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 firstname.lastname@example.org.
Have to agree that most beds are better serviced by a BMET, and that the interconnection will push them even more into our area of expertise. The unfortunate part is that when this happens, the hospital admins do not recognize the labor commitment need to properly address this most fundamental of patient care equipment.
We have 110 beds, which are only 2.5% of our inventory, were above 7% of our labor hours. They all have Mechanical PM requirements, and frequent utilization and interaction with nursing staff generates a pretty steady stream of repairs.
If you are looking to pick up these devices, be prepared for the significant increase in work they can represent. Depending of the numbers you will be taking on, they may even add an FTE to your requirements.
In will only join in from a general perspective informed by experience gained about 30 years ago.
I was asked to put together a PC maintenance program within a CE department. I was not happy about it, but my team and I took it on and were successful. I submitted proposals to ASHE and AAMI to report on our experiences and results, and both were accepted. The presentation at ASHE went well, but at the 1988 AAMI meeting I was verbally harangued by the audience for daring to touch non-clinical equipment.
Fair enough. After all, I wasn’t originally happy with the assignment. But among the things I reported on was the one problem that we hadn’t figured out how to reliably address interconnection issues, even when using “standard RS232”.
That problem turned out to be a jumping off point for me into the world of interoperability, a topic that consumed my attention for much of the second half of my career.
After all these years, I don’t know what to suggest to others when challenged to take the road less taken. There may be very good reasons not to trod it, and indeed not all of my group’s attempts at starting new services went well. Perhaps all I’d suggest is whenever you’re immediate reaction to a request for your help is “it’s not my job”, take a deep breath, step back, and think about what possibilities the request might open up that are not immediately obvious.
For 30 years, I have seen this debate.
I have also seen the problems of bed maintenance from several few points.
The biggest one has been space allocation. the second has been training budgets. Yes, I agree, you have to look at this equipment as a automobile garage activities. One day, some one will see the necessary space and personal needed to address this concern. Wether it be the Biomed/ Clinical Engineering department or the Plant operations. No answers to this problem but just commenting on whatver department, decides to take them on.. have the resources and personnel available.
It can make or break the patient care aspects of that hospital.
I’m with Rick. A variation on “its not my job” is “we are too cool to bother with such matters” whether this is actually spoken or conveyed by attitude. This behavior will not endear you to those whom you are supposed to be cooperating in the interest of the facility and the patients.
To me, this article is right on. The beds and stretchers our patients are in, are part of their care experience and deserve the same high level of support every other aspect of the care environment receives. With the new changes in NFPA99 and TJC the maintenance focus on the “patient bed” should be on the rise. unlike the old electrical beds of decades past. I agree with Pat these are complex medical devices and deserve to be part of any comprehensive maintenance management program. I took care of a fleet of Hilrom 1165s and total cares for a few years. Our customers are our caregivers and a problem with a bed can be just as disruptive to the their patient care mission as a problem with a monitor or any other mission critical device. How often have we heard the phrase “we are waiting for a bed” uttered by a caregiver or unit clerk. for me, BED is part of BiomED.
I’m a one man Biomed shop at a hospital. I have enough work and stress to keep me busy. I want nothing to do with beds unless the company i work for decides to hire another Biomed at the hospital i work at. Biomeds are stretched enough with the amount of equipment and problems throughout the day to have to deal with beds as well. I haven’t seen any problems with facilities taking care of the beds at the 3 hospitals i worked at.
When I started my 2nd. job as a CBET day 2 I received a despirate call from a nurse mgr. of the neurological ICU to complain about rapid noisey signals on the ecg monitor. I was the only BMET the hospital had,and I lived 70 miles away. I heard a shreik and the phone went dead. Well, when I got there an hour and two min. later the nurse was in the ER for electrical shock and the patient died, a comatose lady early 20’s. Did a safety evaluation on the bed, monitor, and area. Found everything had a 2wire power cord with severly old/cracked insulation and determined over 2amps of current had been present.I didn’t quit. 1600 bed hosp.,over 2000 beds on site(30 some diff. mfrs.),(40 some various types). Circle, Adult
Spent my 38 year career 34 yrs CBET working in health care on the front lines. Have extensive experience working on everything, even beds, OR tables, IV stands, parking gates, paging systems, etc. Never say “It’s not my job” or you probably won’t have one, this is health care. I’m retired now but you may call me anytime. Thanks so much,
I first became a BMET in 1981. Army Trained, USAMEOS graduate. As a junior level technician I earned my bones and cut my teeth on Beds, scales, Dental and other electro-mechanical medical equipment. Though the technology associated with Bed maintenance and repair has advanced, I see this still as an area and an opportunity for junior level BMETs to developer their skills and prove dedication and resolve to excell in this critical field. The fundamentals of trade development in our profession have not and should not change. “Medical Maintenance” even at the senior and specialist levels is not all glitz and glamour. This is a service profession and the humility and character necessary to survive and establish career longevity should be taught in the formative years of being a BMET 1 or Medical Equipment Repairer 1 and should be observable by those charged in training and developing these future “Keepers and Carriers of the Flame” of our beloved career choice. The ignoble hospital bed is one off those areas highly suited to provide valuable maintenance and troubleshooting skills to the “Apprentice” technician as well as it ability to separate the “dross from the silver” personnel wise.
Two items I need to address. The “its not my job” is a pathway to being replaced or out sourced. If we remember how our industry started, our forefathers, building maintenance folk, took to being apart of the solution. They addressed the many electrical safety issues found in the hospital, especially hospital beds. Our entire industry has been built on this I can do spirit. We lost an opportunity when it came to assisting with the many computer and IT opportunities. We shouldn’t be easy to pass on a chance to offer value.
Second, today’s beds are very integrated. There are current plans were beds could be an interface for nursing to enter notes and documentation. Also, today’s beds will have device integration into EHR. Again, another opportunity to show value. Look for ways to say yes.
This is from a blog I wrote a few years ago. It deals with the issue of how one might answer the issue of dealing with requests to maintain beds and etc. At the time, I was interested in maintaining the image of my department as being involved in Hi Tech instrumentation and research yet I did not want to say no when my hospital and our patients needed our services. To solve the problem, I took a page from Lexus who managed to produce, sell, and service both hi end (Lexus) and lower end (Toyota)without sacrificing their reputation. — see what follows.
“Are you being asked to service low tech equipment? Branding might be the answer
Marketing and advertising professionals use an approach called branding to differentiate their products. An example of this can be found in the automobile industry. When Toyota wanted to manufacture the upscale Lexus, which sells in excess of $60,000 they knew that people would not pay that kind of money for a brand that also manufactures a $14,000 model called the Yaris. Their solution was to create the Lexus division. Although Lexus is part of the Toyota family it is marketed as a separate brand with separate dealerships and advertising. The success of the Lexus model is testimony to the wisdom of establishing clearly delineated brands. Both Nissan and Honda took the same approach when they established their Infinity and Acura brands.
Branding can be an important asset to biomedical departments who often face the dilemma of not knowing how to respond when asked to maintain lower level equipment such as stretchers, beds, wheelchairs, and sterilizers. If you say no, you risk appearing uncooperative and unwilling to assist your hospital in improving care or reducing costs. If you say yes, you risk being viewed as a low level repair service that is incapable of maintaining high-tech equipment.
It is all about perception: if you are perceived as providing a low level repair service you are unlikely to be called upon to maintain hi-tech equipment. Laboratory, imaging and other departments whose daily operation depends on the reliability of hi-tech equipment might not trust you. Instead, they are likely to rely on outside service vendors. Additionally, it may be difficult for you to hire top quality BMETS who prefer the challenge of hi-tech devices.
I was faced with this dilemma years ago when I was asked if my department would repair beds, stretchers and wheelchairs. Because it was a badly needed service in my hospital, I did not want to say no. At the same time, other departments were asking us to maintain their hi-tech equipment and I felt that it might be difficult to continue to hire more technically trained technicians if I told them that they might be asked to spend time maintaining low tech items. The answer to this dilemma lay in branding. I told the hospital that I would be happy to provide the service they were requesting if they would allow me to manage it as a separate department with a different name and phone number. The hospital agreed and I set up a department which eventually became very successful offering additional services such as fitting wheelchairs and crutches to the specialized needs of patients.
Sometimes the best answers can be found by looking outside of our own profession. We have to realize that someone somewhere has faced a similar dilemma … and someone somewhere managed to solve it.”
The movement of our field to all things connected and cyber is worrisome. A nice pice of metal to work with is a refreshing change form staring at a screen. Bring it on!
I’m a Hospital Bed whisperer
Totally agree with Frank’s response. About 15 years ago I recommended the creation of a sub-department under Clinical Eng. for electro-mechanical service. This would include beds, wheelchairs, stretchers and other of such type of equipment. Of course, the educational/experience level would be a step lower than a Biomedical. After putting together a business plan and budget based on 4 hospitals with 1,600 beds, administration asked who was doing it now; beds Facilities, wheelchairs, stretchers???? recommended to take the 2 FTE’s that Facility had for beds and add one more FTE to do the work. Facilities said no way taking 2 FTE’s from them and just one additional FTE, would not do justice. So, things are still as they were 15 years ago, a hodge podge of service BUT Biomed is not involved. Frankly, better not to do than to do half A.. job
Great article and subject and Love the comments section!! There is some really great HTM experience in here…
The real problem is Healthcare leadership not providing support to HTM departments. I guess they don’t see the CORS being an issue.
HTM departments are already overloaded with work. Adding beds, wheelchairs, and stretchers etc. to the workload would just tip the boat over. Is one of the reason you see that “Is not my job” attitude. Because we are overworked.
My question is what level of BIOMED should work on beds (Exam, hospital and Surgical)?
I personally would put an Entry-Biomed/Biomed-I. That way they polish their skill troubleshooting hydraulics, electronics and integration if is available
While working as a biomed several years ago I noticed that there was a reluctance by both Biomed and Facilities departments to maintain hospital beds so I set out to serve and protect these “red-headed step children” of the hospital (no offence) and started Emeritus Clinical Solutions. We are a SDVOSB that specializing in the maintenance of hospital beds and stretchers of every make and model. In our opinion there is no piece of equipment for vital to the safety and satisfaction of patients in the hospital. Reach out if you want to unburden you departments and entrust your hospital bed fleet to a group of dedicated biomeds that LOVE beds! http://www.emerituscs.com