Hospital Management System Project

Management of Medical Technology – Case Study of a Major Acute Hospital

This paper presents results of a Capital Equipment Management Plan undertaken at a major acute hospital in Australia. By classifying existing equipment using a threshold replacement value into Major and Minor items, detailed planning information was collected for 527 items of Major equipment representing 80% of the hospital’s total equipment stock. A number of meaningful views of this significant asset base are presented, and a prioritisation method used to provide recommendations for future equipment replacement and acquisition for a 5 year planning period. The survey work to identify and document actual equipment items provides a convincing argument for the funding levels required for capital equipment replacement and acquisition, and evidence for the extent of technology reliance in modern health care facilities.

Hospital Management System Project

This paper presents the results of a Capital Equipment Management Plan for a major acute hospital in Australia. Previous papers by the authors have reported the methodology for conducting such a plan, covering the areas of the 3 phases of creating a management plan [1], some issues faced in implementation [2] and using prioritisation to ensure limited funding is used to best effect [3]. These aspects have been combined in this case study, and the overall results for this major hospital are presented.

The subject hospital is a major tertiary teaching hospital with modern facilities located in the outer CBD precinct of a large Australian city of 3.6 million residents. The hospital provides specialist services to trauma victims, a world leading heart & lung transplant unit, radiotherapy services, and has been operating since the late 1800s. It has a 36 bed ICU, 14 operating theatres, and had a reported gross operating budget of A$442.6M in 2005.

Development of the planning framework has been presented previously [1,2]. In this case, the planning framework was developed with the head of the Biomedical Engineering department, with the intention of providing the final report to the hospital’s executive management.

A.Aim There were two main aims for the Capital Equipment Management Plan Project; firstly, to provide a Status Report of the current equipment stock showing the equipment composition and immediate outlook for requirements, and secondly, to provide advice for an approach for the future replacement and acquisition of equipment within likely equipment budgets. The report also covered additional equipment required for normal service expansion and growth, and for some strategic projects currently underway. The planning period was 5 years as this was considered a reasonable limit for service and funding predictability. B.Scope The project included all capital equipment (excluding corporate IT, as this equipment was already covered by and existing planning process). The existing equipment stock was reported in the sections of Major Equipment, for items with a replacement value above a threshold value of A$50,000 (US$40,000 approx.), and Minor Equipment. Major items were reported in detail, and covered Individual Units (e.g. Cardiac Ultrasound Units), Systems of equipment (e.g. the Patient Monitoring System in the Emergency Department), and Aggregates of similar model and age items (e.g. Single channel infusion pumps, used throughout the hospital). Minor items were reported as an overall group since only limited details were collected for these items. C.Method For Major items, data collection consisted of structured interviews with selected departments known to have major equipment. Over 50 interviews were undertaken. The initial data sources were the BME inventory, the Finance department’s Fixed Asset Register, and equipment lists from recent State Government Health Department surveys of major items. Each major item requiring replacement within the 5 year planning period was prioritised, as described below. For Minor items, data collection relied on the BME inventory as it was found to be a reliable source of information for all types of equipment and covering all areas of the hospital. For example, the BME inventory included major items from Medical Imaging and Radiotherapy as well as minor items from Pathology and all other medical departments.

Prioritisation is necessary when the funds are not available for the scheduled replacement and acquisition of all items. Since historical equipment funding levels have not been at this level for this hospital, provision for prioritisation was included in the planning framework for the project. Figure 5 shows the distribution of priority scores for the existing and additional major items considered for funding within the 5 year period. Priority scores were scaled to range between the values of 0 to 100. Priority scores were divided roughly evenly into three bands as shown in the figure: Below Normal Priority (143 items), Normal Priority (131 items), and Above Normal Priority (132 items). Some examples of Below Normal Priority items were: replacement of existing electric beds in ICU, replacement of a coagulation analyser in Pathology, and the acquisition of an additional ultrasound unit for the Emergency Department. Some examples of Above Normal Priority items were: replacement of very old patient trolleys, a mobile image intensifier, and operating theatre lights (all for the Operating Theatre), and replacement of old and unreliable bronchoscopes for the Emergency Department. In this figure the large number of items falling in the priority score range 82.5 to 85.0 includes the theatre lights for the 14 operating theatres which were all of the same age and condition, resulting in a priority score of 84.59 for each item. The priority scores were not used to create ordered lists of equipment requiring replacement, although this would of course be possible. We do not consider this method of prioritisation sufficiently complete to presume it can provide the final ranking of equipment for replacement. However, it does provide a range of equipment for consideration by the hospital executive when funding opportunities arise. At such times a more targeted and complete analysis of items can be undertaken using the hospital’s existing processes.

The Capital Equipment Management Plan created data to support two separate equipment expenditure types. Firstly, the regular capital equipment budget was reported, covering the routine replacement of existing major items, the routine replacement of existing minor items, and the acquisition of additional major items for normal service expansion and growth. The other major expenditure budget reported equipment required for strategic projects. This budget covered redevelopments, strategic service changes and very high cost items. A third equipment expenditure budget is also required, but was not covered by the scope of the Capital Equipment project. This budget is for operational expenses, including equipment maintenance, leasing, and consumables (including consumables contracts). Although not reported here, this budget is also significant and would provide an important extension to the equipment funding picture.

The approach described in this paper to conduct a Capital Equipment Management Plan has produced an invaluable view of the capital equipment needs for the subject hospital. The resulting management level information can be used for overall management of the equipment replacement process. In this hospital’s case, the total existing equipment stock was found to be A$130.8M, consisting of A$104.6M of Major Items and A$26.2M of Minor Items. This stock is nearly all Medical Equipment (>80%), but other categories of equipment are also held in significant amounts. Over the 5 year planning period, a total of A$112.5M was identified as required for the routine replacement of existing Major and Minor items, the planned upgrade of existing Major items, and the acquisition of additional Major items to allow for normal growth and service expansion. The provision of prioritised equipment lists allows for a selection of likely items to be considered in more detail when equipment funding opportunities arise, and provides a means for ensuring that equipment budgets are applied to the most important equipment items according to a transparent set of guidelines. View More

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