equipment audit

Equipment Audit, Maintenance & Repair Dr. L. H. Hiranadani Hospital

Dr. D.Y. PATIL INSTITUTE OF MANAGEMENT STUDIES, NAVI MUMBAI

SUMMER INTERNSHIP PROGRAM

DR.L.H HIRANANDANI HOSPITALPOWAI

“EQUIPMENT AUDIT, MAINTENANCE & REPAIR”

SUBMITTED BY

Dr. ZUBAIR AHMED

MBA – HOSPITAL MANAGEMENT

Dr. Mohd. Saad Dr. Zubair Ahmed1


INDEX

S NO. TOPICS PAGE NO.

01 INTRODUCTION 03

02 OBJECTIVES OF STUDY 03

03 METHODOLOGY 04

04 DATA COLLECTION 04

05 EQUIPMENT AUDIT 05

06 EQUIPMENT MAINTENANACE 13

07 BREAK DOWN MAINTENANCE 20

08 TIME MOTION STUDY 24

09 STAFF REQUIRMENT 25

10 QUESTIONNAIRE 28

11 SUGGESTION AND RECOMMENDATION 32

12 ANNEXURES 34



INTRODUCTION

Hospital equipment appliances & technology have become important issues because of their significant contribution in patient care and hospital management. It is imperative to assess its operative functionality and utilization by equipment audit, maintenance and repair.

OBJECTIVES OF STUDY

The key objectives of the study are:-

To study the system of equipment audit, maintenance and repair in Dr.

L. H. Hiranandani Hospital.

To study the functioning and the work flow of the Bio-medical

department.

To find out the deviation between equipment list of bio-medical &

different departments.

To find out the manpower requirement in Bio-medical department.

To provide suggestions for



METHODOLOGY OF STUDY

Focus group discussions were held with the Bio-medical and different department’s staff.

A retrospective record based (Qualitative & Quantitative) study was

carried out to get insight the process of audit, maintenance and repair

of medical equipments.

DATA COLLECTION

The Data was collected by two sources: -

PRIMARY

By observation

Through personal interview

By questionnaire

Through schedule

SECONDARY

By collecting previous records



“Equipment Audit, Maintenance and Repair”

In recent times, hospital equipment appliances & technology have

become important issues because of their significant contribution in patient

care and hospital management. Planning and acquisition of medical

equipment is a continuous process. It is imperative to assess its operative

functionality and utilization. The medical technology is changing rapidly

with most appliances and modalities, which have a short life span. It

becomes essential to assess the equipment and technology in terms of cost

effectiveness. Equipment audit is thus, an essential requisite along with

equipment planning and acquisition.

In modern hospitals, equipments makes up about a third to a half of

total project costs and it has been revealed that non-functional equipment is

a major contributing factor for wasteful expenditure in health care

institutions.

EQUIPMENT AUDIT

“Equipment audit is a periodic evaluation of the quality of performance of

the hospital equipments.”



ADVANTAGES OF EQUIPMENT AUDIT

The main advantages of equipment audit are as follows:-

It helps in standardization of the equipment.

It provides a satisfactory mechanism to assist at the time of

condemnation of equipment.

The equipment audit report provides an objective method for future

procurement of equipment.

It evaluates concurrent performance and utilization. The inadequacies

are identified and remedial measures are recommended.

UNDER UTILISATION OF EQUIPMENT

The main factors responsible for the under utilization of medical

equipment are as follows:-

Purchase of highly sophisticated equipment without competent

personnel to handle the same.

Purchase of excess equipment without justifiable reason.

COMMITTEE OF EQUIPMENT AUDIT

The audit committee should comprise of the following: -

CEO

Director Professional Services

User Department Head

Head of the Bio-medical Department

Chief Nursing Officer

The committee should meet once in three months



CLASSIFICATION & IDENTIFICATION OF

MEDICAL EQUIPMENT

To insure unique and traceable identification of biomedical assets of the

hospital and classify them according to their criticality and value.

This process is applicable to all biomedical equipments of the hospital

owned or on rental.

POLICY

All Biomedical equipment of the hospital shall be controlled using a

unique identification number issued by biomedical engineering

department. This number shall be visibly labeled / stenciled on all the

biomedical equipment for easy identification.

All Biomedical equipment of the hospital shall be classified according

to their criticality, value, complexity and functionality. This

classification shall form the basis for the extent and their control by

the biomedical engineering team.

PROCEDURE

Unique Identification No.

Each Biomedical equipment shall be provided with a unique

identification number at the time of their installation.

The unique ID No of each equipment shall be traceable to the Asset

master register maintained by Biomedical engineering department.



The unique ID of each equipment shall be prominently and visibly

labeled/stenciled on the equipment. The Biomedical department and

user department shall take precaution, to ensure that the ID is visible

through out lifetime of the equipment.

CLASSIFICATION OF EQUIPMENT

Classification of equipments is as follows:-

All Biomedical equipment of the hospital shall be classified according to

their criticality, value and functional complexity into Class I, Class II and

Class III.

Class I equipment shall be of critical life saving application, relatively

high value and with high functional complexity (e.g. CT SCAN

Machine, Ventilators, Defibrillators ect). The Class I equipment shall

be monitored on a daily basis and shall be tracked using detailed

equipment file.


CLASS I

CLASS II

CLASS III


Class II equipment shall be placed relatively high on the criticality,

value and functional complexity scales (e.g. pulse oximeter, ECG

Machine, Syringe pump etc). These shall be monitored closely on a

weekly basis/twice a week basis, and shall be tracked using a detailed

equipment file.

Class III equipment shall be placed low in the criticality, value and

functional complexity scale (e.g. Stethoscope, BP apparatus, Needle

cutter etc). These shall be monitored on fortnightly, monthly or

quarterly basis. Individual equipment files need not be maintained for

this category of equipments.



The various parameters, which should be considered in equipment

audit procedures, are as follows:

PROCUREMENT

The following need considerations: -

Was the equipment required?

What was the use of coefficient of the equipment?

Where the technical worked out and provided by user department?

PERFORMANCE

The following need considerations: -

History sheet and log book may be gainfully utilized for this.

It is essential for periodic scientific evaluation of the quality of

performance of the equipment is carried out.

This will aid in assessing the future need, planning acquisition and

disposal of obsolete, economically non-viable equipment.

The process of equipment audit will also prove to be an indispensable

tool in formulating standard/specifications of medical equipment and

in establishment of bench marking for medical equipment.



EVALUATION OF LIST OF MEDICAL EQUIPMENTSThis evaluation is done to find out the efficiency of equipment audit in Bio-

Medical and different Departments of Dr. L. H. Hiranadani Hospital.

Selected department are as follows:-

Operation Theatre

Intensive Care Unit

Casualty

Cathlab

Wards

Under the study, Equipments are broadly divided in to Critical and Non-

Critical Equipments:

Critical Equipment = Class I & II equipments.

Non-Critical Equipment = Class III equipments.



ICU : - Department List: 55 Equipments are not recorded.

Bio-Medical List: 55 Equipments are not recorded.

OT : - Department List: 19 Equipments are not recorded.


Wards : - Department List: Maintained Properly.


Casualty : - Department List: Maintained Properly.


Cath Lab : - Department List: 13 Equipments are not recorded.


CONCLUSION

Concerned staff does not properly maintain equipments lists of OT,

ICU & Cath. Lab.

Bio-Medical staffs have not maintained the equipments list of any

department properly.

LIMITAIONS

We could not do the Physical checking of equipments in OT No1, 2,4

and cardiac OT.

We could not get the permission to check all the equipments

physically in Cath lab.



EQUIPMENT MAINTENANACE

“Maintenance is a combination of actions carried out to retain an item or

restore it to an acceptable condition. It also ensures equipment reliability,

productivity, efficiency and safety.”

OBJECTIVES

The main objectives of equipment maintenance are:-

Maximum availability and reliability of equipment.

Extending useful life of equipment.

Readiness of emergency uses.

Safety of operations.

Reduced down time.

Prevention of wastage of consumables and spares.

Maximum returns on investment.

LEVEL OF MAINTENANCE

The levels of equipment maintenance are:-

FIRST - By operator (day-to-day maintenance)

SECOND - By in-house staff

THIRD - By manufacturer, professional repairer, organizational &

Biomedical engineer and through workshop.



55.81% of equipments of ICU are under annual maintenance contract.

In OT class I equipments are under AMC and warranty and 66.25% of

equipments are under In house.

75% of equipments of rest of all the departments are under In house of

Bio-medical.

LIMITAIONS

Equipments of 11 departments are not classified according to the

types of maintenance by Bio-medical Department.

Records are not properly maintained.


CLASSIFICATION OF EQUIPMENTS ACCORDING TO MAINTENANCE

8680

3021

159 7 6

38

53

27

12 155 7

48

18

28 4 49

1 1 20

20

40

60

80

100

ICU OT NICU CASUALITY IPD CATH. LAB CARD. OPD AKD

DEPARTMENTS

NO. O

F EQ

UIPM

ENTS

TOTAL EQP IN HOUSE AMC WARRANTY


TYPES

Maintenance of equipment may be classified as:-

Preventive maintenance.

Breakdown or corrective maintenance.

PREVENTIVE MAINTENANCE

This is the maintenance carried out at predetermined intervals or according

to prescribed criteria and is intended to reduce the probability of failure of

functioning of an item.

ADVANTAGES OF PREVENTIVE MAINTENANCE

The major advantages of preventive maintenance are:-

Reduction in downtime of the equipment: - this insures maximum

availability of a functional equipment for life saving, therapeutic or

diagnostic purposes.

Safety of equipment

Effective and economic functioning: - non-functional equipment will

cause patient to be referred elsewhere for investigations. This will be

an economic liability for non profit making hospitals and a loss if

they are provide hospitals.

SHEDULED MAINTENANCE:

The preventive maintenance carried out in accordance with an

established time schedule is called scheduled maintenance. It may be

a weekly, monthly, quarterly, six monthly or a yearly schedule.



Preventive maintenance may be carried out in a running state or a shut

down state.

Preventive maintenance Sticker should be attached to the Class I and

Class II equipment.

This sticker shows the last date of visit and the future date of

preventive maintenance schedule.

MASTER MAINTENANCE PLAN (M. M. P)

This is maintenance organized and carried out comprehensively, effectively

and efficiently to a predetermined plan. Preventive and corrective

maintenance should be apart of M. M. P. for effective master maintenance

the following are the prerequisites.

Arranging regular training programmes on maintenance and repair of

equipment for the technician and other concern persons.

Establishing a bank of spare parts and crucial components.

Establishing detailed record of the purchase, procurement and the

maintenance of the equipments, e.g. history sheet, log books etc.

Periodic checks and repairs.

Maintaining of the annual maintenance contract (AMC) for expensive

and sophisticated equipments.


PM SCHEDULEEqpt ID No.:Last Date of Visit:Next Date of Visit:


The essential spares should be obtained along with. This should be

incorporated in the purchase contract. The equipment should be under

service contract for at least 5 years.

Developing a maintenance cell for maintenance and repairs.

Follow up of the maintenance and repair services.



EVALUATION OF PREVENTIVE MAINTENANCE SCHEDULE

This evaluation is done to find out the efficacy of preventive maintenance of

Bio-Medical Department of Dr. L. H. Hiranadani Hospital.

Selected department are as follows:-

Operation Theatre

Intensive Care Unit

Casualty

Cathlab

Wards



ICU : - 55 Equipments don’t have updated sticker.

OT : - 22 Equipments don’t have updated sticker.

Wards : - No single equipments has updated sticker.

Casualty : - 25 equipments don’t have updated stickers.

Cath Lab : - 16 Equipments don’t have updated Stickers.

CONCLUSION

Bio-Medical staffs have not maintained the stickers properly for any

department.

LIMITAIONS

We could not do the Physical checking of equipments in OT No1,2,4

and cardiac OT.

We could not get the permission to check all the equipments

physically in Cath lab.



BREAKDOWN MAINTENANCE

This is the maintenance carried out after fault recognition and is intended

to put equipment into a state in which it can perform a required function.

PROCESS:

On the occurrence of a complaint, user departments send the

complaint form, which (Refer to attached format) has been issued to

all the departments, specifying the nature of complaint.

The complaint is accepted only if the equipment No. (e.g.,

NH/CCU/0001) is mentioned in the complaint form. This is to avoid

any mix-up if the two similar machines from the same department are

received.

The complaint form is received by the Biomedical engineer by

provided the user with a complaint number.

The complaint form received is filed and simultaneously written on to

our Complaint Register (Complaint No., Date, Concerned

Department, and Complaint Detail).

The equipment that comes to the department for repair is tagged with

the complaint no. and the status of the equipment (Pending/Working).

The complaint is looked into according to the complaint priority.

Critical equipments are given higher priority (Critical equipments are

specified in our equipment list).

The pending Reports are checked every week and the necessary

details regarding the delay are entered.



Evaluation the Breakdown from Different Departments

This evaluation is done to find out the Breakdown complaints from different

departments and in which how many equipments are repaired, parts are

replaced, condemned and called the Company person.

We have taken the records of previous 3 months from Job response

logbook.

73.80% complains comes from 5 departments out of 15, they are ICU,

OT, OPD, NICU and Casualty


COMPLAINTS FROM DIFFERENT DEPARTMENTS

72

40 3626

12 10 9 9 9 8 5 5 4 4 30

1020304050607080

NO

. OF

CO

MPL

AIN

TS (3

MO

NTH

S)


COMPLAINT REDRESSAL PROCESS FLOW


Dept: Person In-charge

Phone Email

BiomedicalEngineer

Site Visited

Error checked on the spot

If Repairable

If notRepairable

To BiomedicalDepartment

Repairable

Equipmentrepaired

Equipmentrepaired

CompanyService

EngineerCalled

If notRepairable

Equipment takento service station

Work/Purchaseorder given

Quotation sent to Hospital; Negotiation takes place

Purchaseorder given

Equipment has to be serviced

Equipment spares to be replaced

1) If required urgently by the dept., a spare/ stand-by will be provided, if available.

2) If stand-by is not available, equipment will be made available from unutilized area.

Maximum time 45 min. for response. Reason for delayto be mentioned in case

response > 45 min.Signature of complainingStaff/dept. to be taken on

Job Log

Detailed job sheet ismaintained for each equipment in soft copy for archiving purpose

Quotation sent to Hospital; Negotiation takes place


RESPONSE OF BIO-MEDICAL DEPARTMENT TO DIFFERENT

COMPLAINTS

252 complaints were come in previous 3 months and there are different

responses of the Bio-medical department.

Equipments are

Repaired

Parts are replaced

Condemn the equipment

Call the company person

57% of total complaints required repair works.

In 28% of total complaints they have to change some part of the

equipments.

In 12% of total complaints they have to call to the company person

because the equipments are under warranty or AMC.

3% of complaints require condemnation.


Response to Complaints

57%

28%3%12%

Repaired Replaiced Condemn Called CO.Person


In 33% cases of total repair Bio-Medical Engineers have to instruct

the staff how to operate the equipment.

LIMITATION

We have taken the records of Jan, Feb and April 2008; we could not

get the records of consecutive 3 months because Bio-medical

department lost it.

Even the record that we got was also not properly maintained.


TYPES OF REPAIR

22%

45%

33%

Clean & Calibration Done Repaired the Fault Instructed the Staff How to Operate


TIME MOTION STUDY

This time motion study of attending the breakdown call to repair the equipment is based on observational study. The duration of observation was 15 days.STEPS ACTIVITIES TIME TAKEN 01 Department Person In charge files a complaint to

Bio-med dept.

00 min.

02 Response Time: Bio-med. Engineer visits the site. 15-30 min.

03 Bio-med Engineer takes time to diagnose the

error/fault.

25-30 min.

04 Time taken to repair the equipment 1hr 30 mins-2 hrs

Total 2hrs 10 mins-3 hrs

STAFF REQUIREMENT


Dept: Person In-charge

Biomedical Engineer

Phone Email

Site Visited

15-30 mins.

25-30 mins.

Error checked

Repair the Equipment

1hr 30 mins to


Biomedical Engineers are responsible for performing and monitoring of

preventive maintenance activities, breakdown maintenance, calibrations and

verification and maintaining relevant records, as require.

Sr.No. ACTIVITIES TIME

01 Hours required for daily maintenance 5-6 hrs

02

Response the breakdown call takes 15-30 mins/call

Average daily there are 4 calls

(4*15-30 mins)

1-2 hrs

03

To diagnose the error or fault

Takes 25-30 mins/equipment

(4*25-30 mins)

1hr 40mins-2 hrs

04

Repair time

1 hr 30 mins-2hrs/equipment

(4* 1hr 30 mins-2 hrs)

6-8hrs

05

Paper work

Takes 1 hr daily

1hr

06

Conversation with the vendor or company person

Takes 1hr daily

1hr

Total 15hrs 40mins-20hrs

Staff requirement for preventive maintenance activity and from

attending the call to diagnose the error or fault.

Calculation of available manpower hrs: -

Total number of days in a year = 365



Annual leave provision for the staff

Sick leave = 7 days

Casual leave = 7 days

Paid leave = 21 days

Weekly offs = 52 days

Public holidays = 10 days

Total number of leaves = 97 days

Therefore, the total number of working days in a year

= Total number of days in a year – total number of leaves in a year

= 365 – 97 = 268 days

Total number of working days in a month

= Total number of working days in a year / 12

= 268 / 12 = (22.33 days) = 22 days

Total number of working hrs/ day = working hrs/day – lunch hr

= 8 hrs – ½ hr = 7½ hrs.

Therefore, the average available manpower hrs per month for 1 person

= 167 hrs/ month/ person

The total number of manpower hrs available.

= Average available manpower hrs/ month/ person * total number

of available manpower – Thane visits (5 visits in a month by

one person = 35 hrs)

= 167 * 3 (as 3 staffs are in the Bio-Medical department) – 35hrs

= 501 – 35 manpower hrs/ month

= 466 manpower hrs/month

Total number of manpower hours required/month

= Total number of manpower hrs available/day * total number of



working days in a month

= (15 hrs 40 min – 20 hrs) * 22.33

= 350 – 447 hrs.

CONCLUSION

The total no. of manpower hrs required for Bio-Med. Dept. = 350 – 447 Hrs.

The total no. of manpower hrs available for Bio-Med. Dept. = 466 Hrs.

So, the Bio-Medical Department can manage the workload and no

additional manpower required in the department.

LIMITATION

Bio-medical engineers have not maintained the job closure of the

equipment breakdown.

So we cannot calculate the actual staff requirement for Bio-medical

department for preventive maintenance activities, breakdown

maintenance, calibrations and verification and maintaining relevant

records.

QUESTIONNAIRE



The questionnaire is based on equipment maintenance and repair, to find out

how efficient is the process of usage, maintenance and repair of medical

equipments.

Points covered in the questionnaire are as follows:

Training proved by Hiranandani hospital, how to operate the medical

equipments.

Duration of the training.

Training provided by whom.

Response time by Bio-medical Dept. to different complaints.

Whether the Bio-med. Dept. repair or replace the equipment within

the given time.

Sample collected = 56

Method of selection of sample = Random Sampling

Departments Covered Under Survey

ICU OT CASUALTY CATH LAB DIALYSIS CARDIAC OPD BLOOD BANK WARDS RADIOLOGY PATHOLOGY

OBSERVATION



18% of total staff has not received the training when they join the

hospital.

82% of total staff has received the training when they join the

hospital.

But the duration of training was very short (4hrs to 1 day).


TRAINING PROVIDED

82%

18%

YES NO


46 % of total staffs have received the training from company person.

22% of staffs have received the training from senior staff, colleagues

etc.

70% responses are before 30 mins.

30% responses are after 30 mins.


TRAINING PROVIDED BY

32%

46%

22%

BIO-MEDICAL COMPANY PERSON ANY OTHER

RESPONSE TIME

32%

38%

22%

8%

0-15 MINS 15-30 MINS 30-45 MINS MORE THEN 45 MINS


In 84% of total cases Biomedical department complete their work

within the given time.

CONCLUSION

18% of total hospital staff could not get the training when they join

the hospital and those who got the training the duration of training

was 4 hrs to 1 day.

Only 32% of total staffs have received the training from Bio-Med.

Dept.

In 16% of total cases Bio-medical department does not repair or

replace the equipments within the given time.


EQUIPMENT REPAIRED OR REPLACED WITHIN GIVEN TIME

84%

16%

YES NO


SUGGESTION AND RECOMMENDATION

The Equipment audit committee should meet once in three months to

evaluate the effectiveness of the equipment.

Few points like job closer time, total break down time, any spare part

provided should be there in the job response log in order to provide

the complete details of each and every complaint.

Lists of all the medical equipments should be properly maintained in

the Bio-medical Department and respective department.

Bio-Medical Department should do the Periodic monitoring, regular

updating and systemic maintenance of equipment files.

Providing user training on operation and maintenance of the

equipment, where required.

Bio-medical department should work efficiently according to the

maintenance schedule.

Monitoring the effectiveness of user trainings.

Co-ordination of the user training activity, along with the user

department.

Bio-medical department should maintain the job response log properly

and regularly.

At least one Bio-medical Engineer should always be there in the

department to attend the phone calls in order to prevent the

unnecessary delay.



Bio-Medical department should have a protocol to which department

they should give the priority when more that one calls come

simultaneously.

Bio-Medical Department should maintain the “Maintenance Stickers”

of all the medical equipments properly.

Bio-medical engineer should carry their tool kit along with them when

they go to attend the call.



ANNEXURE I

HISTORY SHEET OF EQUIPMENT

Sr. No HISTORY OF EQUIPMENT DETAILS

01 Name of equipment

02 Equipment ID number

03 Date of purchase

04 Cost of equipment

05 Name & address of supplier

06 Date of manufacturer

07 Date of installation

08 Dept where installed

09 Environmental control

10 Warranty periods

11 AMC periods

12 Down time

13 Cost of maintenance and repair

14 Date of condemnation

15 Date of replacement

16 Other relevant remarks



ANNEXURE II

LOG BOOK OF EQUIPMENT

Sr. No

Name of Equipment

Equip.ID No.

Warrantyperiod

AMCperiod

Date of break down

Date of repair

Cost incurred

Details of preventive maintenanc

e



ANNEXURE III

PREVENTIVE MAINTENANCE SCHEDULE

Sr. No

Equipment Company Eqpt ID No Dept AMCPeriod

PM Date

Next PM



ANNEXURE IV

EQUIPMENT COMPLAINT FORM

Biomedical Equipment complaint Form

Date: Department:

Name of In charge:

Sr.No. Equipment Equipment ID No.

Complaint details



AN

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RE

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Att

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Sign

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aff

Rem

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Bre

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Tim

e

Job

clos

ure

Res

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e

time

Tim

e

of

com

plai

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Com

plai

nt

mad

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Com

plai

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Des

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Eqp

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No .



D

AT

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JOB

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ESP

ON

SD

epar

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tSr

.

ANNEXURE VI

TRAINING PROGRAMME DEPARTMENT___________________________________________

SR. NO.

TRAINING TITLE(EQUIPMENT NAME)

DATE

01

02

03

04

05

06

07

08

SIGN:-_______________________

BIO-MEDICAL ENGINEER:-________________________________

IN CHARGE / HOD:-________________________________________



SR. NO.

ATTENDED BY SIGN.

01

02

03

04

05

06

07

08

DEPARTMENT IN CHARGE:-____________________________

SIGN:-_________________________________

DATE:-________________________________

DEPARTMENT OF BIO-MEDICAL ENGINEERING.



ANNEXURE VII

QUESTIONNAIRE

This questionnaire is based on equipment maintenance and repair, to

find out how effective is the process of usage, maintenance and repair of

medical equipments.

Name of employee:-_____________________________________

Department:-___________________________________________

Designation:-___________________________________________

HF No:-_______________________________________________

Date:-_________________________________________________

1. When did you joint the Hiranandani Hospital?

______________________________________________

2. Did you get the training how to operate the medical equipment?

a. Yes

b. No

3. Training provided by whom?

a. Bio-medical Department



b. Company person

c. Any other

4. If any technical error or failure occurs in the medical equipment, whom

do you contact?

_____________________________________________

5. What is the procedure of contact?

______________________________________________

6. How much time they take to respond?

a. 00-15 mins

b. 15-30 mins

c. 30-45 mins

d. more than 45 mins.

7. Do they provide the stand by equipment if failure occurs?

a. Yes

b. No

8. Do they inform that how much time they will take to repair?

a. Yes

b. No

9. Do they repair the equipment within the given time?

a. Yes

b. No

10. If any suggestion, Please mention_______________________________

_____________________________________________________________



Signature______________

Thank You


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