Managing Medical Devices in an Managing Medical Devices in an Acute TrustAcute Trust

Dr Andy Smith

Head of Clinical EngineeringRoyal Berkshire NHS Foundation Trust

Royal Berkshire HospitalRoyal 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

Key Clinical Engineering ResponsibilitiesKey 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

Database

Database

Website

Phased Replacement

Multi Vendor ServiceMulti Vendor Service

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

Multi Vendor ServiceMulti Vendor ServiceKey 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

Multi Vendor ServiceMulti Vendor ServicePre 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 manufacturer’s 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

Multi Vendor ServiceMulti 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

Multi Vendor ServiceMulti 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)

Replacement of Infusion SystemsReplacement 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 270+100 option Following trial chose Orchestra DPS £0.74M for 290+100 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

Replacement of Infusion SystemsReplacement 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

Infusion SummaryInfusion 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

Medical Equipment LibrariesMedical 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

Infusion Library

Medical Equipment LibrariesMedical Equipment LibrariesDynamic 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

Mattress Library

Anaesthetics

AnaestheticsAnaestheticsMaintain Royal Berks/Newbury and Windsor all

in houseRecruited ex Datex-Ohmeda engineer1.5 wte within Clinical Engineering, fast on site

responseIncome generation potential (prev contract with

Independents)ISO 9000 registeredSaving £80,000 per year

Beds & Static MattressesBeds & 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

Maintenance ContractsMaintenance Contracts

Maintenance of all medical devices managed by Clinical EngineeringThree 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)

Disposal Of DevicesDisposal 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

Training – Notices - IncidentsTraining – Notices - Incidents One Medical Device Training Coordinator Established Link Nurses throughout the Trust Besides delivering some training, co-ordinates training

with manufacturers/suppliers/trainers/users 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

QuestionsQuestions

How much does your Trust allocate per year for new/replacement of medical equipment:a) up to £500,000b) £500,000 - £1Mc) £1M - £2Md) over £2Me) Don’t know

QuestionsQuestions

Does your Trust have a Phased Replacement programme:a) Yes

b) No

c) Don’t know

QuestionsQuestions

Has your Trust entered into a Multi Vendor Service arrangement:

a) Yes

b) No

c) Don’t know

QuestionsQuestions

If yes is it delivering the expected service/savings:

a) Yes

b) No

c) Don’t know