Ever more complex hospital technology requires expert monitoring
Hospitals should be compelled by law to employ a chief biomedical engineer to reduce the hundreds of deaths each year that are related to faulty medical equipment, experts have said.
In 2013, 13,642 incidents related to defective medical equipment, leading to 309 deaths and 4,955 people sustaining serious injury, were reported to the Medicines and Healthcare Products Regulatory Agency. These incidents involved a variety of equipment ranging from pacemakers to the CT or MRI scanners used for diagnosis. Malfunctioning equipment, or its unavailability, is also one of the
main causes of surgical operations being cancelled.
Dr Patrick Finlay, chairman of the IMechE’s Biomedical Engineering Association, said that as the technology used in hospitals became ever-more complex, a lack of engineering knowledge would continue to be a contributory factor in deaths and injury.
“There is no consistency of engineering advice among NHS trusts,” he said. “By law there is a requirement for a chief nurse, and for a chief pharmacist – but not for a chief biomedical engineer. That must change. And I think that legislation
is needed.
"Government and the NHS need to take urgent action to prioritise
the role engineers play in hospitals and trusts.”
Finlay’s words were echoed by Anthony Bull, professor of musculoskeletal mechanics and head of the Centre for Blast Injury Studies at Imperial College London, who said that responsibility for the care and maintenance of equipment within hospitals was often outsourced to the manufacturer or was down to the estates department. “That is not always the right way to go about it,” he said.
Finlay said that with technology becoming more complex within hospitals, a lack of engineering knowledge would add to the danger of using improperly calibrated and validated equipment. Indeed, he said, there were huge implications for the miscalibration of even basic equipment such as weighing scales. In 2008 a medical devices alert warned of incorrect calibration of scales, which led to several patients being given the incorrect dosage of medication. “It comes to something when a hospital is not competent to calibrate a set of scales,” he said.
A more robust approach to engineering within hospitals would also lead to greater availability of equipment, added Finlay. “It is vital that engineers are at the heart of the planning, procurement, use and maintenance of high-value equipment, as well as its calibration. It is only with engineers that properly informed choices on these issues can be made in the best interests of patients and taxpayers.
“We haven’t done a cost-benefit analysis on hospitals employing a chief biomedical engineer, and subsequently having a consistency of approach to these matters. But I believe it can only help save money. If we cut down on having rooms full of broken machinery, then surely it has to pay for itself.”
Finlay and Bull’s remarks came at the launch of the IMechE’s report Biomedical Engineering: Advancing UK Healthcare.
As well as calling for the introduction of a chief biomedical engineer in every NHS acute trust, the report also highlighted what it saw as the problem of UK biomedical engineering research results being sold to international corporations for development and marketing, because of the lack of long-term domestic venture capital.
In addition, the development of many technologies, and in particular e-health, was being hampered by
a lack of international consensus
on standards, practices and
patents, it said.
The report made several recommendations, including: industrial and taxation policy changes to promote long-term investment in biomedical engineering to encourage domestic development and manufacturing; and an international consensus on global standards, a common device regulatory and approvals regime, and harmonisation of patent legislation on medical devices.
Finally, Bull gave insight into how he saw biomedical engineering developing in the near future, pointing towards the emergence of more responsive healthcare based on realtime information provided by better sensing equipment.
“Advances in physiological monitoring will lead to lower-cost intervention,” he said. “Online, permanent monitoring technologies will have the power to change care regimes almost immediately. Advances in mobile phone and sensor technology will mean more responsive healthcare.
“But there are challenges, such as how to handle huge amounts of data, and around safety.”