Working through the nursing department may be unconventional, but it proves effective for the clinical technology services group at OHSU

The nurse understands why it is important. The biomed tech understands why it is important. Yet it still seems impossible to get a signature approving the funds to make it happen.

This aggravating scenario is nothing new to many in today’s tightly budgeted health care industry. But thanks to some creative thinking and organizational initiative, it has all but been eliminated for the members of the clinical technology services group at Oregon Health & Science University (OHSU) in Portland.

Several years ago the decision was made for all clinical engineers (CEs) and biomedical technicians to report—through the department director—to the nursing team. Conventional, no. Effective, yes.

“I think it has a tremendous impact. In any of the other organizational structures, you’re having to explain to someone why you have to spend money to support a particular device that most likely is not part of that individual’s responsibility,” says Dennis Minsent, MSBE, CCE, who brings more than 3 decades of experience to his role as director of clinical technology services for OHSU. He estimates that roughly 90% of the service and support his team provides is for the nursing staff. “Working directly for nursing, we’re doing things for our own organization, so you’re requesting it from the people who are going to be the beneficiaries of that additional support.”

Having oversight coming from those who are most directly impacted by your service also limits duplication of effort. Multiple nursing units through OHSU are looked at comprehensively, so dollars for maintenance and purchases can be maximized.

“We are very engaged and involved in supporting nursing and their budgeting for equipment replacement, coming up with a strategic plan for them as a whole,” Minsent says. “By doing this, we’ve reduced the administrative work on the part of our nurse managers and allowed them to more closely focus on what they need to do to provide direct patient care.”

That direct link—between the work of biomeds and CEs and the treatment of patients—was the primary driver for the creation of this pioneering approach. About a decade ago, OHSU was in need of a clinical engineering director. Hoping to improve the service provided to her perioperative department, Melody Montgomery, RN, MBA, and now division director, perioperative services, at OHSU, stepped up.

“The operating rooms are very equipment intense, and I wanted to ensure they received service while also monitoring the progress on improving the level of service to them,” Montgomery says. As interim director, Montgomery dedicated one CE and one BMET to the periop team.

A New Game Plan
Halting the flow of complaints from nurses about poor service topped Montgomery’s list of priorities. To tackle the issue head on, she developed a customer service survey that techs and engineers were required to carry—and distribute—when going out on calls.

Composed of a dozen or so questions, the postcard-sized questionnaire provided internal customers a way to bluntly, and anonymously, grade the service provided by their biomed or CE. Techs could determine who to give surveys to, but expectations were that every employee would get at least between five and 10 back every month.

“I wanted the nurses to give them honest feedback, because it’s filtered when it comes to me or another manager or lead person,” Montgomery says. Survey results were reported widely, listing both individual and aggregate results. “We not only witnessed an improvement in service, but it was actually a morale boost; people were proud of their feedback.”

Noticeable improvements were immediate, and eventually biomeds and clinical engineers in all areas of the hospital fell into the same reporting structure, all of which works to improve patient care.

“By reporting through nursing, there is a tighter connection between the actual patient care providers and the clinical engineering department,” Montgomery says. “For us, the clinical engineers didn’t always realize what the impact of their service—or lack of service—meant to the direct caregivers and ultimately to the patient. If you don’t hear it spoken about, it’s easy to get away from looking at the real reason why you’re there.”

Reaching Out
That growing sense of pride brought with it a very proactive spirit. Instead of assessing each piece of equipment on a structured schedule, the clinical technology services team works to minimize the number of routine, planned maintenance inspections by making regular rounds.

“What we’ve tried to do is really eliminate unnecessary planned maintenance inspections based on reviews of our service histories and are instead spending much more time in the units and clinics, working directly with the nurses,” Minsent says. “Nurses traditionally are very, very creative in keeping things going just as long as they possibly can, without having to send it out to be serviced. By visiting regularly, we can take care of little things before they become more serious problems or issues for our nursing staff.”

Clinical technology services’ support structure is also expanding to direct patient interaction. A pilot program currently under way at OHSU requires biomeds and CEs to visit each unit’s room whether it is occupied by a patient or not. During the visit, a quick, general assessment of the condition of the equipment is completed, searching for anything that appears to be damaged or in need of attention.

The CE or BMET will also talk with a patient, making sure the bed and remotes are working properly and finding out if any of the equipment in the environment can be improved in any way.

“Oftentimes, we can take care of things on the spot for them, just correcting little things,” Minsent says. “We’ve gotten great feedback from patients saying they really appreciate someone coming in. They see us as trying to make their stay in the hospital better.”

Leaping Forward
The focus on improving services from clinical technology services has not taken place in a vacuum. Over the last 2 years a vast hospital expansion project has been under way, including a 16-story, 400,000-square-foot Center for Health and Healing in the South Waterfront area and the 335,000-square-foot Peter O. Kohler Pavilion.

Filled with state-of-the-art equipment, one of the most innovative aspects of the Kohler Pavilion is what patients do not see. A comprehensive wireless infrastructure was incorporated into the building’s design, providing staff with access to a myriad of advanced technologies.

“We were building this new structure and the question was, are we going to operate the same way we are now, or is there new technology that can help us be more efficient?” says Retty Casey, director of clinical facilities development, OHSU, who was tasked with heading up nine subcommittees to provide direction on the new building project.

One of those groups, the technology subcommittee, consisted of about 15 individuals from various areas in the hospital, such as nursing, architecture, facilities, IT, clinical engineering, respiratory therapy, and the operating room (OR). The team began by researching new and emerging technologies and visiting hospitals employing them.

The subcommittee soon targeted specific solutions: to use radiofrequency identification (RFID) asset tags; a wireless, voice-activated, wearable communication system; and to install the hardware required for both wireless solutions to function. Graduate students helped detail the return on investment that could be realized by implementing the strategy, and Casey presented the proposal to the Capital Council. All three projects were funded.

Demonstrating specifically how new technology will improve the bottom line—and ultimately the care provided—is the best way to obtain funding for substantial renovations.

“The plan was approved because of the return on investment, both financial and human,” Casey says. “We employ full-time employees whose sole job is to locate lost equipment, which can cause delays in care, delays in procedures, and delays in OR start times.”

No Place To Hide
Simply knowing where equipment is can save money, as it allows every piece to be used fully.

Pieces of equipment bearing RFID tags may wander, but they will not be lost. Each tag contains an integrated circuit that uses an antenna to communicate with a transceiver. This wireless interaction allows the tag to send and receive information, such as its location, which is particularly important with specialty equipment.

“There are a lot of items where, because they’re so expensive, we only own a few of them, and yet when you need that piece of equipment you need it,” Casey says. She gives bariatric wheelchairs as an example. “Certainly, that’s not something you have in every room, but if you need it to discharge this patient and can’t find it, you’re delaying the discharge and tying up that bed.”

RFID technology can keep an eye on anything to which a tag is attached.

“Sometimes a piece of rental equipment ends up getting pushed aside while the room is being cleaned, so we continue to pay rental charges on equipment that is not currently being used on a patient,” Minsent says.

The RFID tags themselves have some functionality and can be programmed to send an e-mail, for instance, to the equipment room as soon as a rented item is no longer in use. Quick calculations show that this feature alone helps the wireless capability pay for itself.

“In one year of renting a piece of equipment called a wound vac, we spent what we would have spent on the entire asset-tracking project,” Casey says.

According to Minsent, the RFID program will provide financial payback about 9 months after its implementation.

Growing Assets
OHSU initially purchased 3,000 RFID tags. Priority was placed on the most expensive and mobile pieces, with a collection of new intravenous pumps receiving the first 1,600 tags. Currently, the RFID tracking software is being fine-tuned. At this point it can identify a tag’s location within about 3 meters. Casey estimates that the system will be fully online and in use throughout the facility before the end of the year.

Though the project was initially defined and developed around the ability to locate equipment, Minsent foresees the benefits it would bring to other applications.

“We are already having discussions around being able to use RFID tags to more closely watch patients who might be prone to get up and wander, such as those who have neurological injuries,” he says. “In looking at the device and what it’s capable of doing—tracking, monitoring, or locating virtually anything—you are only limited by your imagination.”

Inanimate objects did not receive all the attention during OHSU’s upgrades. Communication among the nursing staff was also addressed with wireless functionality. The three newest nursing units in the Kohler Pavilion are delighted with a new hands-free, wireless communications system that works through a pendant worn on a lanyard around the caregiver’s neck. Making a call is as simple as pressing a button and giving voice commands to connect with another individual. The receiving party is told who is on the line and is given the option to accept or ignore the call (which prompts the system to take a message). Calls can be placed to anyone signed into the system or to a landline connected with the hospital’s phone system.

“It’s wonderful; we don’t get the pages we used to get, because when I get a call I can answer it right then and I don’t have to go to a phone to try to reach the person,” says Montgomery, who is part of the pilot group that is using the devices.

Along with overhead pages, patient call lights are also a thing of the past, thanks to the voice-call system.

“It is interfaced with the nurse call system, so when a patient presses the nurse call button at their bedside, that call is routed directly to their care provider,” Minsent explains. “This is a tremendous way of being able to much more quickly connect the patient and their caregiver together.”

Open Arms
The new construction and technology upgrades brought with them a multitude of changes, all of which were embraced by the staff of OHSU. The wireless communication devices are a prime example. Since going live in March, the staff has come to rely heavily on the system. In July alone, approximately 54,000 calls were placed through the wireless system.

“I think our staff is really sold on the changes, because they understand it makes their job easier,” Casey says, acknowledging that new technology is sometimes resisted because it demands that employees change the way in which they work. “An important step is selling the staff on why it’s going to change the way in which they work for the better, so they are more ready to be early adopters.”

Dana Hinesly is a contributing writer for 24x7.