Dear engineers and technicians, I wanted to contribute to the previous Soapbox discussion. I agree that some members of the biomedical/clinical engineering community have been practicing evidence-based maintenance or trend analysis, but, from my point of view and experience, they do not make up the majority.

I believe that manufacturers give their recommendations based on a “supposed” condition of use, but they do not really know what is happening in the field. It is not based on a real condition of use that, sometimes, exceeds their own expectations. We have to keep our eyes open all the time because there is no general rule on how the OEM actuates the market. In the mentioned case of the infusion pump, I believe that it was only a necessary upgrade of a product that was shown to be inefficient. This is much more of an obligation, because the product is not good for the users. It has, then, a proactive action or a monitoring trend, or even an evidence-based improvement. If the product presents any deficiency, we should not buy it.

As an example that illustrates the opposite, I can mention a different case. I received 12 ventilators that the hospital bought from an OEM. They did the start-up of two of the 12. Some days after, one of the ventilators presented a problem. The manufacturer took the ventilator to its workshop, and some days after advised me that all the remaining ventilators (11)—including the ones in the box—had to be sent to its workshop. When I asked why, the manufacturer said that during transport some boards may have been pulled out of place and each needed to be reviewed. I asked them to look at the problem again before I sent the others back. The final result was a voluntary recall revealing the problem, and then I sent the ventilators to them. The manufacturers are not always as proactive as they should be, so let’s keep our eyes open.

In spite of the fact that the manufacturers state their mission is to improve patient safety, improve the quality of health care delivery, and improve the safety of health care workers, they still need to make a profit. There is no shame in profit—I believe that this is an important part of the market—but it has a limit. So I understood that Wang is just trying to alert us to use our expertise and knowledge to make a difference in our daily job. If a recommendation by the manufacturer shows us to be inefficient by some evidences or trends, why should we adhere to that recommendation? Just because the OEM said it and wrote it in an operator’s manual? Just because I can be prosecuted in the court? I know we can do more than this.

I understood that the main idea of Wang in his article was not to ignore preventive maintenance necessities; his idea was to inspire us to design a PM plan using evidences or trends that we perceive in the hospital we work for. So, if we can go far away from the lawsuit issue and beyond reactive positions and start proactive actions in order to have a true and very safe PM plan, why not? Do we have to stay at the same place just because it was started this way when the profession began? We have to go farther, go beyond.

There are new challenges to engineers inside hospitals and in health care systems, and we cannot stay at the same place forever. We have to look to the maintenance patterns that the industry has adopted, and we have to be more aggressive and less afraid when using the knowledge we have. I do not believe that this purpose is to reinvent the wheel, but instead of this, the main idea is to grow. I agree that we have to keep in touch with the OEMs—in fact, smart OEMs have much to learn from us—but the preventive maintenance plan should be done considering each specific case, each hospital, each risk management plan, each engineer in charge, not only the OEMs’ recommendation. From my point of view, the OEMs’ recommendation should be the first step, not the final one.

Finally, I hope that these comments also can help clinical engineers to think more about the increasing costs of technology. Are the costs of health care technology increasing, or is the way we administer them leading to increasing costs?

Lúcio Flávio de Magalhães Brito, CCE, is the director of engineering, Medicorp Tecnologia Ltda, São Paulo, Brazil. For more information, contact .

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