By Patrick Lynch, CBET, CCE, CHTM, CPHIMS, FACCE
Here are 10 quick and easy tips for you to use when planning in your hospital, based on my own experience and observations. Note: All “rules” are based upon a general hospital, which offers a broad spectrum of services. If you have any differing opinions or additional “Rules of Thumb,” however, please let me know.
1. Experienced HTMs (in the same job at the same hospital) can take care of approximately 10% more equipment each successive year. The reason for this is that as biomeds become more knowledgeable about the departments they serve, the customers they interact with, and the equipment they maintain, their ability to go straight to the heart of a problem becomes more keenly honed. This is yet another reason to retain employees and not take them for granted.
2. The department staff handles roughly 1,700 pieces of general biomedical equipment, valued at $5 million—with imaging specialists handling $12 million worth of equipment. Although there is controversy surrounding this rule of thumb, the fundamental assumption is that there are no labor contracts on any of the equipment being counted. The exact mathematical “formula” continues to be a closely guarded secret; however, the calculations are ridiculously simple, with three or four factors at most. They are not the complicated, multivariate, logarithmic, Laplace transforms that only geniuses could understand.
Pricing and staffing for an entire hospital can be done with a four-function calculator and a couple of hours to spare. The biggest challenge is just getting an accurate inventory. But examining the staffing and pricing for literally hundreds of hospitals throughout my 43-year career—23 years of which were spent selling biomedical repair services—yielded the above norms. Even so, they may vary slightly, based on non-equipment responsibilities and the frequency of staff turnover.
3. In a general hospital, the equipment value is divided as follows: 50% for imaging devices, 6% for laboratory equipment, and 44% for general biomedical devices. This, too is based upon the analysis of more than 300 U.S hospitals and assumes that all imaging, laboratory, and general biomedical equipment is inventoried and tallied accurately.
4. Manufacturer contracts (full-service, per year) cost approximately 18% of the total new equipment cost. Averaging the cost of 24×7 contracts, parts included contracts on all types of medical devices reveals a range of 12% to 20% of the original price, not including software licensing fees. Software-only contracts and support fees tend to be whatever the market will bear and, thus, are often higher than 25% per year.
5. In a mature program with few contracts, in-house biomedical costs can operate at a ratio of about 4%-6% of the original equipment cost. Some outsourced programs may operate this efficiently, but the true cost must include all extra billings that make up the biomed budget. Outsourced departments often bid low to get the business, but the customer is then billed for everything outside the contract, such as batteries, patient cables, overtime, etc.
6. Electrical safety testing (EST) takes about 15 minutes to complete—locate, test, document— on average.
7. Most general biomed PMs average 40 minutes. Averaging many man-years of data reveals that preventive (or scheduled) maintenance of normal (non-imaging, non-laboratory) medical equipment averages about two-thirds of an hour. This includes PMs, which are just EST, combined with a visual inspection.
8. In a general biomedical setting, repair work orders take about one hour. Doing a simple division of many man-years of data indicated that most repairs average about one hour to complete. Laboratory and imaging are significantly higher— as much as double, on average.
9. In a hospital that uses a risk-based PM system, approximately one-third of their medical devices are not scheduled for a PM. Extremely aggressive programs can raise this to nearly 50%. But what surprises me is that so many U.S. hospitals still insist on placing their hands on every item of equipment at least once a year. And I’ll bet their rate of medical device patient injury doesn’t vary 0.000001% from the risk-based departments.
10. More than half of the time, the HTM shop is located in the basement, has no cell phone coverage, and shares at least one common wall with the morgue. I found this to even be true in Havana, Cuba, when I visited Hospital of the Americas—Cuba’s largest hospital—a few years ago. The hospital is 25 stories tall, but biomed is—you guessed it!—in the basement, around the corner from the morgue. Who woulda thunk it?
Patrick Lynch is a biomedical manager with 40 years’ experience. Questions and comments can be directed to [email protected]