Managing Medical Devices in an Acute Trust

1. Managing Medical Devices in an Acute Trust Dr Andy Smith Head of Clinical Engineering Royal Berkshire NHS Foundation Trust

2. Royal 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

3. Key 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

4. Database

5. Database

6. Website

7. Phased Replacement

8. Multi Vendor Service The Concept: • Guaranteed savings • Simplified management • Flexibility • Consistent service quality • Compatibility • Evolution • Efficiency

9. Multi Vendor Service Key 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

10. Multi Vendor Service Pre 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

11. Multi 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

12. Multi 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)

13. Replacement 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

14. Replacement 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

15. Infusion 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

16. Medical 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

17. Infusion Library

18. Medical Equipment Libraries Dynamic 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

19. Mattress Library

20. Anaesthetics

21. Anaesthetics • Maintain Royal Berks/Newbury and Windsor all in house • Recruited ex Datex-Ohmeda engineer • 1.5 wte within Clinical Engineering, fast on site response • Income generation potential (prev contract with Independents) • ISO 9000 registered • Saving £80,000 per year

22. Beds & 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

23. Maintenance Contracts • Maintenance of all medical devices managed by Clinical Engineering Three 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)

24. Disposal 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

25. Training – 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

26. Questions • 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

27. Questions • Does your Trust have a Phased Replacement programme:a) Yes b) No c) Don’t know

28. Questions • Has your Trust entered into a Multi Vendor Service arrangement: a) Yes b) No c) Don’t know

29. Questions • If yes is it delivering the expected service/savings: a) Yes b) No c) Don’t know