International Survey of Clinical Engineering Departments
Twelve years ago an international survey of clinical engineering departments (CEDs) was conducted by Monique Frize. Due to the important changes introduced to the sector it was felt that updating the information on the current situation worldwide was needed.
The present survey, launched in July 1998, was performed in two successive stages, using structured questionnaires. The first stage involved a questionnaire aiming to identify the structure, personnel, responsibilities and resources of the departments in different countries. More than 1000 questionnaires were distributed all over the world, both by regular mail and over the Internet. The second stage is aimed at investigating trends in current practices and addresses selectively those institutions, identified from the first stage, as having well established clinical engineering services. The results from the first stage are briefly presented below.
Figure 1: Regional distribution of answers
In total 150 valid responses were received and were grouped in regions as following: North America (USA and Canada), Nordic countries (Norway, Sweden, Finland, Iceland and Denmark), West Europe (Germany, the Netherlands, UK), South Europe (Italy, Greece and Cyprus), Australia and Latin America (Argentina, Brazil, Cuba and Mexico). The samples from Eastern European countries, Asia and Africa were considered inadequate and were excluded from the analysis. Figure 1 shows the regional distribution of answers.
A good range of hospital sizes from about 100 up to more than 1500 beds was obtained. Teaching units predominate. Generally, irrespective of the hospital type, a problem in handling financial data by CEDs was observed. Questions related to replacement value of biomedical equipment in hospitals, approximate budgets for new equipment per year, and the replacement value of biomedical equipment under CED management were not always answered.
The majority of responses were from departments that exist as separate units. Few answers came from hospitals where the clinical engineering services function as a part of another department, revealing this to be 'plant operation' or 'engineering services' in North America, 'technical department', 'medical physics' or 'medical physics and bioengineering' in Australia, 'clinical physics' or 'technical service' in Europe, and 'engineering' or 'maintenance' department in Latin America. More than 70% of all respondents, however, were satisfied with their reporting authorities despite the fact that they vary greatly in the different countries.
In all regions CEDs are staffed predominantly by BMETs (biomedical equipment technicians). However, in some departments in the Nordic countries and Latin America, the number of engineers is equal to or sometimes higher than the number of BMETs. In North America and Australia the number of engineers is relatively small compared to the number of BMETs. In Europe, a very high percent of the CEDs employ engineers with PhD degrees, in North America the majority hold an MS. degree, while in Australia and Latin America the predominant degree is a BSc. In North America and Australia, all BMETs have a two-year technical education following high school. Nevertheless, there are BMETs with BSc degrees and some in USA and West Europe even hold MSc degrees. In Latin America all departments employ engineers, while in all other regions studied there are departments identified without any engineers. On the other hand, there are departments in Latin America and in Europe that do not employ any BMETs. CEDs in all regions still remain predominantly male workplaces, although more than half of them have at least one woman employed. Most departments in all regions report inadequate staffing levels.
Training and continuous professional development of CED personnel appears to be a common practice in most regions with the exception of Latin America. The highest frequency of training courses is in North America, Nordic countries and West Europe, where engineers and BMETs follow courses on average every six months. In Southern Europe, the majority follow courses once per year, while in Australia, once or twice every two years. Few departments in North America and South Europe report no training at all, while this is true for the majority of CEDs in Latin America.
CEDs in North America and Nordic countries usually support a larger number of devices than the departments in other regions. In the majority medium-sized (501-1000 beds) hospitals in North America and Nordic countries and in the large (more than 1000 beds) hospitals in all regions, CEDs support more than 4000 devices and equipment valued at more than US$ 20 million. In the largest hospitals, CEDs support more than 10000 devices. More than half of the large hospitals in North America, the Nordic countries and Western Europe support equipment valued at more than US$ 40 million.
In assessing resources available to CEDs, comparisons were based on the value of test equipment, spare parts inventory and budget as a percentage of the replacement value of the equipment under CED management. A significant number of respondents did not answer these questions. Based on the responses received, however, it seems that the available test equipment and spare parts inventory are considered adequate, except in Latin America. Budget allocations are higher in teaching hospitals. Space allocations appeared to be most generous in the Nordic countries, followed by Australia.
Finally the survey showed that computerized systems for equipment management and quality assurance have widely penetrated the CEDs. The majority of them feel well accepted and recognized in their institutions. The main problems faced are a lack of highly qualified personnel and cost constraints. Both engineers and BMETs responded that a harmonized worldwide certification scheme would be useful.
In an attempt to collect more answers and therefore more representative results, we would like to invite biomedical/clinical engine-ers currently working in hospitals all over the world to participate in the present survey by filling out the attached survey form (.PDF) or contacting us.
MARIANA GLOUHOVA, NICOLAS PALLIKARAKIS
Department of Medical Physics
University of Patras
26500 Patras, Greece
Email: marianna@bit.med.upatras.gr