Advanced Clinical Engineering Workshop
Buenos Aires, Argentina
Equipment Maintenance Program
Julio Huerta
University of North Carolina
Technical Services:
Maintenance
– Corrective maintenance or
repair
– Planned Maintenance
– Performance
testing/Quality assurance
– Safety testing
– Upgrades
– Installations
– Calibration
– Overhauls & refurbishing
– Maintenance by users
Managing Your Medical Equipment
Maintenance Program
Elements of Maintenance Management
Managing Labor
– initial training
– on-going training
Managing Spare parts and Service Information
– spare parts supply stream
– service and operator manuals
Managing workspace, tools, and test equipment
– place to work
– specialized test equipment
Managing Data
Equipment Maintenance
Repair :
required when the equipment fails
PM provides :
manufacturer-specified attention to the
device’s non-durable parts (if any);
assurance that the device is performing
properly;
assurance that the device is operating
safely.
Repair
When the equipment fails – or
appears to fail –the user needs
the device restored to proper
working order as soon as
Planned Maintenance
Scheduled Maintenance is required for
all devices with parts that have known
deterioration/depletion rates or with
performance degradations that can be
practically tested/identified e.g. filters,
batteries, cables,and bearings
Performance Verification and Safety
Testing are considered important and, for
certain “critical” devices, are sometimes
required to be monitored.
Managing Your Medical Equipment
Maintenance Program
Scope of Problems
– high maintenance costs that kill your budgets
– problems that cannot be duplicated (resulting from
users lack of proper training)
– equipment users and administrators that blame your
department for all their equipment problems
– broken equipment that exceeds your resources
– equipment becomes unsafe due to misuse/abuse
– patient’s road to health improvement hindered by
Breakdown of Medical
Equipment Maintenance
Expenses
Expenditures by Percent (%) Total
8%
49%
13%
11%
19%
Clinical Lab
Imaging
Surgery
Critical Care
General
Medical Equipment
Maintenance Services
US Market (1998) in $ Billions
Totals
Manufacturers
ISOs
In-house
Imaging
equipment
2.89
1.99
(69%)
0.55
(19%)
0.35
(12%)
Biomedical
equipment
2.80
1.35
(48%)
0.57
(20%)
0.88
(32%)
5.69
3.34
(59%)
1.12
(20%)
1.23
(21%)
Fact: service has larger contribution
margins than sales for Original
Equipment Manufacturers (OEMs)
Benchmarking Technical
Support Services
Cost of maintenance services over the equipment life
Example: Nuclear medicine system
– Cost: $400,000
– Manufacturer Service Contract: (12%) $48,000/year
– Life cycle: 10 years
– Total life cycle cost: $480,000
Benchmarking Technical
Support Services
Accepted benchmark for service costs
Annual Service Cost
= X %
Acquisition Cost
Less than 5% is target for U.S. hospitals
Maintenance Cost - Medical Equipment
Ted Cohen - 1997 Survey
3.2%
3.8%
4.0%
4.2%
5.2%
5.9%
6.0%
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
7.0%
En
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MC/AC
Types of Equipment
UNC OEM CONTRACT COST ANALYSIS - 1997
OEM Cost
0%
5%
10%
15%
20%
<$10K
>$10K
<$50K
>$50K
<$200K
>$200K
Service Cost
OEM Cost
UNC INVENTORY AND MAINTENANCE COST
July 2002 – March 2006
A21 A22
B1
B2
B3
B4
B5
B6
B7
B8
B9
B10
B11 B12 B13
B14
ACQ. COST
MAINTENANCE
Linear (ACQ. COST)
Linear (MAINTENANCE)
Cost
Downtime
Minimal downtime reduces:
disruptions to patient care
loss of any associated revenue
Equipment Not Available for
Patient Care: Downtime
Example: Computed Tomography Scanner
One of the most critical items in U.S.
hospitals
– Dramatic effect on patient care
Lost revenues
– Average Cost of a CT Scan: approx. $1,500
– CT scans per day: approx. 30/system
Equipment Not Available for
Patient Care: Downtime
Other Examples:
Lost revenues
– Average Cost of an MR Scan: approx. $2,000
– MR scans per day: approx. 20/system
– Lost revenue: $40,000/day
– Average Cost of a Nuc Med Study: Aprox. $1,000
– Nuc Med studies per day: approx. 10/system
Equipment Not Available for
Patient Care: Downtime
Other Examples:
Lost revenues
– Average Cost of a Vascular Study: approx. $1,500
– Vacular studies per day: approx. 6/system
– Lost revenue: $9,000/day
– Average Cost of a Lab Test: Aprox. $60
– Lab tests per day: approx. 4,000/system
– Lost revenue” $240,000/day
Technical Service Planning:
Must take place prior to purchase
Develop plan for service based on
– Resources
– Clinical need
– Vendor factors
– Logistics
Equipment Life
Equipment Life
-
-
Cycle Model
Cycle Model
Maximum
leverage with
vendors is prior
to purchase
Managing Your Medical Equipment
Maintenance Program
Scope of Medical Equipment
– Level 1 - stretchers, beds, wheelchairs
– Level 2 - physiologic monitors, IV pumps,
electrosurgical units
– Level 3 - general radiology, lasers, anesthesia
– Level 4 - CT, MRI, PACS, PET
Managing Your Medical Equipment
Maintenance Program
Level 1 or “low-tech” equipment
– usually in-house program
Level 2 or “medium-level” equipment
– usually in-house program
Level 3 & 4 or “high-tech equipment
– usually a mix of manufacturer, independent
service organization and in-house
Service Contract Basics
Contract agreement to provide service according
to terms and conditions
Manufacturer or independent service provider
Many types of agreements
– Full service, preventative maintenance, parts, labor,
biomedical screening…
– Reagent and lease agreements
What type of equipment is
typically under service
contract?
0
10
20
30
40
50
Modality
Imaging
Lab
Sterilizers
Anes/Vent
Dialysis
Biomedical
Percent of
Devices
Under
Service
Contract
When is a service contract
needed?
Keys elements for service not available
Parts, Expertise, Training, Documentation, or Special Service
tools including software
– Company will not provide it or will not provide it
under reasonable conditions
– In-house staff or alternatives not available
Uptime must be guaranteed
– or alternative such as loaners
Less costly than alternatives
Maintenance Management:
Manufacturer Full Service Contract
The most basic approach;
a collection of manufacturer’s FSC’s
Advantages
Simple to set up, minimal paperwork
Disadvantages
The most expensive approach (~10% RC)
- beware the hidden cost of contract exclusions,
Many contracts to negotiate and manage,
Maintenance Management:
Maintenance Insurance
Incorporate an independent maintenance
insurer to guarantee the repair budget
Advantages
Consolidation of financial risk can reduces the
cost - by up to ~10%
Eliminating contracts in favor of T&M improves
flexibility; the detailed T&M service reports create
good maintenance histories.
Maintenance Management:
Independent Service
Organizations
Incorporate (local) independent
maintenance service providers
Advantages
Lower rates (and less travel) lowers the cost
- by up to ~25%
If local, shorter travel improves response time
Disadvantages
May encounter manufacturer reluctance to provide
support for competing ISOs
Maintenance Management:
In-House Program
On-site manager & service providers
Advantages
Lower labor costs and zero travel reduces the total cost up 50%
On-site/ local staff to provide user support
Vendor-neutral technical staff to assist with replacement
planning and equipment selection.
Faster response reduces overall down-time
Disadvantages
SERVICE PROVIDER COMPARISON
OEM
ISO
In-House
Response Time
Questionable: in
some cases the
service personnel
has to come from
other states
Reasonable: usually
these groups have
better local
presence
Good: the service
personnel is always
in the facility
Expertise
Good:
manufacturers have
large R&D facilities
and resources
Reasonable: a large
portion of their
service personnel
comes from the
manufacturers
Variable: larger
facilities can do a
better job at
maintaining up-to
date expertise
Experience
Good:
manufacturers work
on a large number of
similar devices
Reasonable: these
groups can increase
their experience by
supporting multiple
facilities
Variable: there is
only a limited
number of similar
devices to service.
SERVICE PROVIDER COMPARISON
OEM
ISO
In-House
Spare Parts
Good: manufacturers
support a large
number of similar
devices
Reasonable: these
organizations share
the cost of
specialized
purchasing groups
among multiple
facilities
Variable: larger
facilities can
dedicate staff to
purchasing functions
Training
Good: manufacturers
have adequate
training facilities and
resources
Reasonable:
expensive training
can be justified by
supporting multiple
facilities
Variable: expensive
training is hard to
justify when the
number of similar
devices is small
Price
High: large overhead
and cost shifting
(sales to service).
Usually over 8% of
equip. acquisition
cost
Moderate:
duplication of some
hospital functions.
Usually around 5% to
7% of equip.
acquisition cost
Low: cost oriented
and low overhead.
Usually 4% to 6% of
equip. acquisition
cost.
Technical Services:
Vendor Partnerships
Work with manufacturers and service
vendors
– Win-win situation
– Example: First look by in-house staff
Hospital – fast response, trained technical service
staff, improved morale
Vendor – does not have to travel to hospital, better
relations and communication
Technical Service Personnel:
Requirements
Technical education and training
– Formal
– Service training
Basic troubleshooting skill
Understanding of hospitals and patient care
implications of technical services
Technical Service Personnel:
Requirements
Resourceful
Focus for the future
– Information technology
– Imaging
Converting a Manufacturer’s
Contract to IH Staff (Imaging)
$100,000 contract includes $40,000 of labor charges
$40,000 of labor charges = 267 m-hrs of labor (at $150/hr)
267 m-hrs of labor =
0.24 FTE (1,113 m-hrs/year)
Potential saving: $16,020 ( = 267 x $60) in labor charges
+ $60,000 parts only contract
= $76,020
( 24% savings )
Converting a Manufacturer’s
Contract to IH Staff (Biomed)
$100,000 contract includes $40,000 of labor charges
$40,000 of labor charges = 345 m-hrs of labor ( at $116/hr)
345 m-hrs of labor =
0.31 FTE (1,113 m-hrs/year)
Potential saving: $19,320 ( = 345 x $56) in labor charges
+ $60,000 parts only contract
= $79,320
( 21% savings )
What is best ?
A mix
In general, the best option is
a mix of
– In-house service
– Vendor time and materials
– Service contracts and/or
– Managed maintenance
Technical Service Operations:
Computerized Management
Knowing your medical equipment assets
Determining the level of management of assets
Using a computerized database to manage assets
– Inventory, work orders, parts, PM, reports
Controlling for cost-effective operations
Use data and knowledge to make safe, effective equipment
available for patient care
Technical Service Operations:
Computerized Management
Information About Each Device
– Equipment information
– Purchase information
– Warranty
– Maintenance Intervals & Procedures
– Service history information
Technical Service Operations:
Computerized Management
Information entered MUST use
Standardized Nomenclature
AAMI EQ56-1998 Recommended Practices
for a Medical Equipment Management
E q u ip m e n t ID D e p t. N o E q u ip m e n t D e s c rip tio n M a n u fa c tu re r M o d e l S e ria l N o P u rc h a s e C o s t P u rc h a s e D a te
(1 ) (o w n e r) (2 ) (3 ) (4 )
(1 ) A u n iq u e ID n u m b e r s u c h a s a F ix e d A s s e t N o . o r P ro p e rty N o . if a v a ila b le . (2 ) A tw o o r th re e w o rd d e s c rip tio n o f th e e q u ip m e n t's fu n c tio n .
E x a m p le s : P o rta b le X -R a y , P o rta b le C -a rm , Im a g in g U ltra s o u n d , T h e ra p y U ltra s o u n d , V ita l S ig n s M o n ito r, In fu s io n P u m p , R e s p ira to r, A n e s th e s ia M a c h (3 ) P ric e p a id if p u rc h a s e d n e w , o r a p p ro x im a te ly m a rk e t v a lu e if k n o w n .
Equipment ID:
Dept. No (owner):
Section ID:
?
1010 - Biomedical
?
1020 - Imaging
?
5000 - Other
Equipment Description:
Manufacturer:
Model:
Serial No:
Location:
Acquisition Cost:
Acquisition Date:
Warranty Expiration Date:
Fixed Asset No:
Comments:
Equipment ID:
Dept. No (owner):
Section ID:
?
1010 - Biomedical
?
1020 - Imaging
?
5000 - Other
Equipment Description:
Manufacturer:
Model:
Serial No:
Location:
Purchase Cost:
Purchase Date:
Warranty Expiration Date:
Fixed Asset No:
Comments:
Equipment ID:
Dept. No (owner):
Section ID:
?
1010 - Biomedical
?
1020 - Imaging
?
5000 - Other
Equipment Description:
Manufacturer:
Model:
Serial No:
Location:
Purchase Cost:
Purchase Date:
Equipment Tags
Control Numbers
Informational Tags
– Color coded
Recordkeeping
Incoming Inspections-gatekeeper
Standards for work orders
Technicians versus Clerical Staff
INITIAL INCOMING INSPECTION & EQUIPMENT EDIT FORM
SECTION I
ACTS #
_______________
Old ID: __________
System ID
Hosp. Asset #:__________
= Addition To Inventory
= Edit/Change To Inventory
= Delete From Inventory
ACQ COST : $___________ ACQ DATE : __ __ /__ __ /__ __ __ __ INSURANCE CONTRACT SERVICE CONTRACT
WRTY EXP: LABOR
__ __ /__ __ /__ __ __ __
WRTY EXP: PARTS
__ __ /__ __ /__ __ __ __ DOWNTIME YES NO LIFE (YRS) _____________ SEV INDEX ____________ UTIL CODE ____________ OWNERSHIP HOSPITAL CONTRACTED LEASE/LOAN/RENTAL OTHER CONDITION CODE _______________
ORIG INV DATE:
__ __ /__ __ /__ __ __ __
SCO DESCRIPTION : ________________________________________ ALTERNATE DESCRIPTION : _________________________________ STATUS : ACTIVE STORAGE DELETE MANUFACTURER : _________________________________________ MODEL NAME : ____________________________________________ MODEL NO. : ______________________________________________ SERIAL NO. : ______________________________________________ DEPT NO. : ________________________________________________ LOCATION : _______________________________________________ EQ TYPE : __________________ SECTION: ____________
CAPITAL PURCHASE ORDER # _______________ ADDITIONAL NOTES OR COMMENTS:
____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ _____
IF NO MDR DESCRIPTION IS AVAILABLE, ASSIGN A SEVERITY INDEX, PM PROCEDURE, MONTH & FREQUENCY:
SEVERITY INDEX VALUE : _______ PM PROC NO. : ________________ MONTH : _______________________
SR# : ______________
ANNUAL MONTHLY SEMI-ANNUAL QUARTERLY OTHER: ___________ ACTS
CONTRACT STATUS SERVICE FREQ HRS DAYS PARTS GLASS
DEFAULT WR PM 85 MF 00 00
RECOMMENDED DEFINITIONS
*For Additional Definitions Refer to Your CTS Policy Manual
WR=Warranty PC=ARAMARK
PM=PM Only
FS=Full Service 85=8:00am-5:00pm MF=Monday-Friday
AL=All Parts 00=No Parts
00=No Glassware AL=All Glassware
SECTION II
WR# WORK REQUEST CLASS :
DATE RECEIVED : PROBLEM CODE : PROBLEM REPORTED:
_________________________________________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________________________________
REQUESTOR NAME: REQUESTOR PHONE:
SR# COMPONENT:
WORK TYPE: WP STATUS:
SECTION III
1. Does the device appear to be undamaged? Yes: Proceed to step 2.
No: Do not accept for use and contact seller for corrective action. 2. Is the device electrically operated by 120 VAC?
Yes: Proceed to step 3. No: Proceed to step 6.
3. Has the device been evaluated by a qualified testing laboratory? Refer to hospital policy and state administrative code or policy, if applicable.
Yes: Proceed to step 4.
No: Do not accept for use and contact seller for corrective action. 4. Visually inspect power cord, plug, and strain relief’s. Refer to NFPA 99 chapter 9.
Pass: Proceed to step 5.
Fail: Do not accept for use and contact seller for corrective action. 5. Does the device pass electrical safety inspections? Refer to NFPA 99 Chapter 9.
Yes: Document results in Section II and proceed to step 6. No: Do not accept for use and contact seller for corrective action.
6. Does the unit seem to be operating properly? Refer to manufacturer specifications. Yes: Proceed to step 7.
No: Do not accept for use and contact seller for corrective action. 7. Have all accessories been included in shipment?
Yes: Proceed to step 8.
No: Do not accept for use and contact seller for corrective action.
8. If ownership is loan, demo, rental, or other, how long will the device be in the hospital? If hospital owned or leased, proceed to step 9.
Less than 6 months: W rite the serial number in the equipment ID field in Section I and proceed to step 15. 6 months or greater: Proceed to step 9.
9. Have (2) two operator, (2) two service manuals, OPERATING & DIAGNOSTIC SOFTWARE been included in shipment? Yes: Proceed to step 10.-- SOFTWARE COPIES SHOULD BE RETAINED IN CLINICAL TECHNOLOGY SERVICES. No: This is basis for non-acceptance. Evaluate literature needs. If adequate proceed to step 10.
Otherwise do not accept for use and contact seller for corrective action. 10. Has technical service training and operator training been provided for the device?
Yes: Proceed to step 11.
No: This is basis for non-acceptance. Evaluate educational needs. If training is adequate proceed to step 11. Otherwise do not accept for use and contact seller for corrective action.
11. W ho will be responsible for the management of the device?
ACTS: Affix a ACTS identification label to the device, indicate in Section I and proceed to step 12. Other department: Proceed to step 15 and contact appropriate department for inclusion in their program.
12. If applicable, evaluate the Clinical Application, Physical Risks, Maintenance Requirements and Incident History of the device. Assign a severity index value to the device. If the device is not listed in SAMM, calculate the severity index value according to the scoring criteria in Table I. High Incident history or failure rate may indicate the need for a more frequent inspection interval than required by Severity Index.
Severity Index Value From SAMM =__________ Indicate severity index value in Section I and proceed to Step 13.
Equipment Function: Physical Risks: Maintenance Requirements: Calculated Severity Index Value: Incident History Reviewed
= __________ = __________ = __________ = __________ 13. W ill the device be included in the ACTS Planned Maintenance Program? Refer to Table I for inclusion criteria. (Note: All
equipment items that are the responsibility of ACTS will be inventoried. The risk assessment determines inclusion in the PM program only.)
Yes: Proceed to step 14. No: Proceed to step 15.
