Managing Medical Devices in an Acute Trust

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Managing Medical Devices in an Acute Trust

• Dr Andy Smith
• Head of Clinical Engineering
• Royal Berkshire NHS Foundation Trust

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Royal Berkshire Hospital

• Medium size Trust 825 beds
• Main site - Reading, Prince Charles Eye Unit -
  Windsor, Theatres and out Patients Newbury
  external contracts
• Physics includes Clinical Engineering,
  Radiotherapy, Nuclear Medicine and Radiological
  Protection
• Medical Devices Managed by Clinical
  Engineering
• 2 state registered clinical scientists
• 7.5 clinical technologists
• 2 ICU technologists
• 1.5 Anaesthetic technologists
• 1 Training Coordinator
• 1 Library/Contracts manager and 3 support staff

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Key Clinical Engineering Responsibilities

• Service maintenance of medical devices
• Management of equipment libraries
• Management of service contracts
• Income generation via external contracts
• Develop implement replacement programmes
• Management of SABS notices for medical devices
• Investigation of medical device adverse incidents
• Co-ordination of training for medical devices
• Healthcare standards for medical devices
• Disposal sale of medical devices
• Participation in training scheme for Clinical
  Scientists

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Database
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Database
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Website
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Phased Replacement
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Multi Vendor Service

• The Concept
• Guaranteed savings
• Simplified management
• Flexibility
• Consistent service quality
• Compatibility
• Evolution
• Efficiency

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Multi Vendor Service

• Key Objectives for Royal Berks
• Reduce costs
• To provide an improved and standardised level of
  service
• Equipment maintained 24 hours a day, 7 days a
  week
• Guaranteed uptimes, fix times and performance
  outputs with penalties
• Provide flexibility in the various levels of
  service
• To provide the convenience of a single focus
  one number to call
• Increase in the amount and accuracy of data
  concerning the management of equipment
• Improved service history for each item of
  equipment to monitor and set performance targets
• Fixed payment made quarterly to one Contractor

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Multi Vendor Service

• Pre MVS
• The value of separate contracts on 100 devices
  731,000 comprehensive level of support
  excluding glassware
• Positive
• Current equipment on contract with original
  equipment manufacturer providing minimum risk
• Original equipment manufacturer guarantee of
  original spare parts
• Confidence in engineers training
• Users confidence in original equipment
  manufacturers support
• Negative
• Minimal opportunity for cost savings as each
  individual contract has profit element built in
  and for a fixed duration no change in level
  during term
• Administratively complex due to large numbers of
  contracts
• Variability of service level between contractors
• No penalty arrangements for poor service or
  unreliability

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Multi Vendor Service

• Tendered for service with three organisations
  submitting bids
• Bids typically came back around 900,000 which
  is interesting as current spend was 731,000!
• Called companies back and banged heads together
• Following further hard negotiations resubmitted
  bids 700,000 - 600,000
• GE Medical selected for the following reasons

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Multi Vendor Service

• Significant equipment base in Trust
• Also some High Risk devices such as Main and
  mobile X-Ray
• Manufacturer of parts for others
• Good track record with MVS, Southampton contract
  renewed
• Good liaison during tender process
• Competitive pricing and flexibility
• No user issues with current level of service
• Contract out to OEM for High Risk devices
• Asset plus for device management
• Agreed to all Trust terms and conditions
• Savings typically 80,000/yr (do not however
  underestimate contract monitoring)

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Replacement of Infusion Systems

• Currently have 200 3M500 Volumetric and 100
  3200 Syringe Drivers in Library
• Current running Costs - 117,458 on consumables
  50,000 on spare parts per year (ex labour)
• Typical use 31,800 vol sets and 16,000 ext sets
  per year
• Capital cost for 290 vol and 100 syr 1,063,375
  inc vat
• Tendered on basis of consumables for 250, 270,
  290 vol and 100 syr drivers
• Seven suppliers bid with costs ranging from 1.3M
  - 0.7M inc vat for a 5yr contract based on
  270100 option
• Following trial chose Orchestra DPS 0.74M for
  290100 based on current set usage (not fixed no.
  per year) net saving 42,000 per year and from
  year 5 set saving of 74,000/yr

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Replacement of Infusion Systems

• Total Intravenous Anaesthesia (TIVA)
• Currently using 3500 system with pre-filled
  Propofol
• Current spend 82,000 per year
• Spend on moving to generic Propofol 21,000 per
  year
• Saving 61,000/yr from drugs budget
• Tendered for 17 systems to administer Propofol
  and Remifentanil
• Two suppliers responded similar cost 20,000/yr
  over 5yrs
• Following trial chose Orchestra DPS with benefit
  of standardisation with library system
• Saving 41,000 per year including cost of pumps

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Infusion Summary

• Trust had no capital and would not consider
  anything other than cost saving/cost neutral
  initiatives
• We were able to replace all library vol pumps and
  syringe drivers. Increase numbers from 200 to
  290, save 42,000 per year during purchase and
  74,000/yr from year 5
• New pumps designed for easy service and spare
  parts economical, error reduction software/bar
  code ready
• Moved to generic Propofol which funded 17
  complete TIVA systems and is scheduled to show
  savings of 41,000/yr
• Standardisation of infusion systems across Trust
  and part of the region for TIVA

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Medical Equipment Libraries

• Standardise maximise the use of devices
• RBH has an Infusion and a Dynamic Mattress
  library
• Biggest problem is the resource to operate the
  libraries efficiently
• Neither library resourced full time or 24 hours
• Infusion
• Porters collect pumps from wards (officially)
  once per day
• Clinical Engineering attend four times per day to
  clean, check and reset pumps for use, ICU
  technicians attend Sat Sun lunch time
• Part of library converted to allow service and
  maintenance
• Running since 1995 lost about 5 pumps and
  regularly run out of volumetrics
• Currently researching RFID to monitor turnaround
  and location

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Infusion Library
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Medical Equipment Libraries

• Dynamic Mattress
• Trust bought/Leased 250 dynamic overlay and
  replacement units
• Users call porters help desk to request a
  mattress, collected from front of library in a
  clear bag which contains a return kit
• Porters pick up used mattresses in orange bags
  and deliver to rear of library
• Mattresses are cleaned and soiled covers washed
  in washing machine then passed into clean area
  for calibration/repair
• Whole process including decontamination
  replicates that used by Pegasus
• Process between 10 and 30 mattresses per day
• Rental system in place to cover out of
  hours/special requirements
• Saving Trust 200,000 per year

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Mattress Library
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Anaesthetics
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Anaesthetics

• Maintain Royal Berks/Newbury and Windsor all in
  house
• Recruited ex Datex-Ohmeda engineer
• 1.5 wte within Clinical Engineering, fast on site
  response
• Income generation potential (prev contract with
  Independents)
• ISO 9000 registered
• Saving 80,000 per year

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Beds Static Mattresses

• Clinical Engineering manage/maintain all beds
  and static mattresses main task for two
  engineers
• Replaced all static mattresses last year
  following Trust wide audit some were 15 years
  old!
• 269 electric-profiling beds 556 manual kings
  fund
• 2002 replacement programme terminated under cost
  recovery
• 136 beds over 18 years old
• Evaluated a range of new beds during
  summer/autumn with the aim to acquire 100 this
  year under phased replacement initiative
• Fast response from onsite staff major parts
  held on site
• Back-up take bed away contract for faults which
  cannot be be fixed on ward

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Maintenance Contracts

• Maintenance of all medical devices managed by
  Clinical Engineering
• Three levels of service
• Fully in house by Clinical Engineering (all
  parts cross charged to device owner)
• Front Line by CE supported by service contract
  (parts and contract cross charged to device
  owner)
• Full service contract with supplier (On receipt
  of fault information CE contact
  manufacturer/supplier and arrange engineer to
  attend site, check service report and negotiate
  contract renewal)

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Disposal Of Devices

• Dispose of devices via Medical Auction
  Specialists, sale on a monthly basis
• Meets requirements of DH for equipment disposal
• Clinical Engineering organise preparation for
  sale which includes evaluation of condition,
  decontamination, user instructions and collection
• Funds raised are not returned to user but are
  invested into the library services to benefit
  majority
• Raise between 5000 - 30,000 per year

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Training Notices - Incidents

• One Medical Device Training Coordinator
• Established Link Nurses throughout the Trust
• Besides delivering some training, co-ordinates
  training with manufacturers/suppliers/trainers/use
  rs
• Feeds into CNST in conjunction with Risk
  Management
• All medical device safety notices and Incident
  investigation managed by Clinical Engineering
• Follow-up reported to Medical Equipment
  Management Group

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Questions

• How much does your Trust allocate per year for
  new/replacement of medical equipmenta) up to
  500,000b) 500,000 - 1Mc) 1M - 2Md) over
  2Me) Dont know

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Questions

• Does your Trust have a Phased Replacement
  programmea) Yes
• b) No
• c) Dont know

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Questions

• Has your Trust entered into a Multi Vendor
  Service arrangement
• a) Yes
• b) No
• c) Dont know

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Questions

• If yes is it delivering the expected
  service/savings
• a) Yes
• b) No
• c) Dont know