During the fight against COVID-19, healthcare organizations have committed their resources to share best practices and collaborate externally to assist all hospitals and treatment centers in providing the best care for their patients. Nuvolo is dedicated to aiding all HTM groups in this time of need.
To help do that, Nuvolo has launched an outreach campaign focused on the discovery and dissemination of best practices and key learnings from our wide-ranging healthcare customers. Over the past three weeks we have been interviewing HTM leaders at 15 different hospital groups and teaching centers throughout the U.S. The culmination of our findings and recommendations are contained within this white paper. We hope that this information and guidance will help to ‘flatten the curve’ as we use our voices to help other HTM groups fight the advance of the coronavirus in their communities.
Please note that these are merely suggestions that other healthcare organizations have adopted and should only be implemented if in accordance with your organization’s policies and procedures and the regulations and laws governing it.
During our detailed interviews with multiple HTM leaders and staff, we have identified three common best practices that can assist other hospitals and treatment centers as they ramp up to support their patients as the coronavirus spreads. These include the following:
Streamline the Setup and Configuration of New ICU Locations: As more infected patients overwhelm the existing ICU treatment rooms. there is an urgent need to expand the number of temporary ICU areas quickly.
Proactive Maintenance for Mission Critical Assets: Specific types of clinical equipment should be categorized as Mission Critical and prepped for immediate service during the coronavirus.
Deferring Scheduled Maintenance: To focus technicians and other resources during the coronavirus outbreak, it is pertinent to push out scheduled PM’s for non-critical assets and flag them for re-evaluation at a later date.
Setting Up Temporary ICU Locations
From recent reports in early April 2020, it has become apparent that a significant number of states lack enough intensive care unit (ICU) beds in their hospitals to deal with the wave of projected coronavirus cases in the coming weeks. The HTM professionals that we have interviewed are working on a fast-track approach to setting up new ICU locations for their hospitals using whatever resources they can cobble together from current inventory or borrowed equipment.
With a projected nationwide shortfall of 16,232 ICU beds, hospitals are having to create temporary ICU’s quickly and efficiently to respond to COVID-19. To streamline the approach for setting up new ICU locations, the HTM groups we have talked with are creating Emergency Response Work Orders that can be utilized to have technicians or other groups rapidly assemble the equipment needed to create a temporary ICU room and perform the tasks to finalize the configurations. This best practice is described below and can help healthcare organizations leverage their CMMS solutions to scale their ICU locations to meet the growth of coronavirus victims projected in their communities.
Grouping Necessary Assets The initial step in this process is to categorize all the necessary equipment to configure a temporary ICU room and add them to a special work order checklist that can be assigned and tracked. Equipment for patient care is the essential priority, where some assets will be available internally, while others will need to be purchased, rented, or procured from another source. An example list of these ICU work order assets includes the following:
- Hospital bed(s)
- ICU level monitors with ECG, Pulse Ox, NIBP modules
- Cables and leads (set of ECG leads, power cables, NIBP hoses, pulse OX cables packaged in boxes for deployment, etc.)
- IV Pole(s)
- Infusion Pump Controller
- Multiple large volume infusion pumps
Creating a new category type, such as “Temp ICU Assets”, within your CMMS application will help track these devices and their availability.
This new category will help the HTM teams receiving this equipment identify which assets need to go to the temporary ICU location and have their location updated in the CMMS.
Setting up specialized CMMS work orders will help streamline the process for gathering these assets and assigning the equipment installation of different ICU rooms depending on the amount of available equipment in this pre-ordained “ICU in a box” classification. The tracking work order can be configured with a basic pre-checklist showcasing the equipment needed along with some disposables. This enables individuals to check off the list via a simple web interface to the CMMS application, or a mobile device if it’s available, and ensure that all items are gathered and available. It also enables HTM groups to track the time spent delivering the supplies and setting up the temporary ICU rooms.
Responsible Team Members for Required Tasks
The internal resources that will most likely play a part in this workflow process to setup new ICU locations includes the following:
- HTM Managers
- Biomedical Equipment Technicians (BMETs)
- HTM CMMS Specialist
- Supply Chain
- Information Technology (IT)
- Facilities/Plant Operations
Be sure to communicate and train the employees with these roles as part of this project.
Workflow Process Steps
There are prescriptive tasks that should be followed in order to successfully deploy these new ICU locations. The hospital’s CMMS solution should be configured with these action items to track the implementation status and process steps to completion. This will assist with the tracking and reporting needed for HTM managers. These steps should include, but are not limited to, the following:
- Work order assigned to either a single HTM coordinator responsible for setting the temporary ICUs up or to multiple BMETs
- All necessary assets confirmed and reserved Assets transported to location
- ICU room setup in progress
- All equipment installed and passed safety check
- ICU room setup COMPLETE
Using specific work orders within your CMMS solution will help HTM groups track the fast-moving tasks underway to setup and configure each new ICU location. An example list view report shown below provides the detailed categorization of different work orders in progress, showing the assigned coordinator and the site locations. HTM managers and technicians can easily refer to these online reports throughout the day to reference where equipment needs are highest and who is accountable for the work.
Proactive Maintenance for Mission Critical Assets
During discussions with HTM managers across the country, we asked them about their most critical equipment necessary to provide patient care at these times. There were five common assets that they all mentioned,along with some interesting insights into how they were prepping these important items before, and maintaining them after, the influx of infected patients. These five mission critical assets include the following:
- Infusion Pumps
- CT Scanners
- ICU Patient Monitors with ECG, Pulse Ox, plus NIBP modules
Categorizing Inventory of Mission Critical Equipment During COVID-19
In order to keep track of the location, availability and condition status of their mission critical equipment needed to treat coronavirus patients, the HTM managers we talked with described their methods of cataloging these assets within their CMMS applications. In addition, seven of the HTM managers we spoke with had included a new classification data field for some of their critical devices to rank them according to effectiveness in treating coronavirus patients. This was specifically stated as a necessary tactic for cataloging ventilators. The newer models were given a higher ranking, while the older types were rated lower. This helped qualify what devices would be dispersed during the first wave of patient intake, while the others would be held in reserve.
The report below showcases current ventilator inventory grouped by condition status for each site location. These type of CMMS charts are very useful to monitor equipment visually in a variety of ways to help HTM teams plan what to use at each hospital and which devices should be leveraged first.
The other categorization example is shown in the CMMS data view below using a list of ventilators. It is based on a newly added, descriptive field called “Respiratory Class” that is populated at the model level to showcase which ventilator models should be used first based on the acuity level of a patient. Additionally, it helps to classify which devices can be used on infants and which can be converted into ventilators in emergency scenarios. This information can be easily loaded once the details are gathered from a Respiratory Therapy team and will enable better equipment triaging. The list view below also showcases the most recent maintenance date to allow for more accurate ranking of mission critical equipment to identify which ones should be used in specific order.
Another use case identified during our interviews was for the classification of devices that could be reconfigured for other purposes. Some HTM leaders described creating a data field within their CMMS application called ‘Configuration Capabilities’ that would identify if a clinical device model could be converted or reconfigured into certain mission critical devices like ventilators. If specific equipment needs increase, this data field would identify which devices can be converted for an alternate use as needed.
Planning Proactive Maintenance Activities
Another best practice described by HTM leaders during our discussions was to target their high risk devices for planned maintenance (PM) before the increase in patients at their facilities. To accomplish this task, they assigned a lead technician to evaluate the previous corrective maintenance work orders for high-risk devices and then identify any assets that had PM’s coming up. They would then generate and assign high-priority work orders to do the required maintenance on the corresponding devices at each hospital or treatment center.
The report seen below provides an example that shows a list of ventilator models that incurred the highest number of failures resulting in corrective maintenance. This report shows the average fault counts over the last 2 years. This type of report can be combined with an overlay of the available ventilators by site location (and their scheduled PM’s) to start planning out a proactive maintenance cycle.
Configuring your CMMS application to gather information in specific data fields may provide intelligent insights that can help manage equipment more effectively. And tracking that detailed information like device failure causes and previous maintenance dates for mission critical assets can help HTM groups make informed business decisions during crisis times.
Stocking Parts for Mission Critical Assets
The final recommendation we heard from HTM leaders was around stocking parts inventory for mission critical devices ahead of time. The HTM teams we discussed this topic with during our interviews were unanimous in their response around this being a top priority.
They described a definite need to ensure certain parts are on-hand to fix ventilators, or other mission critical assets as quickly as possible in the event of a failure. To identify those specific parts, they outlined the research necessary to be proactive. One example was to review previous corrective maintenance activities over the past few years. These would provide detailed information on the parts used to fix specific devices and get them back online.
The report below provides an example that showcases all parts used for corrective maintenance over the last three months on different ventilator work orders. This report provides specific details for the necessary inventory required for ventilators that HTM managers can leverage to proactively order parts. By having these parts in stock during a crisis it helps mitigate the potential, long-term downtime for mission critical equipment.
Deferring Scheduled Maintenance for Low-Risk Devices
As HTM technicians will become overwhelmed with high priority tasks during the pandemic, there are logical steps that should be put in place to reduce the activities for scheduled maintenance where possible. HTM managers should review and consider deferring planned maintenance for non-essential, low-risk assets. However, all considerations should be made for the consequences of deferred maintenance, as it may increase risk of component or system failure. As always, HTM managers should have a plan in place to respond to any major problem, coordinating with maintenance vendors and manufacturers as necessary, to ensure issues can be addressed. Appropriate guidelines for consideration include the following:
- If clinical equipment failure cannot be addressed in a timely manner, ensure procedures to address safe shutdown/isolation of the equipment and the service to the hospital is sufficiently resilient to absorb the loss of failed equipment (at least until the workload can be transferred to a backup clinical system).
- As time passes and restrictions from the pandemic remain in place, revisit deferred maintenance work orders and determine whether continued delay increases risks beyond reasonable tolerances.
Reclassifying PM’s for COVID Hold
During the coronavirus pandemic, it is likely that the regulatory and compliance adherence will be lessened somewhat. An example of this is the reclassification of PM’s for deferment. A common category we heard during our discussions with HTM leaders was to put these type of work orders on ‘COVID Hold’. The example report below shows three different PM’s that have been reclassified under this new state. You can see that a simple addition of a ‘COVID Hold’ to the work order state field allows for a very simple way to report on which work orders were deferred during the coronavirus, so you can easily return to them and still have all the necessary PM dates and documentation needed for surveyors (as long as your policy is clearly stated).
The onset of the crisis caused by the COVID-19 pandemic occurred relatively quickly across the entire world and forced healthcare providers – along with entire populations – to quickly change their normal activities. The men and women in Healthcare Technology Management have demonstrated extreme ingenuity in meeting this challenge. We hope this white paper will provide all HTM departments and organizations with ideas you can use and build upon to respond and assist your hospitals.
If you have questions about the information in this white paper, please reach out to: Kyle.Holetz@nuvolo.com.
Other resources to utilize can be found at AAMI.org.