Minimizing the Downside of Deinstallations

 In the scheme of things, the removal of an aging linear accelerator may not be the element that captures the imagination and attention of the executive suite during your hospital’s expansion or remodeling. It should, however, be on the agenda of the biomedical engineering department several weeks before the removal takes place. The deinstallation of sensitive, expensive, and complicated machinery—which is also heavy and often loaded with recyclable precious metals and difficult-to-dispose-of waste materials—is a simple process for biomedical engineers to participate in. But it is a process that lives or dies depending on the amount of planning you put into it.

Vickie Snyder should know. As the manager of biomedical engineering at Fairview Southdale Hospital, Edina, Minn, she is usually notified of a deinstall if a remodel is planned, construction is under way that will require equipment to be demolished, or the acquisition of a new piece of equipment is being considered. “Most of the time, we’re involved early in the process,” she comments, “which gives us time to make arrangements with our service vendors and liquidators to schedule pickup and removal of what is being deinstalled.”

That can be easier said, as they say, than done. “We need to make sure that our deinstaller can come when we have things scheduled,” she explains. “That can sometimes be a little hectic. We have to schedule the deinstall, then make sure all of the contractors that might be affected—including plumbers and electricians—can be there. And sometimes we have the actual vendor of the device helping, especially if we are going to be reinstalling the equipment in a different location in the future.”

Avoiding the Mistakes
Mistakes can happen during a deinstall, but given the technologically complex nature of the equipment involved, they are almost always big-ticket mistakes. Biomedical engineers and professional deinstallers can minimize the downsides of deinstalls by paying careful attention to the rules of the game and the myriad ways the game can spin out of control.

“State forms and federal Food and Drug Administration guidelines for disposal are part of the process,” explains Thomas J. Gohn, president of International Health Network Inc, Clayton, Mo. “Strict guidelines, especially when disposing of hazardous materials, must be adhered to.” Adds deinstaller Chris Hogan, president and owner of MEPS Inc, Gallatin, Tenn, “In Texas, you have to be registered to deinstall equipment. And there’s voluntary registration with the FDA.”

In addition, points out Vickie Snyder, manager of biomedical engineering at Fairview Southdale Hospital, Edina, Minn, “Our infection-control department gets involved the most, taking air-quality samples and such to maintain a clean and safe environment for our patients and staff. We may have to build or put up barriers. The environment will be monitored during the whole event to comply with Joint Commission on Accreditation of Healthcare Organizations standards and infection standards.”

The price for failing to do things like that can be steep. “You wouldn’t believe what can be messed up,” Hogan quips. “Health risks are one problem. We have to be vaccinated against hepatitis B and at least be prepared for using disposable full suits in some departments.” And, he adds, deinstallers have to watch out for needle-sticks. Because of the stakes, Gohn notes, his company has a blanket $2 million insurance policy. —RJ

She adds, “We have to see what areas will be affected, communicate to those departments what we will be doing, and make sure it is OK. Then, we contact infection control to make sure we meet their needs. There may be asbestos issues we need to worry about, or permitting issues that have to be looked at as well. Sometimes that can take up to 2 weeks of scheduling.”

It is important to have the deinstaller in on things from that point in the process as well, says Thomas J. Gohn, president of International Health Network Inc, Clayton, Mo. “The deinstall process starts with a site survey,” he explains, “checking clearances and exit routes. Biomedical engineers have their hands full with the day-to-day activities of the hospital, but a ‘tech’ or manager is assigned as the go-to person for the project.” Tasks the hospital executive can shepherd include helping the deinstaller shut off the water and power.

He echoes Snyder’s emphasis on early planning. “There are times when equipment should have been removed months earlier,” he says, “but administration issues, such as new equipment that has not arrived or remodeling that has not yet begun, can cause delays. It is best to call the deinstaller as soon as the hospital starts researching the possibility of new equipment. Calculating costs at that early stage helps the administrative staff make informed decisions about the overall costs of the entire project.”

The devil, as always, is in the details, stresses Chris Hogan, president and owner of MEPS Inc, Gallatin, Tenn, whose company sells reconditioned GE Medical equipment parts and systems. Working together, hospital biomedical engineers and deinstallers can stay on top of operational detils, such as:

• You cannot always stage equipment removal by parking things in hallways, because stretchers might be coming by.
• Doors always present a logistical issue. How many are there? How wide and tall are they? Are they easy to adapt to the equipment? How many are secure at night?
• Docks and service elevators are similarly important, especially if they close at night. Also, Hogan points out, “During some hours of operations, you can’t be in certain departments.”
• Equipment manuals and accompanying software and peripheral equipment need to be gathered. If there are items in cabinets that do not leave with the cabinet, someone needs to make sure they are removed before the deinstall starts. That includes linens and other supplies, as well as, say, accessories for the next suite’s matching equipment. Otherwise, Hogan notes, “The guys might just box it up, and out the door it goes.”
• Hospital staffers should provide the deinstaller with the original installation plans for the equipment so the deinstaller can easily find out where peripherals are attached.

Making a Smooth Transition
Deinstalls are not pretty—and they are not quiet. Inside biomedical engineers and outside deinstallers must work together to keep patient and hospital staff disruption to a minimum.

“We’ve been under construction in a variety of ways since 2001,” notes Vickie Snyder, manager of biomedical engineering at Fairview Southdale Hospital, Edina, Minn. “Noise, smells, and vibrations are part of the norm. What helps keep our customers and staff OK with the deinstallation process is sending out weekly communications to let them know what’s going to be happening.”

Also, she reports, her facility has an emergency contact in case the disruption gets to be too much. “For example,” she says, “we were tearing down some walls in our old surgery area when the foreman on duty received a call that the contractor had to stop for 15 minutes for a patient induction. Then, the work could resume.”

Deinstaller Thomas J. Gohn, president of International Health Network Inc, Clayton, Mo, adds that, “The location of a deinstall is typically isolated from the day-to-day patient flow of activity. Noise is kept to a minimum by making sure doors are shut. Dust is contained by vapor walls, and hepafilters are installed as necessary. A demolition job is done at night or on weekends to minimize disruption.”

That is a common tactic, notes deinstaller Chris Hogan, president and owner of MEPS Inc, Gallatin, Tenn. “If anything has to be cut or chiseled, we try to do it after hours,” he says. “In those cases, we try to arrive in the afternoon to check things out.” There is also an element of common courtesy involved, he adds. “If we’re playing music, we have to keep it low, because they might be taking care of patients right next door. And we have to be professional. No foul language, and no comments about patients.” —RJ

Equipment Disposal
Another key element of a deinstall that needs to be worked out well in advance is the ultimate fate of the equipment. The more manufacturers that are involved in equipment replacement, for example, the more likely it is that a screwup will occur. “If the facility sold the equipment because it is being replaced,” Hogan explains, “it makes a difference whether it was sold as a trade-in to the new vendor or sold through a broker. It also matters whether the broker is buying the equipment directly from the facility or directly from the vendor.”

 Deinstallers removing the counter weight.

A potential problem? Say the old piece of machinery is a GE device and the new one is made by Siemens. “It can really throw a monkey wrench into things if the new equipment doesn’t show up on time,” Hogan points out. “The hospital will usually want to keep the old equipment longer.” Also, he notes, whether the hospital plans to refurbish the equipment or upgrade it and reuse it determines how the deinstaller will remove it, pack it, and ship it.

Indeed, Gohn points out, few deinstalled machines are simply written off as junk and demolished. Anything less than 10 years old, in fact, will probably have another life. Roughly half are resold—often to facilities in poorer or less medically advanced countries—while 25% or so are recycled, and about 25% are sold for parts.

 Few deinstalled machines are simply written off as junk and demolished. Anything lessthan 10 years old, in fact, will probably have another life.

The specifics, Hogan adds, depend on the modality, age, and popularity of the equipment. A GE legacy radiography and fluoroscopy room, for example, will most likely be refurbished and resold. But an early Advantix—say, from the late 1980s—will probably be scrapped out and thrown away. In those situations, he notes, parts companies will usually buy the pieces to keep in stock for future repairs. An exception, he adds, is a piece of equipment that may be old and slightly out of favor with biomedical engineers in the United States, but that might represent state-of-the-art technology to those in a poorer country. “If it’s a light-speed computed tomography,” he quips, “you’ll have people falling all over themselves to get it.”

 Deinstallers often deal with unexpected conditions, such as steel bolts hidden under the units.

The deinstaller will often handle the equipment’s future life, he adds. But the hospital’s biomedical engineer has an important part to play in that scenario as well. “When we buy equipment, I go and look at it myself,” Hogan explains. “I write in the contract with the facility—on behalf of whomever I’m buying it for—that the hospital has to maintain it in its current condition until we cut off the power. If that’s delayed because of the hospital, we get our deposit back or the facility has to rent it from us.” That contract clause, he adds, sprang from a bad experience. “Several years ago, I put a deposit on a room and the hospital put me on hold for a year. It was an x-ray room with what was at the time a brand-new tube. If the facility delays you a year, your expensive, brand-new tube is now a year old. You have to renegotiate the price if something like that happens.” 24×7

Before You Decide
• Check Web sites for a listing of services provided by deinstallers.
• Check the references of any deinstaller you plan to use.
• Schedule a face-to-face meeting to make sure you have a comfort level with the project manager, and ask about the company’s insurance and safety record.
• Get three quotes.
• Get in touch with vendors to see which deinstallers they work with.
•Consult magazines, such as 24×7 and its sister, Medical Imaging, suggests deinstaller Chris Hogan.
• Contact the original equipment manufacturer. Vickie Snyder, manager of biomedical engineering at Fairview Southdale Hospital, Edina, Minn, says, “There typically is an extra charge, but it’s worth it.”  —RJ

Russell A. Jackson is a contributing writer for 24×7.