Patients' Lives Depend on Them...But do They Work?

When patients enter a hospital, they think about the nurses that will take care of them, the doctors that will treat them, and certainly the medicine or treatments they will receive. The furthest thing from their minds, however, is the array of medical equipment that may just help save their lives. Fortunately, a patient usually doesn't have to think about these devices, because thanks to modern technology and a skilled team of clinical engineers, they perform reliably. But all medical devices, whether diagnostic, therapeutic, or life supporting, operate with some degree of risk. The cost of failure can range from a minor inconvenience to a negative outcome for a patient.

WHAT CAN LEAD TO FAILURE?

Medical devices have features that can be categorized as either electronic or mechanical. Each type of component has its own risks of failure, and everything must be functioning in harmony for the device to perform as designed. Vulnerability to mechanical failure is essentially dependent on the number and complexity of moving parts. And more devices have moving parts than one might think. Jan Jones, Director of Business Development for Crothall's Clinical Engineering division, explains, "Even an X-ray machine, which basically passes a beam of energy through the body using electronics, has a jointed mechanical arm that must be moved, and a table that can slide, raise and lower, or recline. This machine can weigh up to a ton, and improper mechanical maintenance can result in serious injury."

More medical devices rely on computers than ever before. This provides many advantages, but also some new risks. A device that is in otherwise working condition can be out of service because of malfunctioning software. And with smaller electronic parts, more capabilities and features can be added to a single device, which increases the complexity and potential points of failure. The job of a clinical engineer has certainly become more complex over the years.

SHARED RESPONSIBILITY

Responsibility for medical equipment does not fall entirely on the engineering team. There is a chain of responsibility from the manufacturer to the end user, designed to prevent failures. The manufacturer is held to strict guidelines in the production of the devices, which must be FDA approved before they are introduced.

Hospital administration has responsibility when making equipment purchases to include the appropriate departments in the decision making process. The equipment must be able to handle the specific needs of the hospital, which requires considerable research. Administration is also responsible for training medical staff in the proper use of the equipment.

The clinical engineers have the bulk of responsibility to make sure medical equipment works properly. They perform preventative maintenance, repairs, and in-service training when necessary. The clinical engineering department participates in safety and "Environment of Care" committees, and must understand the needs of all users and make recommendations for upgrades or replacements. Finally, clinical staff members are expected to use the devices properly. They must obtain training, and maintain their competency in using the necessary machines.

WHAT CAN PATIENTS DO?

What can a conscientious patient do to reduce the chance that equipment will fail? Bill Rothgery, Vice President of Crothall's Clinical Engineering division makes some recommendations: "First, look at the condition of the equipment. If it looks dirty and beat up, it may not be properly maintained on the inside either. Inspection stickers are required to be on each device. Finally, watch the technicians as they operate the equipment, and don't be afraid to ask questions. They should be able to explain the functionality to you, and should seem comfortable using it."