Process Mapping Of Medical Equipment Downtime

The real challenge is how to minimise the equipment frequency of breakdown and reduce the equipment downtime, says Deepak Agarkhed

“The patients have to be sent back to the ward as MRI is non-functional since yesterday.” “Ventilator is having major breakdown and cannot be used on patients.” These are some examples of medical equipment breakdown that occurs on an everyday basis in any hospital.

Equipment having breakdown and it being non-functional is inevitable, but the real challenge is how to minimise the equipment frequency of breakdown and reduce the equipment downtime.

Breakdown can be reduced by adopting Total Productive Maintenance (TPM), which will help in maximising equipment effectiveness throughout the lifecycle of the equipment. TPM also involves routine maintenance of system by the paramedical staff biomedical engineer, continual training to end user as per schedule and enhancing problem solving skills and activities to achieve zero breakdown.

The downtime of medical equipment is the period during which the equipment is not in a condition to perform the intended function. It is the summation of problem realisation time by the technician, diagnosis time by the engineer, logistic time, and alignment time of spare parts. Lately, with various hospitals’ emphasis on lesser duration of stay of patient, the equipment uptime is very critical. The downtime of two-five per cent based on criticality of the equipment is permissible. The downtime calculation in hours is based on application of the equipment. Typically, for most of the intensive care equipment like patient physiological monitors and ventilators, the calculation is based on 24 hours working per day. For most of the diagnostic equipment like CT scanner, colour doppler it is calculated considering 10 working hours per day and six working days per week. To illustrate further, considering 300 working days in year, 10 hours per day, two per cent downtime will be 60 hours.

The data on downtime pattern for three months for medical equipment for any multi-specialty hospital is collected from the medical equipment maintenance tracker and the compiled data is given in the form of Table-A and Table-B shown here.

The process map of downtime of medical equipment in a hospital is shown below. In this case, the hospital has adopted JIT (Just in Time) policy for spare inventories and does not keep any spare inventories in there stores department.

The indication of process centre is calculated from total mean value and the process range will provide total variability in a set of measured value. The average downtime of 4.3 days can be improved upon.

The following conclusions have been drawn based on each component of the process map:

The realisation time can be reduced by introducing equipment operator’s shift checklist based on the recommended checks and procedures to be performed and documented at the start of each shift. Delay in inspection time by hospital biomedical engineer is reduced by the technician lodging in complaint in the hospital equipment maintenance tracker software and the concerned engineer will be paged automatically. The escalation of call should be made to the biomedical department head in case the complaints are not resolved by the concerned engineer.

As it is noted from Table-A that the minor (first hand level) complaints form 67 per cent of total complaints but the hospital biomedical engineer was able to rectify only 32 per cent of those. The delay in diagnosis time can be further improved by providing regular training to hospital biomedical engineer and providing good workshop facility for the hospital biomedical engineering department (i.e. well-equipped with toolkits, calibration devices and equipment service manuals). Also, the concerned department should function round the clock.

The delay in inspection by equipment vendor service engineer can be reduced by lodging in call at vendor uptime centre by biomedical engineer in case the problem is not resolved within one hour from compliant lodging.

The biggest challenge is in reducing the spare procurement time. This delay in activity includes:

• Delay in getting proforma invoice from vendor.
• Delay in getting approval from hospital administration on required spare parts. To facilitate the hospital administration in taking decision, the biomedical engineer should provide information on equipment capital cost, age, capital cost, frequency of equipment breakdown, spare part price (when previously ordered).
• Delay in order processing and distribution can be reduced by generating purchase order in hospital information system to enable user departments and stores to have prior information before arrival of spare parts.
• Delay in clearance of spare parts can be reduced by hiring efficient clearing agent and furnishing all the necessary documents before arrival of spare parts.

The downtime can be checked and controlled at the time of negotiation of medical equipment procurement with the vendor by incorporating uptime guarantee (usually from 95-99 per cent) and having downtime penalty clearly specified in the purchase order.

To conclude the above analysis with effective measures taken in each component of downtime process map, hospitals can achieve an average much lesser downtime and thereby improve their patient care facilities and productivity.

The writer is Divisional Head, Biomedical Engineering Department, Artemis Healthcare.
E-mail: deepak.agarkhed@artemishealth.org