In this issue of TechNation, we ask healthcare technology management (HTM) professionals to share their insights regarding patient monitors. Participating in the roundtable article are USOC Medical Quality Manager Joe Bowen, Avante Health Solutions – Patient Monitoring Center of Excellence Lead Technician Minh Bui, Pioneer Biomedical’s Clint Creal, Renew Biomedical’s David Lindsay, Medical Equipment Doctor Sales Representative Alan Rodriguez and Jet Medical Electronics COO David Wakefield.
Bowen: This should be determined on a case-by-case basis. Before purchasing any patient monitors, biomeds should discuss with the unit managers what capabilities are needed and the possibility of future expansion. An ED or a Tele department most likely won’t need end-tidal CO2, but a PACU might. So, to get the most out of your budget, determine needs before purchasing.
Bui: The basic capabilities biomeds must insist upon when purchasing patient monitors should be the basics: pulse oximetry, ECG, NIBP and CO2. However, before making any capital purchases, the biomed should always confirm that the patient monitors they are acquiring fit the needs of their facility. These needs can differ between different departments, like ICR, ER or NICU.
Creal: This should be discussed with the clinicians and biomeds together as a team. The clinicians will know what they want/need measured at the bedside, and the biomeds know how to translate that into equipment capabilities for the order. Biomeds and clinicians often face an “us vs. them” mentality which is tough to get past. We faced it within our company in the past (biomeds vs. sales) and since aligning ourselves as a team moving toward the same goals, we’ve accomplished more than we thought possible. I understand that biomeds are constantly getting hounded to fix the equipment that clinicians break, but the more facilities can face things as a team, the better it’s going to be in the long run. It goes both ways though; clinicians need to stop acting like immortals and understand the frustrating world biomeds live in and respect that they drop whatever they’re doing to come fix a “broken” unit by plugging it in to give it power or hitting the silence button. It takes a team to sail a ship.
Lindsay: Patient monitors must have ECG, pulse oximetry capability and NIBP if used in patient rooms. If monitors are to be used in ICU or the operating room, they should have the capabilities mentioned above and also include IBP (invasive blood pressures), end-tidal CO2 … and a 5 agent gas module if used on an anesthesia machine.
Rodriguez: It really depends on the state of the patient being monitored. If you are in a critical care unit, you are going to need all parameters, including ECG, pulse oximetry, cardiac output, non-invasive/invasive blood pressure, end-tidal CO2, etc. If you are in a non-critical department, ECG, pulse oximetry and non-invasive blood pressure would be sufficient.
Wakefield: The basic capabilities are purely dependent on the care setting. E.g. In a open heart surgery suite, you’ll need the most comprehensive monitor capable of almost every parameter – ECG, Resp, NIBP, pulse oximetry, multiple invasive pressures, cardiac output as well as anesthetic gases. Whereas in a pre-operative care setting you can get by with just the basic ECG, NIBP and pulse oximetry. The basic capabilities are also dependent on the locale. Many rural hospitals work to get the more severe patients stabilized then transfer to a more capable/specialized facility.
Bowen: The basics to patient monitoring are ECG, SpO2 and NiBP. Before making any purchases, the biomed staff needs to ensure that the patient monitors they are purchasing fit the needs of the hospital staff. There are a wide variety of monitors, each with their own capabilities. To determine which monitors are best used for the hospital, good communication between the departments and staff is key. The needs of the patient, the capabilities of the staff and the business needs of the organization all play a role.
Bui: Some new features health care facilities should seek out when purchasing patient monitors are software option compatibility. They may require specific software and options so that the monitor will be compatible with other systems in the hospital. For example, most Philips monitors come with the latest Software M, N and GE Dash 3000/4000/5000 has the latest software 7.2 or 7.3. This may not be compatible with older equipment, like modules, that would be used with the patient monitor.
Creal: A lot of facilities are wanting more and more parameters on their units. Sometimes it’s better to have something and not need it than it is to need it and not have it. We’ve seen EtCo2 requests increase over the past few years and it seems to be becoming a standard of care for most facilities. However, we currently live in an age where software is king. Therefore, when purchasing new equipment, make sure the software aligns with your current system, so you don’t end up paying for an expensive module/unit and need to send it back out because the software doesn’t match up. In addition to software, make sure you have all the correct options loaded onto new units. We’ve heard horror stories of millions of dollars spent on new equipment only to find out that it is loaded with the wrong Spo2 type or it doesn’t have invasive pressure on it and forcing hospitals to send the equipment back to get those features added for a … “small fee.” Do the leg work upfront so there are no issues on the back end.
Lindsay: Ensure that the monitor software is compatible with the existing electronic medical record (EMR) system. This will prevent the need for additional infrastructure updates in the future. Additionally, it will save time and reduce errors in patient charting. Most newer patient monitors have options for touchscreen and Wi-Fi communication. Also, make sure cables and accessories are not expensive to replace, as that effects the true cost of ownership.
Rodriguez: It’s important to consider admit/discharge/transfer integration with an electronic medical record system and bar code technology to help expedite integration. Another feature to look for is large numerics on devices as they can be better seen throughout the department and increase patient safety.
Wakefield: At this point, there will need to be some sort of electronic medical record (EMR) interface. This can usually be done at the bedside monitor with a data out connection or it can be pulled from a central station or server. The seamless throughput of data collection has become vital in today’s health care setting.
Bowen: First and foremost, proper care and handling of all equipment, as a repair facility the amount of needlessly damaged equipment we see is extraordinary. Despite most equipment appearing robust, at the end of the day all of it is sensitive electronic equipment and should be treated as such, whether you’re installing it, moving it or cleaning it care needs to be taken. In addition to this, finding a reputable third-party like USOC Medical, that can repair broken equipment and offer replacement units, can help any hospital extend the life of its aging monitoring equipment.
Bui: Some helpful steps that can be taken to help further extend the usefulness of patient monitors is to always follow the service manual’s preventive maintenance recommendations. Also, using OEM parts and aftermarket parts that are FDA approved/refurbished parts. Make sure parts replaced equivalent with OEM specification will help to extend the life and usefulness of your patient monitors.
Creal: Manufacturers are professionals at scaring customers into replacing units due to end of life. And if scaring them with no support doesn’t work, they’ll charge you some astronomical amount to upgrade your whole system, which may not be necessary. There are a ton of great vendors out there that can continue to support equipment long after the manufacturers discontinue service/support on it. In addition, with everyone recovering from COVID, budgets are tight. Upgrading fleets may be out of the question for some, so extending the life of current units is the only option and can save money over time. However, you can only hold off for so long. I’ve encouraged biomeds to start tracking all the money they’re saving by extending the life of their monitors so when it does come time to upgrade, you can show the “suites” the dollar figure you’ve saved over the past 2-5 years by supporting your current fleet and not having to upgrade everything.
Lindsay: As monitors become end of life but not end of service, proper preventive maintenance becomes even more crucial. A proper PM schedule can extend the life of the equipment, even as parts become less available.
Rodriguez: First, you should verify whether the device is truly end of service life. It can be helpful to utilize a third party to perform an evaluation. Knowing your resources on the third-party market to supply parts and accessories is critical to further extend your monitors’ usefulness. Another important issue to consider is if the patient monitors are connected to a central station that has an outdated operating system which can make them vulnerable to cybersecurity threats.
Wakefield: Proper and timely inspections of patient monitors is key to the longevity of electronic equipment. As a general rule, any device with moving parts such as pumps, motors, fans should always be replaced with new when they fail.
Bowen: A lot of biomeds might not be aware, but most OEMs offer basic training for the biomed/technical aspects of the monitoring equipment they produce. These can be quite pricey so needs and benefits would need to be determined before enrolling. There are however more cost-effective means out there, for instance, USOC Medical has recently started offering basic training courses for most of the modalities that we service.
Bui: Training options for HTM professionals can be found by referencing the service manual of the patient monitor. Some monitors require specialized training, others may not.
Creal: I know the manufacturers offer training on new equipment, but the best training happens during the middle of a repair. As much as biomeds love sitting on the phone listening to current popular musical artists for 30-60 minutes as they wait for the Philips, GE, Mindray and other manufacturers to pick up the phone to answer that one small software question, we’ll get them in touch with a real technician (often sitting right next to me) that has the answer right away! These are techs that have worked for those manufacturers in the past and know what they’re talking about. Think of it as a direct access line for all your monitoring questions. And believe it or not …. we don’t charge a fee for picking up the phone. We tell folks all the time to use us and abuse us with your questions … unless you do truly enjoy waiting on hold for eternity.
Lindsay: Manufacturers (OEMs) offer training, often made available to HTMs via webinars. Personally, I would like to see more “train the trainer” classes. The HTM community is a small community, and we could do better by sharing our knowledge.
Rodriguez: You should always consider the training options available when purchasing patient monitors. Some important questions to ask are: Would the seller come on-site to train and would there be travel costs involved? How many techs can be trained? Does the vendor have a field service team to help with on-site issues or does the responsibility fall solely on the in-house HTM professional? Is there a discount offered on service training when you purchase the product?
Bowen: This question is a tough one, not only do you have the normal difficulties of finding parts for aging equipment, but now with the COVID-19 pandemic and the impacts that it has had on the global supply chain, availability and lead times have all been negatively affected, further increasing the difficulty of attaining parts. The best thing to do is to anticipate these delays and order parts prematurely. For us, we’ve been doing historical analysis and trending to determine our needs, in an effort, to do our best to stay ahead of any delays.
Bui: Techs should be trained to know how to distinguish between OEM and non-OEM parts and their organization should actively seek (and maintain) reputable vendors with low fail/defective parts rates.
Creal: After the past few years, there are some words/phases we hope to never hear again like “Pandemic, unprecedented times, social distancing, mask up,” and the one we’re currently in now … “supply chain issues.” As frustrating as it is right now with supply chain issues, I don’t think it’s going away anytime soon. And since your new parts are on a shipping container along the coast, biomeds will have to rely on preowned/used parts in the meantime. When using used parts, make sure the vendors you’re buying from have fully tested the parts and put a warranty on them. Preowned/used parts don’t have a negative connotation if you’re buying them from a vendor you know and trust.
Lindsay: There are always parts available from the manufacturers or distributors like Master Medical Equipment for units that are not end of service or end of life. There are also third-party parts vendors like PartsSource, for example. Depending on the part, if it is preloaded with software, then it most likely would have to come from the manufacturer. At ReNew Biomedical, we obtain screws locally from Fastenal, which is an example of finding other options if vendors are overwhelmed with parts orders.
Rodriguez: HTM professionals should always examine their service data to develop service delivery plans, including parts that have a trend of failure. Again, develop a strong resource management portfolio that includes independent service organizations, parts depots and organizations that sell used equipment. Also, consider which parts are normally on backorder and obtain a supply of them at your facility.
Wakefield: Having a good source of reputable third-party companies to provide parts/service well beyond OEM support. Jet Medical can still support equipment well in excess of 20 years of age.
Bowen: Research the company you’ll be using for the purchases. Can they support the equipment in the long term? Access to parts is also key. Buy from a reputable source that is qualified and can support the unit in the long term. Though patient monitors have become very versatile and last a very long time, having a company that can support the device even after it becomes end of life can save your facility a lot of money.
Bui: It is always recommended to find a company that has the most ISO certifications and supports quality controls that comply with the medical devices your company services.
Creal: There are so many great companies out there to use for parts, service, rentals and capital equipment when it comes to patient monitors. Competition benefits both the vendors and the biomeds. Use a company that shares the values you have whether it’s high-quality work, true turnaround time and fair pricing or just people you enjoy doing business with. Just always remember, the equipment you send out for repair may be used on a family member of yours so make sure it’s someone you trust.
Lindsay: In the world of technology that we live in, health care is moving more and more toward digital records to reduce time and error. It is essential to know the capabilities and compatibility of the current EMR system in your facility. When PMing equipment, it is vital to be thorough and make sure equipment is clean and free of dust that builds up with the heat from power supplies. Dust only increases the temperature inside the unit and causes components to break down at an accelerated rate.
Rodriguez: Patient monitors are generally reliable, but it’s a good idea to have backup monitors in case of an emergency or even a pandemic. Be sure the preventive maintenance is completed per manufacturer recommendations because a lot of monitors store the last calibration date. We have come across monitors that were serviced in-house for non-invasive blood pressure with calibration dates that were over five years old. Patient safety should always be the priority for patient monitors and that safety begins with proper service.
Wakefield: Many times, the biomed department is not part of the conversation when it comes to purchasing new equipment. An experienced biomed director can convey the importance of choosing equipment that will have support well beyond OEM end of life. You always want to have multiple choices when it comes to service and parts to support your equipment. This especially rings true once you reach the aforementioned OEM end of life.
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