|SLU team members, from bottom left, Keith Hosey, CBET; Jennifer C. Ott, MSBME, CCE, SLU director of clinical engineering; Mark Buescher; and Paul Cain, CBET, perform cable-installation verification.|
In more ways than one, Saint Louis University Hospital (SLU), St Louis, is a teaching hospital. Not only is it affiliated with its namesake, but the organization’s biomedical technicians are also committed to ongoing learning.
Because the clinical engineering department is relatively small—seven full-time techs service the 356-bed, level-one trauma center—it is imperative that each member of the team be trained to handle issues that come up with any piece of equipment.
“We do a lot of cross-training in our department,” says Jennifer C. Ott, MSBME, CCE, director of clinical engineering, SLU. “There is a wide variety of equipment and everyone takes calls once a week, so they really need to have a good working knowledge of a lot of different things.”
While each tech does have specialty areas where they tend to do the bulk of their work, a training protocol is in place that ensures everyone feels confident in answering any call that comes from the front-line clinical staff.
To make this happen, every tech attends at least one training class each year. Upon returning to SLU, that tech conducts a “Train Our Own” class. This peer-to-peer session gives everyone in attendance a chance to benefit from the new information obtained on the equipment in question.
The clinical engineering team can also refer to manuals created by the technicians who have attended vendor training. Designed as a quick-access guide, the manuals provide relevant documents and step-by-step procedures for common issues that arise from a specific machine. In many cases, the techs will also include photographs or diagrams to provide the level of detail necessary to get the system up and running again.
“These on-call books are also where we put important information, so you can quickly find out things like who your service engineer is or what your contract number is, in case you do have to call the manufacturer,” says biomedical technician Paul Cain, CBET. “It gives you another resource if something happens when you’re on call, and gives you some idea of the issues the clinician may be dealing with, instead of answering the call totally in the dark.”
Ongoing training for existing pieces of equipment is also critical. Every year the SLU biomeds perform competencies, which are an annual assessment every technician is required to complete. Techs attend training based either on the results of these competencies, or on requirements for their professional advancement.
“We certainly look at our own internal processes in our development,” Ott says, emphasizing that ongoing training benefits not only the techs, but the hospital staff as well. “Having this depth of knowledge means we can provide quality support for our customers in a timely manner. The more people are familiar with the device, the more they’ll take the initiative to go down and fix something rather than having to call in or wait for the vendor, or to spend money on a service contract.”
Striking a Balance
|The SLU team service the Accuray Cyberknife, a noninvasive, frameless system that performs stereotactic radiosurgery.|
Such straightforward cost savings is beneficial not only to SLU, but also to Ott and her team.
As is the case with many health care organizations, education dollars are often in short supply. Before Ott came on board, formal training was less frequent and techs often took the initiative to gain the knowledge through independent research and on-the-job experience. In order to gain the funding she wanted, Ott analyzed the true cost to the hospital.
“We did a lot of return-on-investment justification, where we explained what the cost of the service contract was versus the cost of the training,” Ott says. “I also explained that we were going to share that knowledge with the other staff members, so it’s not just one person who will be trained. We are here all the time, so there will always be someone who is at least able to take a cursory look to help save some costs or eliminate service contracts.”
It wasn’t long before contracts were being scaled back to parts-only agreements or, as in the case of the majority of imaging modalities, done away with altogether. These changes didn’t impact the level of service provided to clinicians.
“We respond to everything in the same manner, even when systems are under contract,” Cain says. “We do a look-through and try to make sure it’s not something simple to fix, like a button that’s not pushed correctly.”
Which isn’t to say that OEM agreements are a thing of the past for SLU. Some highly complex systems warrant the vendor coverage. The hospital’s CyberKnife® is a perfect example. A noninvasive, frameless system that performs stereotactic radiosurgery, the CyberKnife is such a unique, software-intensive device that it demands an ongoing service agreement.
“But we do some first response on that, as well as helping look at some of the basic things that can go wrong with it, and we always work closely with the vendors,” Ott says. “We’ve done some troubleshooting over the phone for them to resolve some issues and assisted them so they haven’t had to come in to take care of something.”
When vendors do come to the hospital to repair equipment, a biomed tech accompanies them in order to learn as much as possible. Having biomeds work with the vendor—whether on the phone or in person—is a vital component to the training structure. This dedicated, consistent approach has resulted in fewer challenges in getting funding or having training rolled into capital purchases.
“We’ve shown that the training has paid for itself. We’ve never had an issue where they tell us training won’t be available, since we can prove our worth and have shown that it’s beneficial for the hospital,” Ott says. “It’s also beneficial for the front-line clinicians because we are there to help them more quickly than a vendor technician can.”
The innovative, do-it-yourself skills fostered by the clinical engineering team at SLU paid off when the techs recently rewired the entire intensive care unit (ICU). Working nights and weekends, they ran all of their own cable, installed their own switches, and terminated all of their own fibers to create an infrastructure for the monitoring system.
“My technicians were very adamant in wanting to do that because we have to support the system when everybody walks out the door,” Ott says. “If we install it and we terminate it, we know what’s going on and then we are very comfortable with supporting the whole thing.”
Installed and working well, the staff had no formal training in technical wiring. “Clinical engineering installed this totally from scratch,” says Dan Motherway, CBET, senior biomedical technician at SLU. “We decided we wanted a fiber backbone, so we went out and figured out how to do what we wanted and how to test it. We installed fiber and learned how to terminate and test fiber. None of us had had occasion to do this type of thing before, so we did our own self-training and research.”
In addition to making it easier to repair, separating the information services (IS) system from clinical engineering’s network also helps the biomeds more easily maintain the equipment in use. While computers used for clerical-type work are often subjected to software uploads—virus patches and quick fixes, for instance—such proactive measures can wreak havoc in telemetry systems.
“IS can be blocking a virus and then suddenly, somebody can’t print,” Motherway says. “Our biggest fear is if we put some kind of patch on it and it is blocking something, that maybe it’s not access to a printer, it’s an alarm coming from an arrhythmia—and we can’t risk that kind of thing.”
The new wiring also makes it possible for new monitors to actually compile information for the hospital. Reports can now be generated that provide aggregate data on the types of patients and conditions or injuries being treated in the ICU. It also prepares the hospital for future federal regulations, such as electronic health records.
The Next Generation
About 6 years ago, Ott petitioned for money to start a paid internship program in the clinical engineering department, driven in part by the hospital’s close proximity and tight working relationship with the university.
“I said, ‘We are a teaching hospital, so then why can’t we teach engineers and technicians as well?'” Ott recalls. “Saint Louis University actually has a biomedical engineering program, so it was ideal; we currently have one part-time intern.”
Interns work between 6 and 10 hours per week, depending on their class schedule, and can put in up to 32 hours per week during the summer. They are considered part of the staff—they attend meetings and complete competencies.
“The intern helps out quite a bit actually, and it’s nice to have another person available when you need an extra set of hands,” says biomed technician Mark Buescher. “It also gives him some training, so when he gets out in the job force, he knows what to expect from our field and what they’re going to expect from him.”
The department’s intern makes a vital contribution because he provides assistance with the day-to-day tasks, freeing up the full-time techs to work on the more complicated issues and make rounds. Regular interaction with their clients is important to every member of the clinical engineering department.
“I have pretty good relationships with the managers and the workers, and that’s important for me as a tech,” Cain says. “Sometimes things may not be reported, but if I just go to the manager directly, they can double-check that nothing has been put on the back burner that won’t be noticed until it becomes an emergency. And if it’s a couple of days before it’s been reported, for whatever reason, that aggravates the staff because they feel ignored—and you honestly didn’t know.”
Having a college student in the shop also provides a fresh perspective on the field that can prove beneficial to the clinical engineering veterans working at SLU.
“For us, it’s fun to have ‘fresh blood’ in the shop,” Cain laughs. “It gives you a chance to explain what you’re doing. It’s beneficial for us for the fact we can slow down and show someone else around, instead of us running around all the time because we’re so busy.”
Motherway concurs, saying, “Having an intern is always nice because you can get a little additional help here and there and they’re interested in seeing what you’re working on. It’s new to them, whereas you may not convince another coworker—who has done the same thing 15,000 times over the past 15 years—that, ‘hey, this is still interesting.’ ”
The Big Picture
Creating the internship is just one way Ott has worked to increase the visibility and impact of her department. She is a member of the capital equipment committee—a role that provides her with the opportunity to negotiate for her department, while also assisting other departments with their capital process.
Ott is also cochair of the Environment of Care group, which performs monthly audits throughout the hospital to ensure that hospital standards and performance improvements are being made.
Taking an active role outside of the clinical engineering department is fundamental not only to the hospital but also for her team.
“I think it’s important for exposure, and I think when the hospital staff knows who I am and people have a better understanding of what we do and what we can do for them, then we can work more collaboratively,” Ott says. “It makes it possible for us to work together with the departments to ensure success for their equipment, as well as their environments, which allows them to provide exceptional care for our patients.”
Dana Hinesly is a contributing writer for 24×7. For more information, contact .