Hi all,

I read with great interest both the abstract and full document by Julia Werth (and Dominic Furniss) linked elsewhere on the forum. Good stuff and thank's for providing the links.

Does anyone know of other studies on equipment libraries especially those centred around "before and after" studies of capital equipment usage/investment or the change in levels of statutory compliance?

Thanks, Dave

Hoping to justify setting up an "Equipment Library" from the "money to be saved" angle, I wonder?

Surely a better way of selling the idea is general availability of serviceable kit in adequate numbers (quantity)?

I doubt that you'll find many instances where items on the Library shelves never get used (or "taken out", to carry on the metaphor). That's part of the "numbers game" when planning them, I would have thought:- such-and-such percent will be "off the shelves" at any given moment (sometimes as much as 100%), ergo you don't need shelves (or space) for every item.

It's the "nuts and bolts" like this that we never get to hear about, for some strange reason. I can only assume that most folk don't look at things in such a way.

Meanwhile ... "statutory compliance"? With what? Patients treated? "Positive outcomes"? Overtime for the nurses?

Dave, I am not aware of any 'before and after studies' of Equipment Library usage. If there are any I would like to know as well. I think that these studies, if any, will have been done in-house by each hospital to find out if they have been cost effective or not.

Writing from our experience, we have all Infusion devices and Dynamic pressure mattresses controlled via an EL. That way we have the best cost effective system of using the 'limited' resources that we have.

You will certainly need space for every item as demand for resources fluctuates.

All I can say is that here, the prevailing viewpoint is that the hospital cannot do without our EL even with the limited resources that they give us to run it.

I have written reports for the hierarchy here in the past regarding the present functioning of the EL and how 'efficient' it is, but I am not sure that is what you are after. As I stated, I think the 'info' you need will have been written on an individual hospital by hospital basis.

Plus some big tables for pressure relieving mattresses etc. ... for the checking (cleaning) and maintenance thereof!

All of which goes to show that a bit of planning is essential before folk start charging off and opening up their "EL" (OK, terminology-wise, let's settle for that).

Meanwhile, your figures could be interesting, Mike. How come all of the kit gets to meet up again (sounds a bit like "Toy Story")? Don't tell me that your EL kit is under curfew?

Come on now (whilst we're in the mood) ... what are the formulae we need here?

1) b Beds (indication of hospital size)
2) i Infusion Pumps
3) s Syringe Pumps
4) m Mattresses ... etc.

How many are out at any given time? For how long? How many out of service (unserviceable), and for how long? How often does demand exceed (ability to) supply? "Do the math" (yes, it's a horrible term, but readily understood these days, I believe).

And (whilst we're at it):- what kit goes in the EL (and why)? And, why not "everything"?

Not sure if this is what Dave wanted, but since you ask I will give a response, but before I do, please don't make judgements about what we may do or not do when you know nothing about us:

Big tables for checking/maintaining pressure relieving mattresses. What? Are you really serious? No, no, and no again. That is done where it should be - next door in EBME.

You may rest assured that a lot, and I mean a lot of planning was done by us (and many others) over 12 years ago prior to opening up our EL.

You say - 'Don't tell me that your EL kit is under curfew?' Are you really asking a serious question here? Do you really think that would happen? Our EL kit is available to one and all 24/7. That is the way it has to be. Actually it is the only way it could be.

Serious/decent questions only please.

1) Tables ... I know that some places have them.
2) Curfew ... I was just wondering (most EL's are staffed 9-5 ... and some seem to have "difficulties" with both "tracking" and "out of hours borrowing").
3) How about some clues regarding the "math"?

EBME next door? So what's the drill ... does stuff being returned pass by them? Or do the Library Staff check it out, then pass it back for repair as need be? EL kit is on the PM schedule, of course.

(Me? judgemental? No way. Just interested, that's all)!

Most are indeed staffed 9-5 or similar hours.
Here the EL looks after infusion pumps, syringe drivers, feeding pumps and a few others but the equipment is also serviced/repaired by the tech rather then going into the main EBME dept.

Yep ... that's another "factor":- sometimes EL's have a biomed tech on board, sometimes they don't.

Sometimes the EL comes under the Biomed Department (EBME Manager, whomever), whilst other times it is headed up by *"others"!

* Often ex-nurses, in my experience. Sometimes leading to an element of friction between the EL and Biomed (again, something I have seen). How come? Because they seem to expect (demand) "special" or preferential service (whilst the biomeds may see the EL as "just another user department").

The Equipment Library here is part of EBME. Our Library is physically attached to our EBME workshop. To get to our workshop you have to walk through the Library.

The Librarian issues, records and recovers selected devices and our Techies do the maintenance on those devices. Our Equipment Librarian has been trained on how to check devices so they are safe for re-issue. He is such a 'top chap' and on the ball that he even brings in devices to us in the workshop when they are due for PM.

Clues regarding the math? Come on Geoff, don't go all Americanised on us, it's 'maths' surely unless something changed and I didn't notice. One Librarian and over 300+ different devices (by volume not type!) plus 900+ Nebulisers.

The system certainly works for us, it may not work for others but it has been tried and tested here for 12 years.

I am aware that we are pretty well 'off topic' here - sorry Huw.

Sorry Mike ... we're just trying to attract more American Biomeds to the forum. I'm aware that a fair number lurk from time to time, but rarely (if ever) post.

No ... "Studies of Equipment Library Services" ... pretty much on topic, I would say.

Yes ... your set-up sounds ideal. The one to go for, I would say.

Nebulizer compressors? At one Big Hospital I know they have a store and a guy taking care of those for the whole County (that is, the "Community" and beyond). He issues them out, accepts them back (we hope), and services them as well. Yet another way of doing things.

900+ sounds like a lot. I presume they are for the "Community" as well, then.

Oops, hadn't considered our American buddies. To be honest, I forget sometimes that this site attracts interest from all over the World. Thanks for the comment about our EL, don't know about an ideal set-up, but it does seem to work for us.

Yes. It's one of the reasons I keep harping on about terminology:- many of the techs "out there" are probably puzzled about what an "Equipment Library" is. I should imagine that many, like myself when I first encountered the term, thought it was where the Service Manuals were kept!

So, having once again received a generous dollop of Geoff's opinions does anyone know of any facts, data, numbers?



Feel free to PM or email me if you prefer to keep yourself (or your hospital) out of the limelight.

Thanks, Dave

So, having once again received a generous dollop of Dave's gratitude for trying to tease out some facts, data, numbers ... I must agree that, for some reason, it seems that experienced Equipment Library folk tend to prefer to keep their expertise to themselves (out of the limelight, under a bushel ... whatever).

Either that, or perhaps the "before and after" studies have yet to be carried out.

Don't worry Dave, there's no charge. But if it's consultancy you're after, I expect we could work something out.

I posted a question about Librarys a little while ago which asked what equipment was looked after, cleaning levels and staffing, I got details for six other Hospitals which i could email (small Excel spreadsheet) the main information is shown below (sorry it looked better on the Posting form)-

Trust Beds Staff Deliver Collect Clean Disinfect

Hereford 340 3 Yes Yes Yes Yes
Addenbrookes 1100 3 Yes Yes Yes Yes
CHT West York
Withybush 285 2 Yes Yes Yes Sometimes
Charlie 660 2.5 Yes Yes Yes Yes
Taunton 700+ 2.5 Yes Yes Yes
Hinchingbrooke 340 3 Yes Yes Yes Yes


Static M Infusion P Syringe D Batt Syr D Air Bed Feed Pump

Yes 68 41 22 71 23
386 183 26 Contract 182
69 49 49
On ward 106 49 18 77 23
128 56 28 135 41
Yes 200 100 y 140 80
79 45 22 36 26

When i was looking into setting the Library up i was told by Cardiff and Shrewsbury that their Libraries led to reductions in syringe drivers and infusion pumps required by 20%, however we found that we had to increase numbers of infusion pumps (30%) and air mattresses (10%) and still do not have enough.

Lee

Well done Lee.

As I keep saying (to the annoyance of some, no doubt), it has to be a "numbers game". So how about the correlation between the amount of library kit (infusion pumps, pressure mattresses et al) and number of hospital beds, number of library transactions per month (or whatever)?

And (just to be my usual pedantic self):- when you say that you still don't have enough of some of the kit, what makes you think that? Unable to meet users' requirements (demands)? How often is this happening (and why ... unserviceable kit, or simply "not there" in sufficient quantity)? Can you be sure that "they" are not simply hoarding the kit? More info. please!

Email me your spreadsheet, if you like (and I'll see if anything "jumps out" from that).

By the way, when it comes to tabulating information, you can always use:- [code] (see the # button above your text when making a post).

n.b. that's using the Reply screen as opposed to the Quick Reply screen.

Correct (although I can't see why anyone would want to use Quick Reply, myself)!

At the risk of going off topic....

Because it's right under this post and you don't need to click on anything to get there.

I would think the majority of people use it. I am using it right now.

Disable that feature!

Just for the sake of a mouse click ... folk end up replying to the original poster, rather than the previous post.

I hope I've got that transposed correctly, Lee. If nothing else it's given me a few minutes of fun playing with the "data exchange" tools included in the next exciting revision of the famous TaskMaster program (due to hit a Downloads section near you soon), plus a minute or two more with my favourite DOS text editor.

Straight away we can see that Site C is looking a bit light on infusion pumps and syringe pumps (and Site A is also low on syringe pumps - I wonder why that is? Bad data, I suspect).

Other patterns emerge as well, and I shall leave folk to draw their own conclusions. The trouble is that small amounts of sample data can lead to misguided conclusions! So it's clearly a case of:- more data required (over to you, Neil)!

But as mentioned before, correlating equipment numbers against total hospitals beds is a bit "rough". Number of Equipment Library transactions per month would be a bit more interesting (per equipment type would be even better). But even "per hospital wards" (number of user departments) would be better than just "beds"*.

* As I must have mentioned before (?), patients are cared for by nurses, not beds!

I would like to reply to you Geoff, but it appears that my last post has mysteriously disappeared. Equipment issued to patients and not wards, patient discharged means the equipment comes back, hoarding is what leads to shortages.

"Mysteriously disappeared"? Gad Sir, so it has! There has to be a balance you see:- out there you have the Religious Police, here we have the Thought Police. Same thing, really.

Meanwhile ... do you have a Shared Equipment Store (aka as an "Equipment Library") set up yet, Neil?

Most folk here seem to be in favour of the idea, but to be honest, there's also something to be said for Wards having their own kit - if only that it promotes a sense of ownership, which should lead to the kit being looked after a bit better.

It's the same with pool cars - no-one looks after them (in my experience, anyway). Or indeed anything else that is "shared". There are many examples:- Public Transport, for instance. Public Toilets being another (if you can actually find one in Britain these days, that is).

What does the Equipment Library staff do with "repeat offenders" (that is, kit coming back in [censored] state, and always from the same Ward)? Deny them the kit next time? How can you (they) do that?

Posts will continue to disappear as long as they are offensive, puerile or off-topic.

Now either stay on-topic or don't bother posting.

We are in the process of setting one up, as we have ongoing projects, OPC, Dental, Dialysis, Cardiac Centre all requiring new buildings we will wait until an appropriate space is available as I am tying in the project with Resp. Therapy as they look after all the ventilators and need a bigger space than the one they have. If equipment is returned in an un-hygienic state it is returned as we have a policy not to accept such equipment already in place. Hoarding equipment is not practical as a lot of the equipment is left of-line and the batteries are not happy with this, ownership here does not mean that the owner will look after the kit, although we have addressed that significantly by holding the department responsible for 'willful' damage and the repair costs coming out of their budget. enough for now, think that this is still on topic, don't need a study as I believe all situations are different and you have to treat them as different.

The situations may be different, but it generally pays to "study" (plan) in advance. It's nice as well to find out what other folk have been up to (if only to avoid having to invent that already heavily over-designed "wheel").

If I remember rightly, if staff (that is, individuals) out there are found to be "neglecting" kit, they get hit where it hurts (ie, in the pay packet). Pity that our "culture"* in the UK doesn't permit that sort of approach here, I reckon.

As an aside, and as discussed many times in the past, I like the idea of the "Zero-Budget (biomed) Department" myself, where all user departments get billed for services. Repairs, PM, the lot. Again, it's an approach that probably won't catch on in the NHS.

Meanwhile Neil, do you have any relevant numbers for us?

* "No blame", "Lessons shall be learned" ... etc.

Geoff, Numbers for what. We have done a complete inventory of all the kit, bar-coded it, removed our computers from the IT dept and set-up our own asset management programme. Things are really looking good now!

"Asset management programme"? Not just PM, then?

Sounds like "Back to the Future", Neil (the first thing I did at a [then] well known hospital in Jubail way back in 1987 was to extract biomed from the All Conquering *ADP Department. I think I may have already told the story about the "missing PM's"). Well done!

Numbers? What kit is going into the "Library" (and in what quantity)? How did you decide? Will this be new stuff, or merely a collection from the Wards? How many beds/departments being served? How many transactions per month do you expect? How long (on average) will each bit of kit be "out" for? Have you allowed for demand surges, repairs ... etc. Stuff like that.

And what about staffing? 24/7? 9 to 5? How do users get kit out "after hours"? There are many "studies" to be made there Neil! Meanwhile, crack on Mate.

We're interested to hear about your bar-coding, by the way. What was the thinking there, I wonder (independent of "Property Control")? Was it worth the effort?

* Automatic Data Processing, for those with long memories.

The library is a good 10 months off as we are waiting for the OPC building to be completed, so plenty of time to formulate the plan, actually the plan is in my head at the moment, for it to succeed I need it to be someone else's plan if you get my drift.
Bar-coding I refused for over 2 years to do an inventory for the IT department unless I bar-coded at the same time, eventual gave up on them and got the equipment/software outside of their realm. As each department IT, Property Control and BME had their own numbering systems I decided to tie in with property control. ONE ASSET ONE NUMBER, IT will have to follow suit at a later date. Even though we are using the same numbers as PC we have our own inventory and data base, as mentioned earlier we disconnected our computers from IT, got our own server and switches, wired everything in and we have added wifi to the mix as well so we can experiment with tablets.

*Tablets? Interesting. It's something I would like to have a go at (see here).

Good stuff, Neil. Keep us posted.

I recognise what you're saying about "number wars" out there, though. Sounds like things haven't progressed too much, then. It's all about the "mind sets", of course (and I very much hear what you're saying about the need for progressive thoughts to be sold as "someone else's" idea). Business as usual, the same old same old, "politics" ... whatever.

* Worth opening up a new thread, perhaps.

'Zero budget Departments' won't catch on in the NHS. Not true Geoff, that's the way we work. We have been doing it that way for 20 years. Seems to work for us.

Yet again Mike, I'm impressed!

That's two NHS Zero-Budget biomed departments that I'm aware of now!

Any more out there?

(new thread required)