Improving the Environment of Care

Many changes are about to take place in our chosen profession, and many people in the profession do not see them coming. For the past 35 years, biomedical equipment technology has concentrated on devices—not patients. Changes in the Joint Commission on Accreditation of Healthcare Organizations requirements are pushing hospitals and others to look more at patient outcomes rather than at the traditional environment-of-care questions that were asked and answered in the past. Safety is still a major component of the patient outcome, but not in the traditional way that biomeds have looked at it for years. With the financial pressures on health care, we have to look at better ways of doing our jobs that are cost-efficient and still provide the level of safety expected.

As our profession became more active, one of the driving factors was the undocumented statement by Ralph Nader that 10,000 people per year were being electrocuted in hospitals by defective equipment. In 2004, there was another undocumented statement claiming that between 49,000 and 200,000 people per year died in hospitals or shortly after discharge because of medical errors. So, if history repeats itself, we will see action in our profession to reduce the death rate. While I do not see large and rapid growth in our profession, there are many things that we can do to reduce the death rate—if, in fact, it is real and not propaganda by some group that is pushing its own agenda. To compound the problem, we have financial pressures on health care to do more with fewer resources.

One of the classifications of a trouble call commonly used is “no problem found.” In some hospitals, these compose more than 80% of all trouble calls, especially when combined with the equally popular “could not duplicate” and “user error.” Are we really saying that there is no problem, or that we have no idea what the problem actually is more than 80% of the time? We need to look at these to see what the underlying problems really are. Is it equipment, staffing, education, or some combination of these? We need to identify the problem areas and start working to make the corrections. The corrections can be as simple as an inservice, or as costly as a device replacement or changes in our inspection protocols to meet the current needs. Remember, many preventive maintenace procedures are very out of date based on what we now know about devices and their failure modes. We keep costs down by keeping the equipment in a safe operating condition and available for patient care.

Some hospitals will not allow biomeds to give inservice education on devices, saying that such training must be done by the education department or the education person for each department. Unfortunately, all too many “educators” do not have the necessary training on the devices before they start to train others. This leads to errors in care that often impact patient outcomes. They also contribute to trouble calls that are not true trouble calls to which we respond on a regular basis.

Many of you have conducted “on-the-fly” inservices for nurses and other users when you see that something is being done in a less-than-ideal way. Many of you have also been asked to give quick reviews of equipment setups for the users. But most of you have not formalized what you have done. The record keeping for the “on-the-fly” and other training needs to be done by the biomed department. You do not need names—just dates, the area, times, and topics. All of these events become part of your environment-of-care-improvement program, which needs to be reported to your safety committee.

One last point. We can make a major difference in health care if we will work together, share information, and communicate with not only our colleagues but everyone in the health care field—administrators, physicians, nurses, technologists, financial people, and risk managers. The choice is ours to make. If we do not step up our services to meet the new health care challenges, we will remain a necessary evil in health care—not a major contributor to better patient outcomes.

David Harrington, PhD, is director of staff development and training at Technology in Medicine (TiM), Holliston, Mass, and a member of 24x7’s editorial advisory board.