Mount Sinai Medical Center

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MOUNT SINAI MEDICAL CENTER

CLINICAL ENGINEERING DEPARTMENT REVIEW

By Christopher Maloney

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Abstract

A Clinical Engineering department is among the most important support departments that a hospital can have. Clinical Engineering is responsible for the maintenance and repair of all medical support equipment on a medical campus. They must use their training and experience to be able to troubleshoot and solve almost any problem with medical equipment that a medical staff may encounter during the course of a day.Some of their other responsibilities include building knowledge on the current trends in medical equipment, as well as constantly training to stay updated as equipment gets upgraded. All these responsibilities can be summarized by saying that Clinical Engineering is responsible for ensuring that medical equipment is in good working order and helping the hospital make important decisions on new equipment.

In order to get a detailed look at the operations of the Clinical Engineering department at Mount Sinai Medical Center, I was asked to perform a departmental review. The purpose of this project was to develop a thorough understanding of the processes of the Clinical Engineering department to see that they are operating effectively and if there is any room to improve. To learn about the department, I spent six weeks shadowing different employees to see what their different jobs were and how they interacted with the other employees and went about doing their jobs. The following is a detailed report on what I was able to find during this six week period.

Aramark

The responsibilities of the Clinical Engineering department at Mount Sinai Medical Center are outsourced to a company called Aramark. Aramark is a large, international company, headquartered in Philadelphia, PA, that provides professional services which include food services, facilities management, and uniform apparel to businesses around the world. ("About aramark,") These services are provided to companies in nearly every industry including public safety, entertainment, convention centers, and healthcare.

The Aramark branch that Mount Sinai deals with is the Clinical Technology Services branch. The office that serves Mount Sinai is located in the Miami Heart Institute. At Mount Sinai, they have two separate departments; biomedical engineering and imaging. The biomedical engineering department is located on the ninth floor of the Blum building on Mount Sinai’s main campus. The imaging department is located on the second floor of the main building on Mount Sinai’s main campus.

Department Overview

The Clinical Engineering department at Mount Sinai Medical Center is responsible for everything involving medical equipment owned by the hospital. Their two main tasks include preventive maintenance and broken equipment repair, but their work extendsbeyond that. Some of the other tasks that the Clinical Engineering department is responsible for include new or alternative equipment recommendations, new equipment inspections, daily Operating Room rounds and hospital moves.

Service Calls

Service calls are the major responsibility of the Clinical Engineering department is responsible for. Any employee in the hospital can call the department when a piece of medical equipment is not functioning properly and expect that it will be fixed within a reasonable time period. This function is especially important in the event that equipment is not working before or during a surgical procedure to ensure patient safety.

Preventive Maintenance

In order to prevent incidents, equipment failure, and to meet Joint Commission standards, the Clinical Engineering department performs preventive maintenance on nearly all of the equipment that it is responsible for. The first thing the employee performing the maintenance always does is clean the equipment with alcohol wipes. Then, they will perform tasks ranging from electrical safety tests to checking the fluid levels of the machine. If anything is found to be wrong with the machine during the preventive maintenance inspection, it is fixed before the machine can be used again.

New Equipment Recommendations

It is the job of the Clinical Engineering department to stay up on current trends in medical equipment nationwide so that when called upon for advice in purchasing new equipment, they can provide sound advice. It is also the job of the staff to evaluate the condition of the current equipment as they perform maintenance and make recommendations for new equipment if the old equipment is obsolete or going to be obsolete in the near future.

Incoming Equipment Inspections

When new equipment arrives at the hospital, Clinical Engineering must be informed by the Shipping and Receiving Department. Clinical Engineering then goes to pick up the equipment and perform an incoming inspection before releasing the equipment to the floor. Incoming inspections usually consist of various safety tests and giving the new equipment an asset number.

Daily Rounds

Every morning around 7:30, one technician is sent to make the daily rounds. This entails going to the main Operating Room, the Ambulatory Center, Central Services, and the Operating Room overflow area to make sure that all of the equipment is working as well as it is supposed to in order to make sure the cases can all flow smoothly throughout the day. When the Clinical Engineering department gets itself back to being fully staffed, they plan on doing rounds on every floor at least once during the week.

Hospital Moves

When a department moves within the hospital, Clinical Engineering is called upon to move and set up any medical equipment that is required in the new location. They then monitor the equipment to make sure it is functioning properly as the patients are moved to the new location.

Other Tasks

Among the regular tasks listed above, Clinical Engineering also is responsible for projects that come up periodically. Some of the projects they worked on during the observation period included replacing batteries in monitors with newer models after the failure of some older models, assisting vendors with possible recalls, and teaching hospital employees how to use certain equipment functions.

Staffing

Miami Heart Institute

At Miami Heart Institute, Aramark has 4 employees. The first employee is the supervisor in charge of the Clinical Engineering operations at Mount Sinai. His responsibilities are all business related and he communicates with headquarters, his district manager, as well as Mount Sinai executives. He has experience in the biomedical field and has moved into a management role.

Also employed in the office at Miami Heart are two clerical employees. These two employees are responsible for directing phone calls, payroll, basic accounting, printing work orders for preventive maintenance, filing all work orders, and maintaining their equipment database. They appear to be very busy at all times and have very crucial jobs to the functionality of the department.

The final employee located in Miami Heart Institute is a technician responsible for maintaining and servicing all of the equipment at the Miami Heart campus, as well as assisting the biomedical technicians at the Mount Sinai campus. Due to the small amount of equipment still located at Miami Heart, this technician does spend about 10 hours every week assisting the biomedical technicians at the Mount Sinai main campus.

Mount Sinai Medical Center Biomed Department

The Biomed Department of Clinical Engineering has gone through some major staffing changes. At the moment, they are understaffed as they have lost some employees to military obligations and relocations. When fully staffed, the Biomed Department consists of seven technicians. Of these seven technicians, one constantly works on preventive maintenance and repairing equipment in the shop. The rest of the technicians spend time doing preventive maintenance as well as taking service calls. Additionally, one technician every week is designated as the on-call technician who must be available 24 hours a day for that week in case some essential equipment malfunctions during the night time or weekend hours.

Currently there are five technicians on staff. Three of the technicians are rotating between working on preventive maintenance and service calls. One technician is working primarily on preventive maintenance and repairs. One technician was recently hired and is doing preventive maintenance as he learns his way around the hospital. After he has become more familiar with where everything in the hospital is located, his responsibilities will grow to include taking service calls as well.

Mount Sinai Medical Center Imaging Department

The Imaging Department of Clinical Engineering consists of 2 employees. The first of these employees is a supervisor. His responsibilities include hospital related tasks such asmaintaining equipment, managing service contracts with outside vendors, coordinating service and preventive maintenance with hospital department supervisors,and making recommendations for new equipment purchases. Additionally, the supervisor is involved in two committees outside of Mount Sinai Medical Center. The first is the Quality Standards Committee and the other is the Imaging Sub Committee of which he is the president. Both of these committees’ goals are to improve the quality of service Aramark provides its customers and to create standard practices in the imaging departments nationwide.

The second employee in the imaging department is more of a technician. His main job is to repair and perform maintenance on equipment. He is also responsible for helping outside service vendors when they come to the hospital to repair equipment.

Staff Personalities

The members of the Clinical Engineering department all seemed to interact well with hospital staff. They all seemed to have a “patients come first” attitude about everyday issues that they faced, and this attitude was reinforced by the supervisors whenever necessary. The technicians all seemed to have a sense of pride about their work and would not put a piece of equipment out on the floor unless they knew for a fact that it was going to be functional.

Policies

Staffed Hours

The department is responsible for having technicians in the hospital from 7:00 A.M. until 5:00 P.M. Monday through Friday. In addition, they must have an employee on call 24 hours a day to cover any non-regular hours. The employees come in for work at different times ranging from 7:00 A.M. to 9:00 A.M. to cover their time window. They are expected to work eight hours a day with a one hour break for lunch, although most of the time they stay beyond the eight hours to make sure the equipment is maintained on time.

Preventive Maintenance

All preventive maintenance work orders are issued on the first day of a particular month. The department goal for all preventive maintenance is to have the work order completed within 30 days of being issued. Life support equipment is required to be completed within those 30 days.All other equipment must be completed within 60 days.

The equipment in the hospital is all assigned a priority for completion of preventive maintenance. All life support equipment is listed as urgent. All other equipment that requires regular preventive maintenance is listed as regular. Anything that does not require regular preventive maintenance is listed as deferred.

If a work order calls for maintenance on equipment that is being used by a patient, they have to decide whether to temporarily place them on a substitute of that equipment or to come back at a later time when that patient is moved to a different room. Many times, the technicians consult with the nurses on the floor to make this decision.

Service Calls

When a technician is paged by the office for a service call, they must respond to that page within 10 minutes. From there, it is the department goal to physically respond to the service call within 15 minutes of its receipt. Priority for responding to service calls always goes to life support equipment, but many times it is up to the technician to decide which call is most important.

Unable to Locate Equipment

During the course of a month, the technicians may receive work orders for equipment they cannot locate. When this occurs, they are required to do a reasonable amount of searching which includes spending the last few days of the month looking for lost equipment. If they are still not able to locate the equipment, they change the status in their computer system to UTL and turn the work order in to their supervisor. The supervisor then turns the UTL work orders into the office and they make note of it, stamp the work order, and return it to the supervisor. He is responsible for keeping it for 120 past the original due date before the equipment goes on the official UTL list.

Many times a piece of equipment is found after being placed on the UTL list. If this is the case, they perform the required maintenance and complete the work order. If a piece of equipment has been put on the UTL list twice, it is no longer tracked by clinical engineering.

Work Orders

There are three possible ways for a technician to accumulate work orders. These include preventive maintenance cycles, service calls, or miscellaneous jobs given by the supervisor. Technicians are expected to fill out and update these work orders with accurate information within a reasonable time of doing work on the equipment. Technicians must be able to account for at least 36 of the 40 hours they work during the week in the work orders.

Software

In order to track and maintain information about all of the equipment that they are responsible for, the Clinical Engineering department uses software called ISISpro. ISISpro was developed by Aramark with the purpose of tracking medical equipment and providing useful equipment histories, labor tracking, purchasing information, and reports. ("Aramark healthcare: fact,")

The most common uses of the software for Clinical Engineering were for work orders. Work orders were printed at the beginning of the month for all equipment that needed preventive maintenance and throughout the month for all equipment that was serviced. Whenever there was a change in the status of the equipment, a new part purchased, or a new problem found in repairing the equipment, the technicians updated ISIS. When the work was completed on a work order, the technician would go into ISIS to complete the work order and provide as much detail as possible to what the problem was with the equipment, any issues faced, and how the problem was resolved. Other relevant information included when completing the work order was the name of the technician that serviced the machine, the date and time of the service, and any parts purchased.

The other most useful feature of ISIS was its extensive reporting ability. The system has a large number of pre-written reports that the users can open and run quickly. Users also have the ability to create their own reports based on any fields tracked in the system. The most common reports run by ISIS list the equipment that is due for preventive maintenance and the current UTL list. Any of the information contained in an ISIS report can also be sent to Microsoft Excel which can be useful in communicating with people outside of the department.

Overall, ISIS is very complete software that has very few limitations. It is very user friendly which is crucial in a shop of technicians that are not always great with computers and also limits the time needed to train new employees in it.

Procedures

The following flow charts represent the everyday processes performed by the Clinical Engineering technicians:

Overall Service Call Process

This flow chart describes the service call process from the call to the office to the filing of the completed work order. It gives a look at what each department does and how the information flows from one department to the next.

Technician Service Call Process

This flow chart describes in greater detail the service call process from the technician’s point of view. It is supplemental to the Overall Service Call Process flow chart.

Overall Preventive Maintenance Process

This flow chart describes the preventive maintenance process from the very beginning of the month when the preventive maintenance work order is printed out to the filing of a completed preventive maintenance work order. It looks into the process department by department to show how the information flows.

Technician Preventive Maintenance Process

This flow chart describes in greater detail the preventive maintenance process from the technician’s point of view. It is supplemental information to the Overall Preventive Maintenance Process flow chart.

Work Sampling

In order to get a better understanding of where the majority of the technicians’ time was being spent, a work sampling was performed. Because of the nature of the biomedical technician job and the large territory that they cover on any particular day, the work sampling was performed by following one non-service call technician around for a day and making an observation about their activities every five minutes. After three weeks 853 observations were made, thus giving a pretty sound statistic into what a technicians’ time is used for. The following categories were used to describe the observations: