It’s a big deal when the CT scanner fails unexpectedly at the Memorial Medical Center in Springfield, Illinois. The 24-hour Level I trauma center needs a physician, registered nurse and respiratory therapist to transport each critically ill patient to the main campus upstairs where another CT is located. “These are highly engineered pieces of equipment and they all run a lot of different computer components, so anything can go wrong,” says Kurt Brauer, manager of inpatient imaging at the center.

“Transporting critically ill patients to the upper floor is a resource drain and it’s not the best patient care.” To repair the CT, the field engineers come on site to identify the cause of the failure and order a replacement part.

Since parts such as CT tubes may need to be shipped from another state, the center may have to wait six hours for the part to arrive and then another four to six hours for it to be installed. It can take up to 12 hours to get the CT up and running.



If the CT fails after hours or on a weekend, the center has to pay overtime for the repair team and call in additional staff to transport the patients, which can raise the overall cost to thousands of dollars. “We are focused on providing a great patient experience at Memorial, and having lengthy delays in completing CT exams for ED patients leads to extended length of stay in the ED. That is a patient satisfaction killer,” says Brauer.

Patient satisfaction killer
For facilities that don’t provide 24-hour service, the consequences of downtime are less serious but still have a significant impact. Health care reform is shining a light on patient satisfaction, making financial incentives another driving force behind preventing downtime.

“If you have unscheduled or inconvenient downtimes, that can impact patient experience,” says Lisa Collins, vice president of marketing and business operations for service at Siemens Healthcare. “As many hospitals shift from volume-based reimbursement to value-based, [patient satisfaction] is going to become bigger and bigger.”

The Centers for Medicare and Medicaid Services partnered with the Agency for Healthcare Research and Quality, an agency in the Department of Health and Human Services, to create the Hospital Consumer Assessment of Healthcare Providers Systems (HCAHPS) survey.

It’s a standardized survey that patients fill out in order to measure their opinion of the care they received at a hospital. Hospitals can qualify for bonus payments from CMS depending on the feedback patients provide.

“If an appointment is canceled, it does create some customer service issues but we try to manage those as best as we can and try to assure the patient that the scanner will be up in a certain amount of time,” says Will Cook, director of the Institute for Advanced Biomedical Imaging at National Jewish Health in Denver.

The hospital informs patients that they will receive a call when the scanner is back up so they can come in for their rescheduled appointment. In addition, the hospital has another CT scanner and also a PET/CT scanner which gives them the option of doubling up if time permits.



How to avoid it
Memorial Medical Center performs over 1,500 exams per month on its Siemens SOMATOM Definition CT and now uses the company’s TubeGuard system to spot issues with the CT tubes before they become a costly problem. When the tube starts having issues, the system sends out a notification to the center and a Siemens service engineer.

Brauer then identifies the center’s low-volume timeframes, which are usually between 2 p.m. and 7 a.m. on Sunday and Monday, in order to plan the downtime. “If you have the opportunity to be forewarned, it gives you the opportunity to be forearmed,” he says.

“Taking control and planning downtime is a whole lot better than having your equipment go down on a holiday weekend or a Friday or Saturday night at the traditional high-volume times for your trauma service.”

Wake Radiology Medical Imaging in North Crolina also uses technology to monitor their equipment and reduce downtime. “It’s incredibly helpful when manufacture lets you know they have spotted issues that could ultimately cause downtime,” says Margaret King, CEO of Wake Radiology.

“The advantage of keeping our equipment up and running far outweighs the cost of this service.” King also recommends having a maintenance and service contract with the equipment vendors because when an issue arises, they respond quickly and get the equipment back up and running as soon as possible.“It’s worth that extra expense to keep patients happy and ensure our equipment is in excellent condition,” she adds.

When purchasing a service contract, she suggests that the facility should choose a level of service that reflects the number of patients they see each day and the amount of time each piece of equipment is used.

She believes that a facility should refrain from investing more money to guarantee an immediate response if that equipment is only used a handful of times each day. “Talk with the equipment manufacturer and let them help you select the most appropriate type of service contract for your facility,” she adds.

No more ‘break/fix’ service
Sodexo’s clinical technology management team also provides tools and programs to help their customers reduce downtime. The company’s Computerized Maintenance Management System trends equipment failures and identifies the causes in order to prevent future failures. In addition, it can also monitor error logs and codes on high-end imaging systems in order to identify system performance issues before a major system failure occurs.

“We can actually pre-position high failure components on site, avoiding the additional downtime associated with placing orders for these components and corresponding delivery requirements,” says Steve Cannon, senior vice president of Sodexo CTM.

In the past, most companies only provided “break/fix” service, but Sodexo is moving more toward proactive service. Over the past 12 months, Siemens has also been moving in that direction and its goal is to become a comprehensive total care solution.

Siemens has always provided preventive maintenance and engineering services, but now the company is offering preventive maintenance through its education services, performance solutions and consulting services. Some of its customers are shifting toward in-house service because they have consolidated with other facilities and are able to perform the servicing themselves.

Siemens is looking to partner with them to provide engineer service education and staff assessments if they have a new management team. Whether a facility is a Level I trauma center or a radiology clinic, it’s imperative to avoid downtime.

Not only will it hurt productivity and drain resources, but it will also inconvenience patients and hinder their care. “In our service area we are the provider of choice to our community for emergency department care,” says Brauer. “If I can take control and plan that downtime for the off hours versus having it happen randomly during peak hours, it really saves a lot of stress for my ER physicians, my ER nursing team and my CT team as well."