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| ORIGINAL ARTICLE |
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| Year : 2015 | Volume
: 2
| Issue : 4 | Page : 316-323 |
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Factors affecting utilization of medical diagnostic equipment: A study at a tertiary healthcare setup of Chandigarh
Poonam Chaudhary1, Pankaj Kaul2
1 Department of Anatomy, Government Medical College and Hospital, Chandigarh, India
2 Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| Date of Web Publication | 18-Sep-2015 |
Correspondence Address:
Poonam Chaudhary
Department of Anatomy, Government Medical College and Hospital, Sector 32, Chandigarh
India
 Source of Support: Nil., Conflict of Interest: There are no conflicts of interest.  | Check |
DOI: 10.4103/2348-3334.165741
Context: A quality patient diagnosis and clinical management are largely depending upon the availability of reliable medical diagnostic equipment. However, in Indian scenario, the lack of preventive maintenance, nonavailability of technology and spare parts, and nonavailability of required funds for maintenance are mainly responsible for the failure of equipment maintenance, and hence, their proper utilization. Aims: This study was focused to find out the deficiency in the utilization coefficient (UC) of medical diagnostic equipment and the various factors causing the under-utilization of these equipment. Materials and Methods: This study was conducted in a tertiary health care setup at Chandigarh. Approximately, 30 medical diagnostic equipment were studied for their UC and simultaneously a perception based analysis was conducted, where the faculty and staff members concerned with the administrative matters and use of that particular medical diagnostic equipment were concerned. Factors such as low accessibility, obsolescence, break-down, affordability, availability of trained manpower, nonavailability of consumables and spares, maintenance delays, limited working hours, and restricted availability were taken into account. Results: On an average, 23% of these medical diagnostic equipment were not adequately utilized due to one reason or the other. Conclusions: It was concluded that the most crucial factors affecting the utilization of medical diagnostic equipment as per the perception of the respondents were obsolescence, nonavailability of spares, and maintenance delays. Keywords: Diagnostic medical diagnostic equipment, perception based analysis, utilization coefficient
How to cite this article:
Chaudhary P, Kaul P. Factors affecting utilization of medical diagnostic equipment: A study at a tertiary healthcare setup of Chandigarh. CHRISMED J Health Res 2015;2:316-23 |
How to cite this URL:
Chaudhary P, Kaul P. Factors affecting utilization of medical diagnostic equipment: A study at a tertiary healthcare setup of Chandigarh. CHRISMED J Health Res [serial online] 2015 [cited 2023 Mar 31];2:316-23. Available from: https://www.cjhr.org/text.asp?2015/2/4/316/165741 |
| Introduction | |  |
The "medical device directive" defines a medical device as any instrument, appliance, material, or other articles, whether used alone or in combination including the software necessary for the purpose of diagnosis, prevention, monitoring, treatment, or alleviation of the disease; Alleviation or compensation for an injury or handicap; Investigation, replacement, or modification of the anatomy or of a physiological process; Control of conception and which does not achieve its principal intended action in or on the human body by pharmacological, immunological, or metabolic means but which may be assisted in its function by such means.[1]
However, the term medical equipment excludes implantable, disposable, or single-use medical devices, explains WHO medical device technical series.[2]
Modern medical technology has contributed immensely in improving the quality of health care and state of health profile of nations. The advancement has been mainly due to:
- Improved diagnostic facilities
- Sophisticated equipment, and
- The spectacular progress in development in surgical procedures.[3]
The resultants of the rapid advances in medical sciences and technology have been:
- The physicians are becoming more and more equipment oriented
- The patients are much informed of the modern facilities available in the country and abroad. They start expecting and demanding the same
- There is at present a flair for the introduction of computer technology in the medical field.
Medical equipment contribute to almost 40–50% of costs in a tertiary hospital setup, the medical equipment through cutting edge at the time of purchase poses the threat of inevitable obsolescence within 6–7 years of installation. This problem is compounded by the fact that most of such equipment are imported, and very few local reputed manufacturers exist in India. This leads to putting higher treatment costs, and further, to lesser competitive edges and low utilization rates resulting in undesired operating margins.[4]
Advancements in medical technology are playing a positive role in saving lives. Its positive impact is not only limited to the upper crust of society but also helped the poorer a lot by reduction in infant mortality rate and maternal mortality rate due to usage of right technology e.g., incubators, warmers, better OT equipment, etc.[5]
Bottlenecks in effective administration of medical equipment technology
The neglect of hospital equipment and appliances in the absence of a proper maintenance services was highlighted by the Rao Committee Report (1968). It had recommended that all hospitals should have a properly planned maintenance programs to minimize the disuse and neglect of hospital equipment. The working group appointed by Government of India, Varma Committee (1971) for examining, the emergency set up of hospital highlighted that in the absence of planned maintenance program, breakdowns requiring extensive and expensive repairs are a rule rather than exception. A report from the country in 1978 said medical equipment worth 100 crore had been lying unused in various hospitals in the country for the past several years (December 1978). The magnitude of the problem of unserviceable and irreparable equipment in the hospitals and other health care facilities is immense. The equipment maintenance is a combined effort of all technical and administrative actions including supervision action, intended to retain an item in, or restore it to a state in which it can perform a required function. In other terms, maintenance is an action or combination of actions carried out to retain equipment in or restore it to an acceptable condition (BIS 1994).[6]
Utilization essentially means the use of the equipment to its full potential. Clear vision and thought regarding the use of the equipment are necessary so that realistic performance may be set. It should be the endeavor of the management to optimize the equipment utilization to obtain a maximum return for the capital invested. An optimum utilization of the equipment will result in the following:[7]
- Optimal patient handling and rapid turnover
- Minimum possible cost
- Quality patient care and
- Patient satisfaction.
Aims and objectives
- To identify the deficiency, if any in the utilization of the medical equipment under study
- To identify the factors affecting the utilization of the medical diagnostic equipment.
| Materials and Methods | | |
Research design
Type of study
The study was exploratory and observational in nature and was designed to achieve all objectives of the study work.
Study area
The study was conducted in the diagnostic laboratory (histopathology) of a tertiary health care setup at Chandigarh.
Sampling technique
The list of medical diagnostic equipment under study was selected on the basis of stratified random sampling. A complete list of medical diagnostic equipment was prepared according to different functional areas/sections of the department.
Period of study
This study was conducted in the year 2013. Retrospective data for the year 2012 was collected and compiled. Utilization coefficients (UCs) of diagnostic medical diagnostic equipment were studied for the period of 12 months.
Study population
- Various types of medical diagnostic equipment of different cost categories
- Health care professionals involved in the operation, handling, and maintaining these medical diagnostic equipment were included in the study population which comprised of Professors, Associate Professors, Electron Microscope Specialist, Technical In-charges, Medical Technologists, Laboratory Attendants, and Procurement officials [Table 1].
Data collection technique
- The study was thoroughly on a voluntary basis. Due permissions, from the top authorities of the department were taken before starting the data collection
- Study of various records of the department including purchase files, inventory registers, log books, and service records of individual medical diagnostic equipment
- Semi-structured interview using the standard formats [Annexure I [Additional file 4] ] for different categories of health professionals working in the department
- All the questionnaires were validated by the faculty and other staff members of the department.
Formula for the calculation of utilization coefficient
To find the UC of these equipment individually, working schedule of the department was understood to find the same. It was found that the department was working on the daily work schedule of 9 am to 5 pm without any emergency shifts. One hour lunch time (1 pm to 2 pm) was observed by the employees. Saturday is half working day, that is, 9 am to 1 pm without any lunch break. All Sundays and national holidays as per the calendar were also taken into considerations for the purpose of calculations.
UC was calculated using the following formula:
UC = (A × B/C × D) × 100
Here, "A" is the number of days, the medical diagnostic equipment was actually used during the year 2012.
For this, the time period of the equipment break-down or nonavailability of the equipment was observed from the records and deducted from total working days ("C").
"B" is the number of hours the equipment was actually used for a working day (average time taken by a procedure by that equipment × average number of procedures performed on a working day). The time taken for each procedure was asked, and daily workload status was observed from the log books of all the months of 2012. The technologists were also enquired as to the uses/functions of the medical diagnostic equipment under study.
"C" is the number of days the medical diagnostic equipment could have been available (if the equipment was put in working order). For this, the total number of working days in the year 2012 was found out as mentioned above.
"D" is the number of hours the medical diagnostic equipment could have been available on a working day (if the equipment was put in working order). This figure was taken as 7 h on routine working days from Monday to Friday (daily work schedule of 9 am to 5 pm and 1 h of lunch time is deducted from it). However, this figure is 4 h on all working Saturdays.
| Observations and Results | | |
Analysis of objective 1
Thirty medical diagnostic equipment [Table 2] from different functional units of the department were selected.
Using the above formula, the UC of these equipment were calculated individually, and the results of the above calculations were based on the criteria that if the UC was <50%, it was considered to be under-utilized and vice versa. However, life-saving equipment cannot be subjected to this kind of assessment.[8]
The values of A, B, C, and D for the calculation of UC were observed individually, and these were arranged/ranked as per their rate of utilization [Table 3].
[Table 3] shows that ultra-low deep freezer has been used to its full potential, and hence, its UC was as high as 100%. Of 30 types of medical diagnostic equipment under study 23 of them showed adequate UC, that is, above 50%, and only 7 medical diagnostic equipment were not used adequately as their UC was found to be below 50%. Automatic microtome knife sharpener showed the least UC, that is, 31.0%.
On an average, the UC of medical diagnostic equipment under study (year 2012) was 60.2%, and 77% of medical equipment under study showed an adequate UC, that is, above 50% UC [Chart 1] [Additional file 1] .
By dividing these equipment on the basis of their ranks, the results were found to be spread over 100% (Rank 1, i.e. Ultra Low Deep Freezer) to 31.0% (Rank 26, i.e. Automatic microtome Knife Sharpener). Of 30 types of medical diagnostic equipment, three shared the same rank, that is, Rank 16 which showed the same UC of 54.3%. These were bone saw, automated microtome, and antigen retrieval system decloaking chamber. Similarly, Rank 17 was also shared by three medical diagnostic equipment. These were ultra-microtome and accessories, diamond knife and autopsy saw with HEPA bone dust collector.
However, few medical diagnostic equipment were not fully utilized or they were underutilized to the effect that their UC was below 50%, and one of the machines (automatic microtome knife sharpener) had a UC score of as low as 31.0%. The percentage affected utilization of these equipment was compiled [Table 4]. | Table 4: Affected UC of medical diagnostic equipment under study (year 2012)
Click here to view |
[Table 4] also illustrates that less the number of availability days, the lower is the UC. Hence, the utilization of equipment directly gets affected for the same reason. Furthermore, the graph also reflects that the good proportions of valuable working days were wasted due to break down. The highest affected equipment was cold centrifuge up to 22.1% as it was associated with maximum number of days wasted, that is, 90 days and the least affected was gel documentation system and embedding console system up to 2.2% as the later was associated with least number of affected days, that is, 8 days.
In addition to these, some of the equipment were not being used to its optimum level in spite of their full availability and absence of any break down period, e.g., binocular research microscope for transmitted light with photomicrography attachment camera had availability of 100% but still this was only utilized up to 35.6%. The percentage affected utilization of medical equipments under study is well illustrated in the [Chart 2] [Additional file 2] .
Analysis of objective 2
To ascertain the main causes or factors affecting the utilization of machinery, a perception based analysis was conducted, where the staff using the equipment and dealing with the administrative matters of the equipment were asked about the factors affecting the utilization of the medical diagnostic equipment in the hospital [Table 5]. | Table 5: Percentage of responses regarding factors affecting the utilization of medical diagnostic equipment in the department
Click here to view |
The responses of the above-described respondents were taken in a forced response format as "Yes" or "No" option for unawareness about a factor were given. The respondents were given only two options to make a factor as responsible for underutilization. The unawareness option was taken out of the analysis for the sole reason of getting a forced response to eliminate the effect of neutral responses.
It was found that following eight factors were the most crucial factors affecting the utilization of medical diagnostic equipment as per the perceptions of the respondents. These were:
- Restricted availability
- Obsolete machinery
- Nonavailability of consumables and accessories
- Break-down
- Maintenance delays
- Low accessibility of the procedures in the hospital
- Limited working hours
- Availability of trained manpower.
However, factors such as unawareness among the patients regarding the availability of the procedures in the hospital were not very strongly reported.
Unavailability of trained manpower and low affordability of procedures were found to be two factors, which had no effect on utilization of medical diagnostic equipment in the department.
[Chart 3] [Additional file 3] illustrates that the most important factor that came out as a result of the analysis was the obsolete machinery, maintenance delays, restricted availability, and break down due to nonavailability of spares and accessories.
Another important factor was the low accessibility of the procedures due to the limited working hours. It was also observed that many times when they are required in an emergency situation or otherwise also by different patients from different departments, they become inaccessible due to their being far from the place of utilization.
| Discussion | | |
This study was conducted in a tertiary health care setup at Chandigarh. Approximately, 30 medical diagnostic equipment were studied for their UC and simultaneously a perception based analysis was conducted to find out the various factors affecting the UC of these equipment. Factors such as low accessibility, obsolescence, break-down, affordability, availability of trained manpower, nonavailability of consumables and spares, maintenance delays, limited working hours, and restricted availability were taken into account. It was ascertained that the most crucial factors affecting the utilization of medical equipment as per the perceptions of the current respondents were obsolescence; Maintenance delays and restricted availability were found. Unavailability of trained manpower and low affordability were found to be the two factors, which had no effect on the equipment utilization. Sometimes, the equipment has to lie idle for a long period due to nonavailability of spare parts. This case is even more problematic an issue even in case of foreign-made machinery where the spare parts have to be imported.
| Conclusions | | |
On an average, the UC of medical diagnostic equipment under study (year 2012) was 60.2% (above 50%). The study concluded that the 23 out of 30 medical diagnostic equipment were used adequately. However, seven equipment were not used adequately, and the prime objective of this study was to find the deficiency if any in the utilization of these equipment in the department. A number of days were found out for each diagnostic equipment individually when it was not available for use and their causes were analyzed. It became quite evident that the equipment utilization got affected due to a number of days wasted due to break down or any other reason. The most affected was the Automatic microtome Knife Sharpener, which showed the UC of only 31.0%.
It was ascertained that the most crucial factors affecting the utilization of medical diagnostic equipment as per the perceptions of the current respondents were obsolescence, restricted availability, and maintenance delays. Unavailability of trained manpower and low affordability were found to be the two factors, which had no effect on the equipment utilization.
| Recommendations | | |
Every health care organization must develop a strategic framework to manage medical equipment and adopt a more pro-active role in the procurement of right medical equipment at the right time, equipped with the right technology at the right place of working. Care must be taken at the time of procurement that there must be a provision for the up-gradation of technology after some years of use of that equipment.
The organization must adopt the practices of regular equipment auditing. There is a need for periodic evaluation of the quality of performance of equipment in the hospital. It will be advantageous to all concerned, namely hospital, professional, government, and the management so that better utilization of the resources is ensured.
Acknowledgment
We would like to acknowledge the unconditional support and patience of our friend, Mrs. Adarsh Bala, Assistant Librarian, GMCH, Chandigarh, who has spent hours with us in providing the relevant literature. We also thank the entire faculty and staff members of Histopathology Department, PGIMER, Chandigarh for their persistent support.
| References | | |
| 1. | Medicines and Health Care Products Regulatory Agency. Medical Devices and Medicinal Products. London: Medicines and Health Care Products Regulatory Agency; 2011. p. 15.  |
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| 3. | Gupta SK. Introduction to Management II: Essentials of Logistics and Equipment Management. New Delhi: IGNOU School of Health Sciences; 2010. p. 45. |
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| 5. | Sehgal C. Medical Technology Industry in India. New Delhi: Confederation of Indian Industry; 2010. p. 28. |
| 6. | Joshi DC, Joshi M. Hospital Administration. 1 st ed. New Delhi: Jaypee Brothers Medical Publishers. 2009. p. 352. |
| 7. | Gupta S, Kant S. Hospital Stores Management an Integrated Approach. 1 st ed. New Delhi: Jaypee Brothers; 2000. p. 134-5. |
| 8. | Kumar PN. Utilization study of CT scan in a multi-speciality hospital. Int J Sci Res 2014;3:1-2. |
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]
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