Clinical engineers should be a part of medical equipment dept
A study conducted in a district hospital near New Delhi in the early 90s about the availability and utilization of equipment showed the following results. There was a shortfall of 25.9 percent requirement for equipment compared to standard requirements. The actual utilization of available equipment was found to be only 39.3 percent. The rest were nonfunctional ā 35.5 percent or not in use 25.2 percent. Most of the nonfunctional equipment was lying for condemnation (28.2 percent) and only 73 percent kept for repair.
The reasons for low availability, non-functioning, and underutilization were found to be an improper and poor system of maintenance and repairs, and a tendency to keep some of them in reserve for their future use in the care of breakdown of existing ones.
This is the existing scenario in the most of major hospitals in the country notwithstanding that availability and utilization of various equipment at all levels of the health system for effective and efficient service delivery was amply emphasized in the Alma-Ata declaration at the International conference on primary health care in 1978, which was late included into strategy paper of health for all by 2000 AD. The planning commission of India in their 8th plan document has also emphasized the role of essential equipment in the delivery of health and family welfare services.
Strategy for maintainence
The management of biomedical equipment for optimal and safe use requires a multi-dimensional systems approach. Equipment management should start with a proper purchasing strategy followed by regular preventive maintenance, and occasional repairs, and finally, should conclude with appropriate retirement of the equipment. The best management approach will strive to maximize the usage of the equipment time by more than one hospital or clinic, if at all possible. These objectives can be accomplished by developing a proper maintenance and servicing model of biomedical equipment as follows:
Database:
To determine the nature and magnitude of the problem it is necessary to have a detailed database of the biomedical equipment available in Indian hospitals. Detailed information and history about each piece of equipment should be collected from the hospitals or institutes.
Every minute detail such as cost, benefits, foreign exchange component, supplier, suitable action plan, date of installation, etc. should be incorporated in the data bank of individual equipment.
Manpower:
To organize an effective repair and maintenance service of bio-medical equipment in various hospitals in India, it is essential to have properly trained manpower. In the western world there are well-organized cadre of āClinical Engineersā who are persons with engineering backgrounds and specializations in medical instrumentation and are responsible for the maintenance and proper functioning. Every hospital or group of hospitals in advanced countries has a clinical engineering unit that takes care of the biomedical equipment and systems in the hospital by undertaking routine and preventive maintenance, regular calibration of equipment, and timely repairs. Clinical engineers are thus an essential part of the modern health care system and services.
Repair facility:
To maintain the biomedical equipment in perfect condition for excellent and optimum performance, it is necessary to organize an effective repair facility and workshop in the Indian hospitals maintained by clinical engineers. Every biomedical equipment should be routinely serviced, Calibrated, and tested by Clinical Engineers and āOKā certificate should also be given by clinical engineers before it should be used for patient testing. Management program:
The management must be from the viewpoint of maximizing their correctness, uses and cost-effectiveness. Optimization of the uses of bio-medical equipment and cost-effectiveness is a very important aspect of the modern healthcare system. This can be achieved by employing the latest management practices in this area of national importance. For instance, several computerized software has been devised as maintenance systems in developed countries and are working successfully and profitably. Since conditions in India are not the same as in the developed countries we need to design our own database software and the maintenance/ management system computerized software program with the objective of maximizing the efficiency, life, and cost-effectiveness of the systems in any Indian hospital.
Dr Narendranath V, MD
Hospital Administrator,
M S Ramaiah Hospitals, Bangalore
