EBME Forums Forums Maintenance Technical Assistance Lithotriptor maintenance / qa

Don't you just love this time of year, Tomorrow (Friday) is my 1st day of annual leave, and I'm looking forward to getting away from the office, but guess what, late this afternoon I was told I need to present (in 3 weeks time) a nicely polished business case for performance monitoring and maintenance on a lithotriptor for use in the physiotherapy department. The machine will be primarily used in the treatment of orthopaedics. We are looking to purchase the machine to replace the managed service we currently have.

So I need your help. I know bugger all about lithotriptor maintenance and qa (I know what a lithotriptor is though, and that there are laser and ultrasound variants). I've just spent the last 2 hours trawling the web and cannot find any regulations specifically targeting lithotriptor maintenance (yes, I know it's good practice and all the medico-legal issue if something goes wrong. It's just a lot easier to present a case if I can put a recognised document down that says "you must do this ... or else!")

Now I know what I am about to ask for is a lot, but I'm going to be away from my desk for the next couple of weeks, so I cannot use my normal hospital resources - only what I can find on the web. So if anyone out there can let me know how you test a lithotriptor, the common pitfalls and faults, or can tell me exactly where to look (in legislation) regarding QA requirements (or even if you have any experience in maintaining one), I'd love to hear from you. I will treat all responses with respect and promise not to share information given without explicit permission.

Please contact me direct on my HOME e-mail at : drichard@lineone.net as I will only have limted access to the internet on my travels.

I feel your pain there, David, but can’t help wondering why you need to make a case for maintenance of a piece of capital equipment, and who it is you will be making the presentation to (would they prefer lack of maintenance, with the attending regular breakdowns, patients turned away and all the rest, I wonder)?

I would suggest that the full maintenance package (performance monitoring?) and QA (by who?) should be purchased as part of the acquisition of the machine. If your people can’t afford the complete package, then I would suggest that they should not proceed with a lithotriptor at all. It'll only end in tears!

And why in orthopaedics, I wonder? I thought we were talking about zapping kidney (gallstones, bladder etc.) stones?

No doubt someone wise will come up with the information you seek right here, Mate, but my advice is to forget about it (for a while at least), and go away and enjoy your holiday.

As part of the performance monitoring you should contact your coding team to evaluate the revenue gained from carrying out procedures involved with this device.

It could form a very strong argument in your business case if you can show that 'without this device' you would be unable to carry out certain procedures.

That could be costed under the 'payment by results'(PbR) coding system. Elective procedures carried out by the Hospital generates income from their customers (PCTs/private) under the PbR scheme.

In from prepping the car for a few minutes, thanks for the early replies ...

This device is not a conventional lithotriptor - it threw me when they first asked me to investigate, this is the sort of kit we're looking at : http://www.storzmedical.ch/content/index...amp;Itemid=482. It's small, portable (and not used to zap kidneystones and the like).

Yes, I will be exploring in-house vs 50/50 vs fully contracted maintenance options.

I'm being asked to do the case because I have experience in putting business cases together for the physio department, and as part of medical physics, I provide the QA service to the physio department for ultrasound (and others) together with liaising with our EBME department for in-house repairs and validation prior to "return to service". That and I get on well with the superintendants in the physio department so they tend to listen to what I say. Past experience has told me that if I left it to others, maintenance, QA and legislative issues would be overlooked.

The case will be submitted in writing "up the tree" without any opportunity for a stand-up presentation. This goes for approval to the capital planning group who make a decision based on the information in writing in front of them (only at that stage do we go out to tender). Generally, cases that are prepared by persons that understand both financing and operational matters seem to get a better response (my record is : 2 out of 3 so far).

I have an idea of the finances involved (I am wholly aware of the current bill we get from our current provider, and how many patients we put through them - can't say too much for commercial confidentiality reasons). Suffice it to say, we are looking to save money by bringing the service in-house. Without this device, we continue to pay for an external service, but I need the numbers to prove the costings hence my asking about service support. Yes PbR is how we will prove/approach the funding issues.

I also need to account for any specific regulations governing this equipment.

And before anyone asks, yes, we are taking staffing into account.

Hope this helps,

TTFN

Dave

(now back to the packing)

Frankly Dave, with all that information at hand, I can't see your problem! Enjoy your holiday, Mate. I assume you're heading to Devon, the best holiday county in England?