To the Editor
The article written by Wesley I Frazier, M.1)., in the June Newsletter is timely. AN available service options in all areas of technology used in hospitals (not just anesthesiolo8y) are being scrutinized for efficacy and cost effectiveness.
Point 3 in the support service program should be the main area of development for these reasons: 1) even though items such as pulse oximeters, capnometers, mass spectrometers, etc. are now widely used in the OR, the testing equipment required to maintain and calibrate these and other devices used by anesthesia personnel are too difficult to operate and the results too technical for most lay persons to utilize and interpret, 2) the testing equipment required, if maintained in a separate “anesthesia repair shop” would create a costly duplication of service and equipment, 3) biomedical technicians and engineers are more qualified to deal with factory service representatives and to determine their technical abilities, and 4) the necessary equipment failure profile/history data generated by both in-house and outside (third party or factory) service can be better handled and analyzed by technical people trained to deal with these data.
Training becomes paramount in this situation. Anesthesiologists must take an active role in developing rapport with the biomedical departments and advocating their involvement, including factory training programs, to the hospital administrators. In addition, anesthesia groups should develop training programs and seminars to better tram biomedical personnel specifically in anesthesia practices. This could be (and should be) done in biomedical engineering schools, but could delay implementation of programs by up to four years, eliminate many already competent technicians from working on such devices, and would probably not “fly” at small institutions that cannot support “specialized” technician positions.
There can be no substitute for cooperation between the anesthesia department, biomedical engineering, and the hospital Administration when projects such as equipment support programs are considered. Pre-selection evaluations MUST include input from all areas of expertise. It is during this period that hospital based biomedical personnel can establish base line control over cost and quality of support service. A comprehensive policy is needed that satisfies the operational and safety concerns of anesthesia practitioners, the accuracy, quality of repairs, safety, calibration, and code conformance considerations of the biomedical engineering department, and the cost issues for the hospital administration.
National guidelines, if developed, must be flexible enough to allow for implementation in even the smallest hospitals and should reflect actual requirements. Certification programs should be based on both written skills and demonstrated abilities. Tests designed for academic purposes only do not ensure technical competence.
As with all hospital-based equipment, the user bears the ultimate responsibility for safe use. Anesthesiologists must learn from biomedical engineering personnel the basic principles of function and biomedical personnel must learn application from the anesthesia department.
Additionally, I disagree with the letter to the editor by Michael Shaffer, D.Sc., that most hospital based biomedical departments are limited in time and abilities to perform only the most perfunctory tests. We do not use the standards of the ICAH as our only guidelines. Perhaps Dr. Shaffer should investigate several other sources of “guidelines” such as the AAMI, ASME, etc. Meeting ICAH standards is only a small part of most biomedical engineering policy and procedures. Even if this were true, to meet the criteria of “. . . clean, calibrated, and safe operation. . ” encompasses more than just perfunctory testing.
Please consider these thoughts and try to apply them in a practical manner. Thank you.
Michael E. Seaver, Manager Biomedical Engineering St. Mary Hospital Quincy, IL