Heading for presentation

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Biomedical Engineering  in Optimizing Patient
Outcomes and Controlling Clinical Risk By
Kyril Belle Biomedical Engineer

Department of Health and Human Services State
Health Conference 8-9 November 2007
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Role of Biomedical Engineer

• Apply engineering principles to solve medical
  problems
• Provide clinical support
• Develop bionics
• Biomedical Engineering Departments in Australian
  hospitals support clinical services
• Ensure safe, reliable, effective commissioning,
  calibration and maintenance medical equipment
• Research and design of bionics
• Improved user interfaces (computers!)
• Training on equipment and systems
• Purchasing and service contract supervision

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Increasing Demands for Biomedical Equipment

• Aging population
• Increasing premature birth survival rate
• Greater reliance on technology in diagnosis and
  therapy
• Move to non-pharmaceutical options
• High expectation from the globally informed and
  aware communities and legal system

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Preventable Incidents Due to Incorrect Use of
Medical Devices

• NSW most recent
• Patient death in CCU due to wrong device
  configuration
• Infant seriously injured due to wrong infusion
  pressure setting
• Defibrillator failed resuscitation attempt to
  patient as correct device maintenance protocol
  not followed

• During 1984-1992 US government documented 8000
  cases in which patient had been injured or killed
  due to human error in the use of therapeutic and
  medical devices
• Decade later the number has not changed!
• With much greater computer integration this is
  even more worthy of reflection.

• SA-12 cases (8 requiring MET intervention, 1
  requiring admission to ICU) due to wrong delivery
  of gases

• WA 140 different hip stems, 120 acetabular
  component, and 50 knee prostheses available in
  Australia. WA BME tracking and evaluation found
  that poor microstructure and/or sub optimum
  design factors are commonly featured in recurrent
  failures.
• Tasmania currently does not track implants!
• Are our patients getting inappropriate joint
  replacements because biomedical currently does
  not provide this support?

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College of Biomedical Engineers collaboration
with ACHS

• Identifying responsible approach to risk
  management within clinical engineering practice
• ACHS will include and publish updates to
  Equipment Standards
• ACHS wants help writing update. NPCE (National
  Panel of Clinical Engineers) will draft this
  update due to be released in Feb 2008

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Medical Devices Incidents Reported to TGA
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Risk Management and Liability

• Clinicians act to minimise risks to patient and
  hospital. Decisions assume all equipment
• Is functioning reliably and accurately
• Is safe and meets legal Australian Standard
• Release Clinicians from Biomedical Eng tasks
• Clinicians are currently writing and managing
  technical service contracts that could be done by
  a Biomedical Engineer, diverting time and
  attention from core role

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How to Manage Risk Reduce Cost

• Perform risk assessments on all equipment and
  systems
• Consistent Biomedical delivery
• Hard to achieve with duplicated services
• Release Clinicians from Biomedical tasks
• Biomedical input in purchasing
• Best technology, ergonomics, function based
  specification, life expectancy of the equipment
• Is safe and meets legal Australian Standard
• Combined bulk purchases where possible
• Specific action areas
• Maintain separation of corporate and clinical
  computer systems

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Equipment Capital Costs

• The total value of medical equipment in 91
  Victorian public hospitals was 507 million
  representing 13 of non-current assets (Auditor
  General Health Report 30 June 2003)
• ratios to 84 Million Equipment in Tasmanian
  hospitals
• In Tasmanian hospitals and healthcare centres 80
  of the Biomedical devices used, costs over 1000
  each

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Contracts control costs!

• A recent state-wide equipment contract had
  calibration equipment included by the Biomedical
  Engineer allowing a 30 reduction in support
  costs and an 50 reduction in down time
• 10 cost reduction to the latest laser contract
  by simply running it past the Biomedical Engineer
• Unnecessary supplier schemes and extras are
  picked up by the Biomedical Engineer, and more
  importantly omissions that will cost 1000s in
  contract variations are identified

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Example Management Cycle For Medical Equipment
Hospital objectives (Corporate plans)
Asset Management Plans
Establish new equipment needs and priorities
Asset Register
Identify procurement options and allocate
resources
Review utilisation and replacement needs
DISPOSAL
Keep equipment maintained
Source Based on UK National Audit Office Report
The Management of Medical Equipment in NHS
Acute Trusts in England, 1999.
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Staffing Biomedical Support

• First Australian Biomedical support staffing
  model developed by Royal Prince Alfred Biomedical
  Engineering Department
• Presented in the ABEC 2007 in Freemantle, WA
• This model is yet to be accepted by College of
  Biomedical Engineers
• The model
• Is based on number of beds
• Shows staffing is not linear with size or
  activity
• Includes adequate supervision ratios and leave
  cover

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ABES Model Relationship between the number
beds and the FTE (Courtesy Royal Prince Alfred
Hospital NSW)
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Computer Issues !

• Computers are simply a powerful, yet highly
  unreliable tool
• Computers used for human interface, device
  control and data manipulation/storage
• Failure of the computer within a device usually
  takes out the device
• Worse still it can produce misleading behaviour
• 70 of computer viruses come via the corporate
  network
• Separation of corporate and medical networks
  essential
• Corporate network response to security is to
  lock up the system, denying access to all,
  including those needing it
• Increasing computer integration into medical
  equipment and facilities must be covered by
  computer up-skilling within the Biomedical
  Engineering support

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Out-sourcing

• Can provide short term cost savings at expense of
  control, response time, safety and workload
  transfer to others within the DHHS
• Outsourcing maintenance is cost effective only
  where the amount of work involved cannot support
  an internal technician or the medical service
  company has automated test facilities
• The Biomedical Engineers role cannot be
  effectively outsourced
• Clinicians have to take on the role

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Is Outsourcing the Best Option ?

• In-house presents staffing and accommodation
  problems
• Uncertainty over effectiveness of outsourcing
  risk
• Where involved it will end up in the legal
  system
• Who takes responsibility of quality control if
  Biomedical Engineer is not on staff?
• Difficult to write and administer outsourcing
  specification to deliver quality service meeting
  all required standards to which private
  enterprise can deliver at less cost than doing it
  in house
• Biomedical engineer best placed to write and
  administer service contracts after evaluating
  cost effectiveness

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The Tasmanian Situation

• Biomedical Engineering in Tasmania is currently
  significantly behind all other Australian States
• The North is currently better placed due to the
  Department of Biomedical Engineering
• Where requested BME (North/NW) contributes at a
  state-wide level
• The performance of health professionals
  increasingly dependant on Biomedical Engineering
  hardware and software
• Can only operate within the limits of the
  available tools

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The Way Forward ?

• Develop improved Biomedical Engineering support
  strategy for the state
• State-wide review of Biomedical Engineering
  support needs and outsourcing arrangements
• Survey Clinicians satisfaction with BME support
• Recommend completion before design of RHH is
  completed
• Improved Risk Management
• Need consistent testing priorities for management
  of clinical medical equipment
• Match Biomedical RM to corporate and clinical RM
  practice
• Computer up-skilling within the Biomedical
  Engineering

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Sarah Hedges, LGH Anaesthetics registrar
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Kyril Belle, LGH Biomedical engineer
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• Thank You
• Questions?
• E kyril.belle_at_dhhs.tas.gov.au
• P 03-63487492
• M 0437070870