By Patrick Lynch, CBET, CCE, CHTM, CPHIMS, FACCE
There are always a lot of binary opinions when the topic of bed maintenance by biomeds comes up. One camp says it always has and always should belong to facilities—it is too basic for HTM professionals to handle. The other group says that beds are a patient environment that contain scales, alarms, and surround the patient in a grounded metal frame, with lots of mechanical moving parts to pinch, constrict, and even kill someone if the equipment malfunctions.
Neither group seems willing to budge on their position. In fact, I recently read the letter below in an AAMI discussion forum: [Editor note: The letter has been edited for length.]
My HTM team and I have happily assumed responsibilities for all bed maintenance. I get so disheartened when I hear HTM professionals agonize over the responsibilities for bed maintenance. I view the bed, especially today, as a serious medical device. It certainly isn’t a low-end medical device any longer. Today, the bed is an integral part of the patient care experience. Technology has been packed into the beds, such as scales and bed exit alarms—both of [which can save patients lives]…
One other piece of technology to consider is the ability to integrate the bed into the EMR. Integration of the bed into the hospital network allows scale data, bed-exit status and other data points to flow freely and be parsed into your employer’s electronic medical record. I suspect most maintenance departments do not have the skill sets necessary to manage the bed technology of today. Lastly, why not deliver another value-added feature of your HTM program to your employer and the patients you serve?
As far as education, all of the manufacturers have educational programs that your staff can attend. Additionally, I would expect the HTM professionals in our career field to have the necessary skill sets and education to decipher bed maintenance documentation. I hope you consider assuming these responsibilities and making the business case as to the value that your HTM department could deliver for your employer and patients.
Make sure you gather any data associated with the bed maintenance to date (i.e. service cost history/budget, [full-time equivalent] count currently used to support bed maintenance, etc.). I would view this as a great opportunity to perhaps enhance your FTE count and potentially drop a few other service contracts that might be in place.
[You can also] utilize your potentially new HTM employee to not only do bed maintenance, but also sterilizers and other technologies that might lend themselves well for the skill sets you employ.
—Christopher G. Nowak, CBET, CHP, CSCS
Rethinking the Process
Nowak hit the nail on the head—patient care starts with holding the patient. Whether a patient is being supported by a wheelchair, an exam table, a patient bed, a surgical table, or something else, patient care is rarely delivered with the patient standing up.
Therefore, patient-holding devices must be functional, moving when they should, remaining stationary when they are supposed to, and shifting the patient into treatment positions. And they must do this safely since hospital patients often have diminished consciousness or physical ability.
Unfortunately, facilities and service contractors have a history of delivering inadequate care to these seemingly low-tech devices—although their cost-of-service-ratio (COSR) is often very high.
However, HTM professionals can usually provide a great deal of value is terms of uptime, device availability and functionality, caregiver satisfaction, and cost reduction by managing these devices. But they must focus specifically on it, instead of simply assuming that they can respond to repair requests and fix the devices.
HTMs must proactively attack the devices, query the users, determine what problems are occurring, and examine how the devices are being used. Then they must work alongside the caregivers using the movable assets to devise ways to control them.
Since beds and wheelchairs often travel throughout the hospital, all departments must work together to determine key problems about the devices and find ways to control, track, and report problems about them, as well as get them back to the necessary caregivers. And HTMs professionals may be best equipped to lead this multi-departmental team.
Furthermore, HTM departments must take a dedicated approach to maintaining and supporting these devices. In the big scheme of things, they are no less important than imaging equipment and deserve the same level of attention, planning, and concern.
Patient beds and wheelchairs require a dedicated shop area and staff, adequate backup support from the rest of the HTM department (and on-call staff), specialized test equipment and tools, a training budget, and a large storage area. Parts availability is also critical due to the equipment’s large size. After all, it’s not possible to store patient beds for weeks while waiting on a part to arrive.
Now, let’s talk about staffing: Who should be working on beds, OR tables, wheelchairs, and exam tables? A fully trained BMET? While they could certainly do it, I don’t think that most BMETs went to school to pursue this level of technology.
Next, let’s examine the nature of these devices: Beds, operating room tables, and wheelchairs all have wheels. They are all mechanical, but most have something electric or hydraulic that helps them move or adjust.
And they all move, so they bump into things and get dents and chipped paint. Oh, and they all have some sort of upholstery, which comes in contact with the patient. Kind of sounds like an automobile, doesn’t it?
Well, my friends at Colorado Children’s Hospital in Denver thought so, too. So they went out and hired a self-employed automobile mechanic and auto-body technician who was tired of the dirty, greasy work and was happy to take a hospital job. They set him up with a shop and let him fill it with the necessary tools, lifts, paint, etc., to maintain the functionality and aesthetics of these devices.
That was several years ago. Since then, Colorado Children’s Hospital’s program has grown to two people, with these individuals now responsible for devices not considered “medical equipment.” I don’t know the hospital’s savings or COSR for bed maintenance, but I bet it’s significantly less than a manufacturer contract.
This is a perfect example of a department taking a problem, applying some out-of-the-box thinking to it, and coming up with a superior solution for everyone—the hospital, the HTM department, the caregivers, and—most importantly—the patients. So let’s encourage HTM professionals to never run from challenges, but to look at the hardest jobs as opportunities for the greatest victories.
My personal motto is “never say no.” Not to anything, no matter how offbeat, weird, or impossible it may sound. After all, I’m confident in my ability to get things done just as well—and usually better!—than others. And you can, too, if you believe in yourself.
Patrick Lynch, CBET, CCE, CHTM, CPHIMS, FACCE, is a biomedical manager with 40 years’ experience. For more information, contact chief editor Keri Forsythe-Stephens at [email protected].