Background: A centralized electrocardiogram telemetry monitoring system (TMS) facilitates early identification of critical arrhythmias and acute medical decompensation. Timely intervention can only be performed if abnormalities are communicated rapidly to the direct caregiver. The study objectives were to measure effectiveness of bidirectional voice communication badges versus one-way alphanumeric pagers for telemetry alarm response and communication loop closure. Methods: A sequential observational pilot study of nursing response to TMS alarms compared communication technologies on four nursing units in a 1,061 bed tertiary care hospital with 264 TMS channels of telemetry over a 2-year period. Subsequently, the communication technologies were compared in a randomized fashion on a 68-bed progressive cardiac care unit. Caregivers were blinded to the protocol. All alarm responses were recorded during two periods using either pagers or voice communication devices. Alarm response time and closure of the communication loop were analyzed in a blinded fashion. Results: The direct communication functionality of the badge significantly shortened the time to first contact, time to completion, and rate of closure of the communication loop in both the pilot and study phases. Median time to first contact with the communication badge was 0.5 min, compared to 1.6 min with pager communication (p < 0.0003). Communication loop closure was achieved in 100% of clinical alarms using the badge versus 19% with the pager (p < 0.0001). Conclusions: Communication badge technology reduced alarm time to first contact and completion as well as facilitated communication loop closures. Immediate two-way communication significantly impacted practice, alarm management, and resulted in faster bedside care.

This paper considers a finite element method to characterize blood flow in the human arm arteries. A set of different pressure waveforms, which represent normal and diseased heart pulses, is used for the proximal boundary conditions, and a modified Windkessel model is used for the distal arterial boundary conditions. A comparison of the distal pressure and flow waveforms, for each different proximal pressure, is made to determine whether such waveforms are significantly altered from normal waveforms. The results show that the distal pressure and/or flow waveforms in certain cases are sufficiently different to be possibly used as a diagnostic indicator of an abnormal heart condition. Also considered is the effect of stenosis, change of compliance, and dilatation of the distal beds on the pressure and flow waveforms. A stenosis which has an area reduction of greater than approximately 75% is found to significantly alter both the distal pressure and flow waveforms. Changes in arterial compliance, however, do not strongly influence the waveforms. Dilatation of distal vascular beds is simulated by reducing the lumped resistance of these beds, and this reduction increases mean flow and decreases mean distal pressure, but has little effect on the basic shape of either the pressure or flow waveform.

While debated for over 30 years, productivity and staffing continue to be a challenging topic for the clinical engineering (CE) community. At the core of this challenge is the lack of reliable indicators substantiated by actual data. This article reports an attempt to evaluate some traditional and newer indicators using data collected from 2 distinct sources. Results confirm early concerns that worked hours self-entered by CE staff are subject to misuse and thus should be avoided. In contrast, good statistical correlation was found for staffing data with several hospital indicators that are consistently collected and widely available. Good correlation with CE department indicators was more difficult to find, apparently because of the lack of reliable records and consistent accounting of all CE resources and expenditures. Although no single, easy-to-measure and easy-to-understand indicator emerged as a replacement for the worked-to-paid-hours ratio, it is shown that a multidimensional model can be built to benchmark productivity and staffing. Calculations from such a model are accurate, but not precise, so the results need to be interpreted carefully. With proper precautions, such comparisons can be used as a good starting point for a more detailed analysis of the differences that could reveal substantive causes such as service scope and strategy, organizational characteristics, and geographical challenges as well as opportunities for major productivity improvements.

Patient incidents involving medical equipment are fairly common, but it is unclear how many of them are actually caused by maintenance omissions, i.e., improper or lack of scheduled and unscheduled maintenance. This question is important because hospitals have been allowed by The Joint Commission (TJC) to develop their own maintenance practice instead of following manufacturers' recommended frequencies and procedures. This study reports an attempt to estimate the magnitude of such incidents using the sentinel events database collected by TJC. Using worst-case assumptions, the estimates ranged 0.14-0.74 in 2011, which translates into .00011-.0006 per million equipment uses. These extremely low values were confirmed by a survey conducted by AAMI in which 1,526 participants reported no known patient incidents traceable to maintenance practice. Therefore, it seems unwise to mandate clinical engineering (CE) professionals to refocus their attention to manufacturers' maintenance recommendations versus active involvement in technology management and, especially, user training and assistance, to address the most frequent root causes of sentinel events.

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