Early in the coronavirus pandemic, manufacturers that did not make ventilators as part of their product line, began to produce ventilators to try to make up for a global shortage of the devices.
At the time, this seemed like a generous and extraordinary thing to do, yet these brand-new devices had to be maintained or repaired. A number of new devices entered the health care ecosystem and many were unfamiliar to clinicians and technicians.
The pandemic also provided a new lens into the right-to-repair debate. When emergency equipment needed attention that could not wait, and COVID-19 created new restrictions on movement and admission, the need for in-house repair and maintenance became paramount.
Yet, without the service manuals and often required passwords or service keys to access diagnostic information, and restrictions of field engineers, the problem came into sharper focus.
To “stand up a surge unit” may have been a foreign concept to many in HTM as recently as 2019, but it is a common part of the HTM vernacular today. Telemedicine expanded its scope and use out of necessity, and biomeds were a part of this expansion.
“The COVID-19 pandemic has had a significant impact on society at large and the health care industry and healthcare technology management community specifically. Many HTM departments had to quickly deploy unfamiliar operational strategies like physically distancing, reprioritizing work, and producing necessary personal protective equipment to continue to support medical devices, clinical systems, and health care organizations, all while running on a skeleton crew,” says Donald Morge, a consultant with Sigma Health Consulting LLC.
Morge was a panelist during the virtual 2021 AAMI eXchange Rewired conference for a discussion titled: “COVID-19’s Impact on the Future of Healthcare and HTM.”
The panelists reflected on how the COVID-19 pandemic had changed the health care environment since early 2020 along with many HTM protocols. The panelists also explored the likelihood that many of these changes would endure.
“Many in the HTM industry were quick to publish and share best practices through established organizations like the Association for the Advancement of Medical Instrumentation (AAMI) and ECRI to ensure others had the opportunity to quickly learn and deploy similar practices locally,” Morge says.
He says that the pandemic was a test of the established HTM community.
“While there are still areas for improvement, the decades of hard work that the community has put in helped health care organizations continue to function under such intense pressure,” Morge adds.
The Exhaustion that Exceeds the Norm
Clinicians who have been interviewed by local news outlets have all lamented the exhaustive nature of dealing with the pandemic. Not only the stress of dealing with thousands of very ill patients, but the long hours and taking additional precautions to protect loved ones at home.
This exhaustion has not been limited to clinicians.
“People are tired. HTM is a field that often deals with high-stress situations. We now are constantly sitting with the worry of ‘what if?’ What if I need to don extra PPE to go into an isolation room? What if I need to expand patient care areas overnight? What if I take time to be with my family and I’m needed by the team,” asks Stephanie Drake, clinical engineering manager at Intermountain Healthcare IMC/TOSH.
Drake says that she, and other leaders in health care, have had to affirm these concerns and find ways to ensure there is adequate coverage so that her team and others can accomplish their work while also giving them the personal time they need to regroup and recover.
It is no surprise that biomeds would be worn out when so many additional demands were made on their limited time.
“Our department was called on to assist in making patient rooms fit the current needs, convert units to treat COVID-19 patients, and source and test PPE equipment to protect our team members. We also assisted in accommodating new sterilization procedures, new equipment handling procedures, and new protocol for repairing equipment that may have been exposed to COVID-19,” says Alvin Fajardo, supervisor of HTM at Advocate Good Samaritan Hospital in Downers Grove, Illinois.
He says that like nurses, doctors and other colleagues in the health care field, we have shown up to the front lines every day at a time when most of the workforce was switching to a remote environment.
“Throughout it all, our facility did not experience a drop in the quality of support provided by the HTM team despite additional and evolving demands,” Fajardo says.
Not only did HTM show up, despite fatigue, but the entire field dealt with challenges that were offshoots of the pandemic.
“Supply chain disruptions; obtaining parts in a timely manner. Pricing increases. Burnout. Loss of workplace comrade. An increased visibility on the right to repair,” says Brian, a senior BMET in the northwest who declined to provide his last name.
He says that biomed departments faced struggles when they could otherwise fix a device and keep it going or reduce the cost of care, but vendors will not share the information/sell parts needed to make necessary repairs or perform preventative maintenance even though biomeds are qualified to do so. In some cases the only way to receive the needed items is to first attend the vendor’s school.
“Then, there is a license key fee to access the machines annually,” he says.
How has the Pandemic Changed Health Care?
Clinical staff have witnessed frustration and desperation as they attempted to deal with an illness caused by a virus that offered few therapeutic protocols in the early months. The pandemic pointed out inadequacies as well as best-practices.
“I’ve seen a lot of burnout by both the clinical staff and my HTM staff. All of the ‘extra’ things we have to do every day has taken a toll on what we do every day. A positive note; it does really force us to stop and think through things more to take impacts and precautions into consideration, which I didn’t always see being done pre-COVID-19,” says Anthony McCabe, MBOE, MBA, LSSBB, director of clinical engineering and central equipment at Children’s Healthcare of Atlanta.
McCabe says that resources and scheduling of vendor maintenance has been the largest challenge for HTM at his location.
“Getting parts in a timely fashion has been the largest challenge overall, that has impacted both repairs and PMs. Even if we order parts months ahead of schedule, they still don’t always show up on time. We are also experiencing issues getting new equipment in for replacement projects that were on hold until well into the pandemic for end-of-life equipment, so we are having to try to keep equipment running that is no longer supported for much longer than expected. This has caused some delays in care, as the repairs take longer even if we are prepared,” he says.
Health care has also been forced to be nimbler.
“The pandemic has changed health care by resource mobilization. Health care institutions have learned to move resources and re-tool the environment very quickly. It has also changed the monitoring of usage of available resources through improved communications methods. There has also been an increase of par level stocking of emergency supplies and maintenance parts,” says Joseph Beaudoin, CBET, senior biomedical technician in the clinical engineering department at St. Peter’s Health Partners in Albany, New York.
The pandemic caused many workers to stay home because they were sick with the virus or simply reduce a two-worker household to a single worker or take federal benefit supplements instead of working.
“Difficulty in maintaining adequate staffing levels at hospitals especially in the areas of lab, EVS and nutritional services as so many have opted out of working,” says Paul Gudenau, CBET, CHTM, regional manager, southern region of clinical engineering services for McLaren Healthcare Inc. in Flint, Michigan.
How has the Pandemic Changed HTM?
While most people who lived through 9/11 will remember its impact on their lives and the emotions they experienced, the likelihood that clinicians and other health care workers will always remember the emotions and experiences of the pandemic is a given.
That experience is certain to stay with biomeds for years. The additional challenges imposed by the experience may change future procedures and priorities.
“In our system, we have had some challenges with parts delays because of the supply-chain crisis. Also, during the pandemic peak we had some challenges in getting OEM field service engineers to respond and/or come on site for service needs. Thus, stocking more critical parts and PM kits has become a standard now in HTM,” Gudenau says.
In addition to part acquisition challenges, training and staffing challenges have been magnified by the pandemic.
“It seems to have shifted some priorities of what we do every day, and even how we start our days at work. Getting training has been an issue with a lot of cancellations. Some vendors have moved to virtual learning, which is a better option than nothing, but the techs seem to lose out on the hands-on more,” McCabe says.
He says that staffing challenges seem to be across the board, which was already an issue before COVID-19 started, but has been worse for the whole process of recruitment to actual hire.
“There are individuals now looking for ‘work from home’ jobs, which doesn’t work well in HTM. Others we make job offers and they accept, but then coming all the way up to the start date the new hire notifies us that they’ve taken another position, sometimes outside of health care completely. It seems that the pool of qualified candidates keeps shrinking, and we are having to continue to get more creative and more involved with other partners to help keep the flow of staff going,” McCabe says.
While training and staffing have come into focus, so have some outside services that proved beneficial during the pandemic.
“HTM teams, which typically are not large, have had to find a way to meet the rising demands of a community dealing with a pandemic while also keeping our team members safe. Our organization prioritized by creating a floating pool of medical equipment, such as ventilators, to be dispatched out to any facility that needs it. This has also led to a boom in the use of medical courier services. Couriers are relied upon heavily to make sure equipment reaches the facility in need in the shortest time possible,” Fajardo says.
He says that another change brought about by the pandemic was that his HTM teams have had to work together to develop workflows for disinfecting and handling damaged or defective equipment that may have been exposed to COVID-19.
“The pandemic has provided health care and HTM with many challenges. Resources such as labor and supplies are less available. EMR and integration projects move forward as frontline staff struggle to provide patient care in a pandemic situation. My experience holds suspect the work from home culture and my ability to get the best customer service from vendors and parts suppliers. When speaking with some ‘work from home’ colleagues, I sense a disconnect between the employee and employer. This left me questioning the quality of the supply chain,” Beaudoin says.
On the flipside, Beaudoin says that he has also seen the pandemic bring out the best in some of his health care and HTM colleagues.
“Health care partners who view the pandemic as an opportunity to strengthen weaknesses in our health care systems in order to respond to the challenges the future will bring us,” he adds.
Drake says she has seen a shift in priorities.
“We normally would not have gone in after hours for a PAPR repair but, due to the increase in isolation patients, PAPRs became a high demand item that the floors struggled if they were short,” she says.
“My teams have had to look farther ahead on our scheduled maintenance to ensure we can get into rooms and to high use equipment to keep everything up to date and in line with Joint Commission standards,” Drake says.
She says that a by-product has been the delay in delivery of new equipment for upgrades.
“My facility was set to upgrade our patient monitoring system Q3 2021 and that has been pushed back until earliest of Q1 2022. This kind of situation is not likely to lead to a risk to patient care but makes us aware of the need to look farther ahead to other equipment upgrades that may be more emergent,” Drake adds.
The importance of the role of a biomed can bring with it some stress in a normal environment as PM schedules or servicing critical equipment present challenges. The COVID-19 pandemic, which has taken so many lives and put enormous pressure on health care, has proven to be a sort of baptism by fire for so many who did not ask for it.
HTM has developed best practices and adjusted protocols to best meet the challenge and biomeds have proven their value in meeting the demands of an unrelenting opponent which has tested their endurance and skills.
HTM remains the unsung hero.
