A few years ago, my medical center decided to replace our bedside vital signs monitor (VSM) fleet to new technology that would integrate into the electronic health record (EHR). Because of our focus on an improved patient experience and family-focused care, we install medical devices at the individual bedside using a standard room approach. This Lean-based quality initiative has eliminated hundreds of rolling devices from the hallways and patient rooms. As we considered our new VSM fleet, we wanted to be appreciative of our natural environment and the costs of managing our battery-equipped portable devices.
We quickly realized that our mounted VSMs do not actually need a battery. If the room ever experienced a power loss, our facilities group would quickly resupply power to the patient-care environment. We were excited to team up with a VSM manufacturer who would work with us to realize our vision for a cleaner environment and streamlined management of our equipment inventory. Well, that vision soon disappeared. We learned many lessons from that equipment evaluation process. I hope this blog post will promote a dialogue within the healthcare technology management community and hospital administrators.
One of our primary evaluation criteria was specifying if the device could operate on just alternating current (AC) power with a built-in power supply. We wanted to reduce the wiring clutter at the headwall by eliminating AC adaptors and extra lengths of wiring. We sought to incorporate just the right length of the AC power cord to reach the headwall outlet. Only one of our manufacturer vendors (out of four used in the evaluation) said they could operate the VSM without a battery. But they soon retracted that statement once we began discussing integration into the EHR.
All of the manufacturers compelled us to purchase their devices along with requirements to maintain, condition, or schedule replacement of their internal batteries. One manufacturer even made the battery management issue worse by failing to improve a poorly designed slip-fit style 12-volt direct current (DC) plug for the monitor. That plug design was our primary cause of battery failure due to inadvertent disconnects by clinical and support staff. We now anchor those plugs to the side of the monitor.
We soon realized that the manufacturers had no incentive to make design changes to their devices that would require them to apply for an amended 510(k) or other requirement from the FDA. Perhaps it was naïve of our medical centers to believe that we could improve equipment uptime, save time, and save money by eliminating scheduled battery replacement on what is now considered to be fixed equipment.
With the AC-only option no longer being considered, we did eventually select a new standard VSM monitor. We were pleased with the power design, which provided a direct-to-monitor AC line cord. The bad news came a few weeks later, when we received an urgent product recall—on the battery.
The recall stated that the battery needed to be on a three-year or 300-discharge replacement cycle due to a risk of overheating or shorting. We all lamented that at least the batteries will not have to go through a discharge cycle, since they were permanently installed devices that never need to be unplugged.
The most painful part of this blog post is that we are paying for new technology in all the wrong ways. The Lithium-ion battery that we now need to replace every three years costs $325.00 apiece. That means we now have to add $130,000 to the cost of maintaining our fleet of 400 bedside VSMs when we simply requested a wall-mounted VSM that could operate on AC power alone!
The use of batteries in medical devices serves a critical role and function, but there are also areas where an installed battery would never see any practical service, especially if we mount these devices in permanent locations. I’m confident that my medical center is not the only healthcare facility with this need. I hope that our device manufacturers will sense a vision that we need to think green for all our institutions. Reducing eWaste and unnecessary equipment-support dollars will help in our future partnerships. I encourage manufacturers to design their sales to their individual customer’s needs.
I welcome any thoughts and comments from others in the facilities or the manufacturing world.
David A. Stiles, CBET, is director of the biomedical engineering department and central equipment services at Long Beach Memorial Medical Center and Miller Children’s & Women’s Hospital in Long Beach, CA.