Clinical engineering
Advancing clinical engineering strategies
Technology is at the very core of NHS plans to deliver transformation, but making these big breakthroughs requires investment in medical equipment, IT infrastructure, and clinical technology expertise. Ruth Strickland and Caroline Finlay discuss the challenges and solutions required to ensure effective management of clinical technology.
Medical devices management is a regulated activity under the Health and Social Care Act (2012), and vitally important to the safety and efficiency of every healthcare organisation. Technology is necessary to optimise clinical outcomes and ensure clinical users have the right technology at their fingertips. NHS and private healthcare providers need to choose, use and manage clinical technology safely, compliantly, and with maximum operational and financial efficiency. This is becoming known as ‘clinical technology management’ – the strategic management of medical devices across single and multiple site hospitals. Internationally, it has been proven that adopting systems for management of clinical technology will deliver better patient outcomes, operational, and financial sustainability. Typical findings are:
1. 20-40% of equipment remains under-utilised. l Poor standardisation. l Equipment delivered without installation. l Delivered without user or technical training.
2. 20-50% additional costs for maintenance. l Purchase of sophisticated equipment where maintenance costs are high and often unnecessary.
l Point of sale warranties and service contracts were not considered.
3. 10-30% unplanned costs. l Poorly specified technology. l Additional costs for consumables; service parts are not considered.
4. 25-35% of equipment out of service. l Due to absence of preventative maintenance. l Poor equipment use. l Users not trained.
5. Loss of 30-80% of the potential lifetime of equipment.
l Due to all the above factors.
Alongside repair and maintenance, clinical engineering staff are also responsible for the
wide range of clinical technology management activities (Figure 2). To understand the challenges of professionally managing clinical technology, one must first appreciate how an organisation’s technology management processes operate. The process for managing devices requires the procurement, use, maintenance, and governance of devices, but with a focus on continual improvement that aligns with the MHRA regulations, digital health agenda and cyber security (Figure 3).
Challenges The challenges for a typical acute general hospital, managing large volumes of equipment, include: l A typical general hospital might have 8,000- 15,000 items of equipment from hoists and IV pumps to MRI scanners, managed as a mix of in-house clinical engineering service provision and contracts managed by departments with third-party suppliers.
l A typical hospital will have upwards of 300 individual maintenance contracts, so costs associated with managing such a portfolio are high.
Figure 1
As devices become more sophisticated and the volume of connected devices increases, expertise is needed to manage cyber security risks to ensure that clinical technology provides a secure opportunity for establishment and maintenance of a connection through which data is transferred between a medical device, such as a patient monitor, and an information system. The introduction of digital technologies is a key part of the NHS digital strategy and will require new skills from clinical engineering professional teams. At a basic level and in the face of increasing demand for services and budget pressures, medical equipment must be managed efficiently and transparently to support patient safety.
September 2023 I
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