"Smart phones could replace
[radiofrequency] scanners and dynamic dispatching tools. Every smart
phone has a camera and with apps like RedLaser, they can scan products
or locations and provide real-time transaction-level information that
could be processed and optimized to direct or dispatch supply chain
personnel to the next most efficient task. This transaction-level
detail could also be used to track the productivity of the workforce
and to establish work standards that will help in assuring the maximum
utilization of all human and physical assets."
Vance Moore, senior
vice president, operations,
Sisters of Mercy Health System
"UPMC decided recently to move the
management of the pharmacy company under the supply chain management
organization since both areas perform many of the same operational
processes... In the past, these activities were governed under
separate policies using different processes and technologies. Many of
the pharmacy processes were manual. It made sense to tap the resources
active in the supply chain transformation and avoid additional staff
cost for UPMC."
Mary Beth Lang, R.Ph.,
MPM, senior director, supply chain management commercial services,
University of Pittsburgh Medical Center
"There hasn’t necessarily been an
emphasis on reimbursement for the treatment of obesity, but there is a
lot of emphasis on the treatment of the co-morbidities for obesity."
Cathy Denning, vice
president, sourcing operations at Novation
"The prevalence of antibiotic
resistance is rapidly increasing in both healthcare and community
settings. According to the CDC, antibiotic resistance is a major
patient and medication safety issue in modern healthcare. The
Infectious Diseases Society of America (IDSA) and SHEA have published
extensive guidelines for antimicrobial stewardship, which clearly
outline that more than 50% of antimicrobial use is inappropriate."
J. Hudson Garrett Jr.,
PhD, senior director,
Clinical Affairs, PDI
"Using our tracking system in so
many different ways has helped keep everyone focused on quality and
following good practices."
Carmen Ferriero III,
MBA,
sterile processing manager, Albany Medical Center
Reducing unscheduled equipment downtime in
CPD and OR
by Ross W. Simon,
BA and John H. Dzialo, RN, BSN, MBA, Beth Israel Deaconess Medical Center,
Boston, MA
The
key goal of the Central Processing Department (CPD) at Beth Israel Deaconess
Medical Center (BIDMC) in Boston, MA is to clean and provide sterilized
surgical instrumentation when needed in the operating rooms. To do so,
equipment in CPD must be available and working properly; prompt repair and
effective preventive maintenance is an absolute necessity. This article
describes a simple reporting tool developed and implemented at BIDMC to
effectively communicate the need for repairs to the appropriate individuals
and departments. The report (FIGURE 1) also provides an historical
perspective of equipment performance to highlight chronic failures and
therefore help make informed decisions to replace equipment for which the
cost of ownership has increased to unacceptable levels; by doing so, it
assists in capital planning. In addition, the report monitors compliance
with preventive maintenance (PM) schedules.
Figure 1 - Click image of table
above to view at full size.
The following key information is included
as comments in the cell listing the name of each piece of equipment;
hovering over the cells brings-up these data.
• Manufacturer
• Model
• Serial number
• Installation date
• End useful life date
• PM Schedule
Unscheduled downtime caused by aging
equipment and its increased usage provided the impetus for developing this
tool. As part of a multi-pronged approach including replacement of equipment
that had exceeded its life cycle, a service technician on-site at the start
of every day, a change to the notification system to eliminate the middleman
as well as maintenance staff working directly with an equipment manufacturer
representative and the CPD’s supervisor, the increased awareness and sense
of urgency that this report provides helped reduced unscheduled downtime.
Discussion
Initially there was no structured method to
report equipment failures. The first attempt was a daily email message; it
was a point-in-time snapshot, usually in mid-afternoon stating which piece(s)
of equipment were not functioning. Importantly, it did not provide an
historical perspective of equipment performance. Though effective to alert
personnel of which pieces of equipment were unavailable (so work-arounds and
repairs could ensue) there were no means of tracking downtime and
identifying or responding appropriately to equipment that was chronically
down.
This initial process for reporting and
initiating corrective action is outlined below:
Equipment failure
Supervisor notified of equipment failure
Supervisor notifies Service Response Center
Service Response Center notifies Maintenance
Maintenance inspects to see if it’s an
infrastructure/utility related issue
99% of the time, Maintenance calls-in Manufacturer’s
authorized service technician
To reduce response time we had the
supervisor call the technician directly:
Equipment failure
Supervisor notified of equipment failure
Supervisor calls-in Manufacturer’s authorized service
technician
To further reduce response time, we
established a contract with the manufacturer’s representative to have a
service technician on-staff from 0830 – 1700 Mon-Fri.
To address a continuing high level of
unscheduled downtime, the authors developed a simple reporting tool
providing a daily and historical perspective of equipment performance – see
below. Up or down arrows on a colored field denote equipment status as
follows:
-
Equipment operating normally
-
Unscheduled down
- Operating with problems
-
Intentionally down for construction or other facility improvement
requiring equipment to be shut down
The report is issued and reviewed daily by
the Maintenance Department and Sr. Vice President, BIDMC Facilities. It is
also reviewed at a weekly Central Processing Department Workforce meeting to
discuss trends and act accordingly.
Note the cell comments which list key
information for each piece of equipment:
• Manufacturer
• Model
• Serial Number
• Installation Date
• End Useful Life
• Scheduled Preventive Maintenance Dates
Ross Simon is senior
management engineer at Beth Israel Deaconess Medical Center.
John Dzialo is project director, perioperative services.
As a subsequent improvement of this report,
compliance with scheduled preventive maintenance (PM) will be indicated by
color coding the name of each piece of equipment as follows.
GREEN -
PM up-to-date
RED -
PM late
Equipment reliability is, of course, linked
with PM schedule compliance. These PM schedule compliance indicators enable
the organization to respond in a timely manner to service provider
performance or lack thereof. It provides a visible measure of the
performance of the service technician to the medical center’s maintenance
department, hospital administration, and the provider. It also facilitates
optimization of PM by visualizing the effect (unscheduled downtime) of
reducing the frequency of PM.
Conclusion
A simple equipment downtime reporting tool
has been developed and implemented at Beth Israel Deaconess Medical Center
to assist in reducing unscheduled downtime for critical path equipment used
to reprocess surgical instrumentation in the CPD and operating rooms. The
report shows, at a glance, patterns of unscheduled downtime indicating
chronic mechanical failures that may help prioritize capital equipment
purchases and save money by, in the long term, reducing the cost of
ownership. The cost or replacement may outweigh the cost of continued
attempts at repairs and work-arounds. It also assists in capital planning.
