Disinvestment. Utilization indexes for medical equipment a pilot model. U. Nocco1, G. Lolli Ceroni2, E. Lettieri2, S. del Torchio1

1. UTILIZATION INDEXES FOR MEDICAL EQUIPMENT
A PILOT MODEL
U. Nocco1, G. Lolli Ceroni2, E. Lettieri2, S. del Torchio1
1
Clinical Engineering Department, Varese Town and University Hospital, Varese – Italy
2
Politecnico di Milano School of Engineering, Milan - Italy
Corresponding author:
eng. Umberto Nocco
Clinical Engineering Department
AOU Ospedale di Circolo e Fondazione Macchi
Viale Borri, 57 – 21100 Varese – Italy
Tel +39 0332 278301 - mobile: +39 335 7882671
e-mail: umberto.nocco@ospedale.varese.it

2. Medical Equipment
BACKGROUND
To a Healthcare Institution medical
equipment represents:
-investment;
-source for clinical information;
-stakeholder to process definition;
What we don’t know…
- How much is each device used?
- Can we define theoretical productivity?
- Which devices are eligible for utilization
assessment?
- Can utilization assessment be used in a
disinvestment process?
But, first of all
- Do we have data?
U. Nocco et al. - Utilization indexes for medical equipment. A pilot model
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3. Which devices are eligible for evaluation?
BACKGROUND
Mandatory:
There are devices that are needed in each ward:
-defibrillators
-ekg machines
-….
due to regulation
Strategic:
Other devices are needed “just in case”: a pediatric bed in a ICU is needed
although it might be used once a year
Eligible devices are those related to a specific procedure, those that require
a high investment (US machines), or those who have little cost but big
numbers (infusion pumps).
The more complete an IT scheduling and reporting system the better.
U. Nocco et al. - Utilization indexes for medical equipment. A pilot model
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4. Purpose
OBJECTIVES
Main objectives of the project are:
1. Propose a model to define productivity indexes for medical
equipment;
equipment
2. verify whether they can be calculated easily
3. verify which stakeholders are to be considered during data
analisys
U. Nocco et al. - Utilization indexes for medical equipment. A pilot model
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5. Concept approach
METHODS
cal
-Asset utilization index (S)
reti
Theo
-Yearly exam index (Y)
- Daily exam index (D)
-Yearly number of exams
- Daily number of exams
- Asset daily productivity
Actu
al
- Clinical
- Organizational
- Demand
- etc.

6. Index definition and calculation
METHODS
Phase Index name Index
Annual theoretical exam Number EY = Ew ⋅ 50
Theoretical
EW
Daily Theoretical Exam Number (NTd) NTd =
G
Assett daily productivity (S) N Td and S R = N Ad
S=
M M
Ea
Acutal Yearly Exam Index (Y) Y = ⋅100
EY
Ea ( 50 ⋅ G )
Real Actual Daily Exam Index (D) D= ⋅100
N Td
Ew weekly exams per schedule Assett Utilization Index (S)
Sˆ ( *) ( E ( 50 ⋅ G ) )
= a
M ( *)
G=weekdays in schedule S ( *)
U. Nocco et al. - Utilization indexes for medical equipment. A pilot model
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7. Index evaluation
METHODS
Given that the main hypothesis to the model is that daily schedule is
determined considering epidemiology, resources and assett availability, index
evalutation is being carried out as follows:
Saturation indexes (Y and D):
Index value judgement
Y and D >90% ok (10% mortality on booked exams is acceptable)
75%< Y and D <90% actions needed, expecially referred to production
analysis
Y and D <75% Heavy activity is needed on organization, device
condivision ect.

8. Ultrasound machines
RESULTS AND DISCUSSION
US machines were analyzed in Pediatric Cardiology
Entry data:
Ew=19 G=3 M=2 Ea=661 working weeks: 50
EY = 19 ⋅ 50 = 950
N Td = 6,3
N Ad = 661 = 4,4 Is this number of exams/day or
150 (worse) this number of
S = 3,1 exams/day/device sustainable?
Which actions should be
S R = 2,2
implemented? Device condivision
661
Y = ⋅100 = 69,5% Saturation index is quite good both
950 for yearly exams and device
661 utilization
BUT
D = 50 ⋅ 3 = 69,94% Hospital administration should
6,3 verifiy why only 70% of available
ˆ
S = 71% schedule is used by patients.
U. Nocco et al. - Utilization indexes for medical equipment. A pilot model
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9. Gastroscopes
RESULTS AND DISCUSSION
Gastroscopes
Entry data:
Ew=100 G=5 M=14 Ea=5000
working weeks: 50
4900
EY = 100 ⋅ 50 = 5000 Y = ⋅100 = 98%
5000
N Td = 20
4900
N Ad = 4900 = 10,88
250 D = 250 = 98%
S = 1,42 20
ˆ
S = 98%
S R = 1,4
Can such a small number of
exams/day/instrument can be acceptable?
U. Nocco et al. - Utilization indexes for medical equipment. A pilot model
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10. Gastroscopes
RESULTS AND DISCUSSION
Gastroscopes
ˆ As far as endoscopes are
S = 98% concerned, not only do we need
to consider the exam time, but
S R = 1,4 also disinfection time
If we consider
disinfection time,
14 endoscopes
are needed to
cover daily
schedule
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11. Did we get to the point?
CONCLUSIONS
- Proposed indexes seem to be easy to determine and provide valuable entry
data for further discussion;
- The problem is by all means hard to model, since there are many variables
that need to be considered at different points of the analysis;
- Entry data need to be present and read correctly. A multidisciplinary
approach is needed.
Further work
- Indexes need to be tested outside the proposing facility (at the moment
being on the run);
- Stakeholders should be modeled and introduced in the core model at fixed
points to standardize the process.
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12. THANK YOU FOR YOUR ATTENTION
UTILIZATION INDEXES FOR MEDICAL EQUIPMENT – A PILOT MODEL
U. Nocco1, G. Lolli Ceroni2, E. Lettieri2, S. del Torchio1
1
Clinical Engineering Department, Varese Town and University Hospital, Varese – Italy
2
Politecnico di Milano School of Engineering, Milan - Italy
Corresponding author:
eng. Umberto Nocco
Clinical Engineering Department
AOU Ospedale di Circolo e Fondazione Macchi
Viale Borri, 57 – 21100 Varese – Italy
Tel +39 0332 278301 - mobile: +39 335 7882671
e-mail: umberto.nocco@ospedale.varese.it