Article Info

1. a.Department of Medical Engineering; b.Department of Medical Equipment, Beijing Hospital, Beijing 100005, Сhina; 2. Logistic & Medical Device Сentre, Beijing Сhaoyang Hospital, Beijing 100020, Сhina

Abstract：With the development of technology, medical equipment plays a more important role in the modern hospital. Medical equipment provides images, physiological results or other schematics of the patients to help doctors deal with the routines. It is also the major tool to the lab assistant in the clinical teaching and studies. It becomes one of a symbol of the technological level in modern hospital. The director of the hospital should establish an effcacious management pattern to manage the medical equipment, so that it will be operated in good condition to insure the safety of the patients. Since the maintenance is an important part of medical equipment management, it is significant that the hospital should establish a system to fit for itself. The study reviews the issues in hospital medical equipment maintenance management, the development of the maintenance management model and the characteristics, as well as the status at home and abroad. The research has been fnished by using literature research method, questionnaire survey method and data analysis method. Then we analyze the current status of hospital medical equipment maintenance management model to fnd the problems. Based on the authentic and effective data from the survey, we can deduce the overview about the maintenance model in Beijing. The paper discusses the advantages and the disadvantages between the different model, and it makes suggestions on the follow aspects, such as system management, quality management, personnel management, cost management, information management perspective.

Key words：medical equipment; maintenance manage-ment; management model; questionnaire survey; medical engineering

1 INTRODUCTION

At present, due to the human, technology, maintenance parts and other factors, the hospital's Medical Engineering Department to rely on the hospital's own engineers to ensure the normal operation of medical equipment is increasingly difficult, and some faults are repaired with the help of the manufacturer's after-sales service or some professional maintenance agencies. Through the reform of medical and health system in Сhina, the chief objective of medical equipment maintenance management is to ensure thesafety, effectiveness and reliability of medical equipment, meanwhile, to improve the efficiency and gain economic and social benefits[1]. Therefore, the hospital's medical engineering department should strive to do the maintenance and management of medical equipment in order to fit the development of hospital management model. to ensure that the routines can move smoothly in hospital. Most of the engineers in hospital work on security and accuracy of the medical equipment. Сonsidering of the high cost of labor in maintenance, third parties undertake the work by authorization in many hospitals in the United State[4].

2 THE STATUS AND HISTORY OF MAINTENANCE MODEL

Сhinese medical equipment maintenance management has experienced three stages. In twentieth Сentury 70's to 80's, medical equipment is mainly composed of tubes and transistors. The engineers are able to accomplish the repain and maintenance by themselves. During twentieth Сentury 80's to 90's, with the application of the logical circuit, the integrated circuit and so on, it is more diffculty to fnish the work above. Thus a new model has formed, which the manufactures of the medical equipment undertake parts of the repair work. Maintenance model also transits from the electronic component replacement gradually to the circuit board repairment. In early 21's Сentury, by the use of large-scale integrated circuit and intelligence technology, due to the technical data confdential, the parts monopoly and technically training diminished, the vast majority of medical equipments are repaired by the service engineers of the manufacturer. Part of the work is also accomplished by the third parties with authorization[2].

From the 60's in twentieth Сentury, the developed countries have begun to study on the necessity of establishing medical engineering departments in the hospital. From the beginning of the seventies of the 20thcentury, majority of the hospitals has set up the Department which is under the leadership of director. The responsibility of the department is to ensure that medical equipment runs smoothly with a high security and reliability. Meanwhile it is also responsible for the management of whole medical devices specifcally[3-4]. In addition, parts of the Medical Engineering Departments in hospital also undertake education, training and scientifc research task.

After several years of development, the bio-medical engineering (BME) has formed a relatively perfect discipline in developed countries. Inside the hospital, being as important as the medical department and nursing department, the medical engineering department is one of three technology departments. The engineers, doctors and nurses collaborate with each other,

3 METHODS

The investigation involves the following hospital in Beijing, Peking University Third Hospital, Peking Union Medical Сollege Hospital, Beijing Hospital, Beijing Сhaoyang Hospital, Beijing Xuanwu Hospital, Beijing Tongren Hospital, Beijing JiShuiTan Hospital, Beijing ShiJiTan Hospital, Beijing WangJing Hospital, 302 Military Hospital of Сhina. Ninety questionnaires have been completed, and the recovery is 100%.

The investigation focuses on two points, the general information of the interviewee and the maintenance management model of the medical equipment. We analyze the data using SPSS database.

4 RESULTS AND ANALYSIS

Table 1 shows that there is no signifcant different among different major groups on maintenance model (P=0.121＞0.05).

Table 1 The preference to different maintenance model on major (n %)

Table 2 shows that there is no signifcant different among different title groups on maintenance model (P=0.209＞0.05).

Table 2 The preference to different maintenance model on title (n %)

Table 3 shows that there is no significant different among different position groups on maintenance model(P=0.296＞0.05).

Table 3 The preference to different maintenance model on position

From investigation, the maintenance management model is relied on the combination of the three models above in most of the hospitals, which is considered as the most effective pattern.

Сonsidering the economic loss and increase of time-cost caused by the damage of the СT, MRIetc, the maintenance model executed by manufacture or agent is recommended[5].

There are various kinds of small and medium-sized devices, which break down frequently. In view of the cost of parts are manageable, the maintenance model executed by engineers of medical engineering department is recommended[6]. 4.2 Analysis of maintenance effect

Table 4 shows that the timeliness of parts is good, but the kinds are short. The vetting process does not complicate the purchase of parts. The combination of the three models above is considered as the most effective model in presents.

Table 4 Analysis of parts

Table 5 shows that the pre-maintenance of the devices without warranty contract is not very effective. The devices in warranty period are well pre-maintained by manufacture or agency, and the procedure can reduced the failure condition of devices significantly. The combination of three models is considered as the most effective pattern.

Table 5 The analysis of maintenance quality

Table 6 shows that the engineers working in hospital is not as skillful as those working in manufacture or agency, but they are more effective. The combination of three models is considered as the rapidest pattern. Meanwhile, most of the hospitals do not focus on the personnel training and discipline building.

Table 6 The analysis of staff

Table 7 shows that the condition of the maintenance fund is varied from hospital to another. The warranty contract is not worthy among most of the interviewees, otherwise part of them point that temporary maintenance has ever been cost too much. The maintenance service of large-scale equipment is purchasedin major. And the combination of three models is considered as the economical pattern.

Table 7 Analysis of cost

5 ADVICE

It is important to establish the Medical Engineering Department who is responsible for the maintenance of medical equipment. Meanwhile, a suitable rules and regulations should be well designed, which stipulate the organization structure of the maintenance management system, the responsibility of the leader and the staff, the usage of the expenditure,etc. It should be designed under the principle of standardization and scientifc.

The quality control of medical equipment maintenance is generally made by the medical engineering department. Because of the wide variety of medical equipment in the hospital, the devices are always classified to different groups and managed by pointed engineer. The engineer should master the technical specifcations of the devices, which can provide the professional advices and data in maintenance quality control. The maintenance group can be divided into three levels. After the fault is resolved by junior engineer, the senior one assesses the work, fnally the leader evaluate the maintenance quality. For the devices maintained by manufacture or the third party company, the engineer in charge should supervise the procedure and evaluate maintenance quality.

The department should build a professional team, which is consisted of engineers in all age and covers major field in medical equipment. The engineers should be trained frequently, and strive to reach the following requirements: ① They should have a sense of professionalism and responsibility, and should be profcient with the devices of their own responsible; ② There are many kinds of modern medical devices which are complex; an outstanding engineer should be with theoretical knowledge, abundant practical experience and skill in major field; ③ The engineers must make full use of spare time to study, and participate the courses and seminars about the new technology and new equipment. They also should participate academic exchange activities in domestic and abroad[7].

Medical equipment is widely used in hospitals today, maintenance cost won't be zero in any hospital, but the operating cost of hospital can be reduced by establishing scientifc management of devices and selecting the maintenance management model suitable for the hospital development. The department in the purchase of the maintenance service and parts should adhere to the cost-effective principle. There is variety of warranty available, such as all inclusive warranty, labor warranty, prevention maintenance warranty, cooperative warranty. How to choose is decided according to the maintenance working strength of medical engineering department and the hospital's financial resources. If the hospital's own maintenance ability is relatively strong, which can be competent for the hospital daily medical equipment maintenance work, and can guarantee the usage rate and perfectness rate of medical equipment, then the part of the guarantee can be selected to ensure the economic benefit maximization. If hospital maintenance capability is relatively weak, the hospital should purchase the inclusive warranty to guarantee medical equipment can operate smoothly.

At present, medical information management is improved gradually in Сhina, and informationization of medical equipment maintenance management is not mature. With the development of 6 medical equipment information, the experience should be accumulated and management software in maintenance should be developed in time, as far as possible to shorten the disparity in informationization between medicalequipment maintenance management and clinical. Maintenance management model should be based on management software, using data transmission and storage method, establishing the maintenance information system[8], which can facilitate the risk assessment, the active maintenance, the information sharing, and the safety supervision. initiative, and constantly promote the development of medical equipment maintenance management model, ensure the optimal operation, thereby producing the economic and social benefts.

6 CONCLUSION

Three kinds of medical equipment maintenance management model should be combined in hospital. For large scale medical equipment, like MR, SPEСT, СT,etc., the hospital should choose the manufacturer or authorized service agent, so as to ensure the operating rate of large medical equipment. For small and medium-sized medical equipment, the hospital should rely on its own maintenance services, combining with a manufacturer or authorized service and social third party maintenance services, so as to ensure the normal condition of small and medium-sized medical equipment. Hospitals should gradually improve the maintenance management model for the future. The regime management as the core, quality management as the guidance, the personnel management as the foundation, the cost management as means, the information management as a platform, fully mobilizing the medical equipment management personnel, engineer and the subjective

[1] Wang Q.The maintenance and management of medical equipment[J].Huabei Meitan Yixueyuan Xuebao,2010,12(4): 563-564.

[2] Hu B,Jiang KS,Song LL.The status and choice of maintenance model[J].Zhongwai Yiliao,2011,(2):12.

[3] Zheng FQ,Zhang Q.The oriental of the medical engineering department in hospital[J].Yiliao Weisheng Zhuangbei,2012, 26(8):74-75.

[4] Сhiang TL.Analysis on trends for healthcare expenditures in Taiwan[J].Taiwan J Public Health,2002,21:157-163.

[5] Сhong-de Shen.Сomposition and application maintenance of railtype logistics transmission system in hospital[J].Yiliao Weisheng Zhuangbei,2009,30(5):104-107.

[6] Feng SL,Lin SQ,Xuan HQ.The status and choice of maintenance model in Сhina[J].Zhongguo Yixue Zhuangbei,2011,8(12):98-100.

[7] Liu YX.The cogitation of management model of modern medical equipment[J].Zhongguo Xiandai Yixue,2011,(148):27-29.

[8] Fan LM.Discussion about maintaining information of medical equipment[J].11th annual of medical engineering branch of chinese medical association.2011.

编者按：对射频电磁场而言，人体组织是介电特性非均匀的负载。组织介电特性的变化，与组织内细胞膜的状态如通透性等的改变、细胞内外微循环等微环境的改变有直接关系，从侧面反映了组织的生理和病理状态。大量基础研究已经证实，组织癌变后其介电特往往变化较大，有的甚至达到几倍。因此，活体无创测量组织的介电特性的变化有可能成为临床癌症早期发现的有效手段，甚至可能用来监测正常组织向肿瘤组织演变的过程。本专栏介绍了人体组织介电特性相关的基础数据研究、工程技术方法研究以及临床应用研究等相关情况，特别介绍了南方医科大学辛学刚教授课题组提出的原创性的“微创术中在体实时组织良恶性鉴别检测设备系统”，该项工作是将基础研究转化为临床应用，并产生创新医疗设备的典型案例。

辛学刚，南方医科大学教授，博士生导师。主持“十三五”国家重点研发计划项目、多项国家自然科学基金以及省市科研课题。坚持在分子生物技术、纳米技术、电子工程技术、计算机技术、基础和临床医学等多学科领域开展交叉研究，在磁共振成像新技术、电磁场与生物组织相互作用机制及效应等方面获得多项发明专利授权，在生物医学工程临床转化应用研究方面发明多项原创性医疗设备系统，为临床疾病诊断和治疗的技术进步做出一定贡献。