At Children’s Hospital of Eastern Ontario (CHEO; Ontario, Ottawa, Canada), a 167-bed acute care pediatric healthcare center, medical equipment purchases too often were made without a balanced view of the organization’s current equipment requirements or a clear vision of its future needs. To change that situation, the clinical engineering department spearheaded an effort to implement a health technology planning program—an effort that has brought order to the purchasing process and safer equipment to the front lines of patient care.

As the go-to department when medical device problems arose, the clinical engineering group was keenly aware of the consequences of equipment management practices that lacked a strategic vision:

• Obsolete medical devices remained in service because the hospital lacked a clear equipment replacement plan. While high-visibility diagnostic and surgical devices received top priority for replacement, many less-glamorous but commonly used devices remained in service long after safer or more advanced technologies had become available.
• A consistent stream of emergency equipment replacements were required during the course of each fiscal year because the facility had not planned for equipment reaching the end of its useful life. This strained the capital equipment budget and, on a number of occasions, even forced the delay of major capital equipment projects as resources needed to be diverted to the emergency equipment replacements.
• Clinicians became skeptical of the hospital administration’s ability to meet the facility’s short- and long-term equipment needs. Clinical service lines could request new equipment, but the approval process lacked transparency, and little feedback was provided about why a request was denied. “There was a real disconnect between the healthcare workers making the requests and the decision makers,” noted Kim Greenwood, CHEO’s director of clinical engineering.

To turn this situation around, clinical engineering sought to develop and implement a new long-range clinical equipment plan.

To accomplish this, they first began collecting information—specifically, identifying the equipment requirements of desired new programs and services (as outlined in the facility’s long-range corporate plan), compiling a detailed inventory of the hospital’s clinical capital equipment, and interviewing clinical stakeholders to get their input.

With this knowledge, the group developed its long-range plan. The plan covers five years, with a new plan being developed toward the end of the five-year cycle. This approach has now been used for several planning cycles.

CHEO’s long-range clinical equipment plan consists of the following components:

1. A theoretical replacement plan. For this component, the group first takes the existing clinical equipment inventory, classifies the inventory by device type, and assigns an estimated life expectancy for each category of device. Life expectancies are based on established benchmarks or on the facility’s past experience.[1] For example, CHEO uses the American Hospital Association’s “Estimated Useful Lives of Depreciable Hospital Assets” as a starting point and then modifies the life expectancy data based on its own documented experience.

Next, the theoretical remaining life expectancy is calculated for each device in the inventory. This is done by subtracting the actual age of the device from the life expectancy value assigned to that category of device. The remaining life expectancy values are then used to generate theoretical device replacement lists for each of the next five years. Budgetary factors and other capital equipment needs will dictate whether (and when) a device that is nearing the end of its life expectancy is replaced. At minimum, though, the list prompts the organization to begin planning for the device’s eventual replacement.

2. An emerging technology plan. A technology forecast is developed for each clinical program to review the emerging clinical technologies that are of interest. A ranking system is used to assess each of the identified new technologies, and a cost analysis is performed. CHEO uses this information to develop a five-year prioritized list of new clinical technologies.

3. A fleet equipment plan. The “fleet equipment” classification is used to organize like equipment into groups to better manage the use, maintenance, and replacement of these devices. CHEO uses this classification for larger groupings of equipment, such as stretchers, beds, physiologic monitors, infusion devices, ventilators, and defibrillators. This component of the plan encourages standardization of like equipment in order to decrease operating, capital acquisition, and maintenance costs. Standardization also can have patient safety benefits, such as reducing the risk of operator error. The replacement of fleet equipment can be prioritized using, for example, the average age of the equipment in each group.

In addition to the above, the plan lays out the financial requirements necessary to meet the defined objectives.

One final ingredient is that the clinical engineering department takes an active role in championing the plan. This long-range clinical equipment planning approach was initially met with skepticism by members of the existing capital equipment committee, so it became essential to lobby internal stakeholders on the benefits of the plan and its eventual positive effect on patient care.

Best Practices

The clinical engineering department at CHEO has positioned itself to manage corporate healthcare assets, to provide the technology planning resources needed to identify future needs, and to review and plan for emerging health equipment technologies. The department’s structured approach to planning for future equipment purchases has yielded the following benefits:

• It has helped keep capital equipment current, thus making the clinical environment safer. In 2006, the equipment in the facility’s inventory had an average remaining life expectancy of 1.5 years. For the 2011 plan year, that figure increased to 5 years, indicating that fewer of the devices in use were at, near, or beyond their expected end of life.
• It has gained clinician confidence through the use of a balanced and methodical equipment selection process. Despite knowing the value of the approach from the outset, Mr. Greenwood admits to being “taken aback that it worked as well as it did” right from the start. Clinicians, department heads, and administrators all are happy with the process.
• It has resulted in more predictable expenditures. The facility’s “contingency fund” for the emergency replacement of obsolete but essential medical devices previously had taken up 15% to 20% of the capital equipment budget. It now takes up less than 5%.

Congratulations and thanks to the people who submitted Children’s Hospital of Ontario’s application for the Health Devices Achievement Award: Kim Greenwood, Marie-Ange Janvier, Y. Rachel Zhang, Gaëtanne Heggie, and Marjan Yazdanpanah.
______________________________________________________________________________________________

[1] ECRI Institute’s BiomedicalBenchmark™ service includes equipment life-cycle data to help members plan for equipment replacement.