Supporting Equipment in Clinical Laboratories

It is sometimes difficult to walk around a modern clinical laboratory and remember what they used to be like — a multitude of workers, bent over benches performing delicate tasks. Probably no area of healthcare has felt greater impact from advances in medical technology than clinical laboratories.

Unfortunately, too many service people are still stuck in the past when it comes to laboratory equipment. The lab is no longer just microscopes, diff tally counters, light sources and low-speed centrifuges. Even the ovens and incubators have changed and require a different approach to service — within both the preventive maintenance and unscheduled repair functions because up-time in the clinical lab is critical.

Tests that were either not possible 10 years ago or too expensive to be done in a regular laboratory, are now routine. For those who already work in clinical laboratories, the biggest changes have occurred in staffing and the number of devices. Fewer people, fewer devices, but more functions than in the past. Tests that took hours — or days – to do manually are now accomplished in minutes or seconds automatically. This put greater demands on both equipment and staff to be 100 percent at all times.

More testing is being done at the patient’s side, also altering the dynamics in clinical labs. Unfortunately, many of these devices are not run by lab techs but other, less skilled people.

Some manufacturers move machines into the lab and never transfer ownership to the hospital. The manufacturer charges per test and for the reagents. In most cases, the BMET at the hospital cannot work on these units — they are not trained and, in some cases, manuals are not available. If the on-site BMET can’t work on the system, when the analyzer fails, the hospital must to go elsewhere for tests.

This was one of the original areas where remote diagnostics was supposed to save the institution money. While it may save the manufacturer money, it is not clear how it helps the hospital. If the unit is down and needs a part, someone has to respond and put that part in. It can’t be done remotely. It is not clear how much it costs the hospital when tests are diverted to another lab, but patient care suffers.

What can the BMET in a hospital do to support this new technology better? I often hear that question and the answer I give has several parts. First, the BMET needs to keep current with lab technology. This is done by reading, talking with users and manufacturers’ personnel when they are in the hospital. On your rounds, stop and talk with the technologist at a new machine. Ask them for an in-service on the system, including what tests it performs and what concerns the technologists have about the machine.

Second, establish a good relationship with the techs so they will call you when the service person comes in. Talk with the service person to help you understand the device better and ask them to show you the most common problems that occur. Most service techs will be happy to show you how to correct the little problems so they won’t get bogged down with as many minor trouble calls in the future.

Third, keep your equipment records up to date, including service reports generated by manufacturers and other outside service groups. These records are vital when contracts come up for renewal, to justify renewal or to decide to replace the system.

Fourth, plan your PM inspections for an off-peak hour. Don’t go into a clinical lab before 11 a.m. and expect to get access to many machines. In general, later in the day is better for PM work. And your PM program should be more than lick’n’stick electrical safety. Follow good procedures and do it regularly — not just when CAP or JCAHO are due.

Finally, don’t over-commit your time and knowledge by saying you can fix something until you know that you have both the resources, (parts, schematics, software, etc.), and the time to do totally solve the problem.

Working with the laboratory techs, an on-site BMET can provide good service on laboratory equipment — if you apply cooperation and constant effort.

Veteran clinical engineer and 24×7 contributing editor David Harrington is the Director of Special Projects for Technology in Medicine, Inc. of Holliston, Mass.