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Supporting hospitals buying new equipment

Key points

  • CHI+MED research has directly informed a £2.5 million procurement decision at a welsh health board, leading to safer equipment being bought. It provided the evidence to support one kind of device being rated more highly due to its ease of safe use.
  • Advice from the project has also been directly incorporated into the specification used in the procurement of infusion devices at a major London Foundation Trust. This will prevent devices being bought that contain a range of safety issues identified by CHI+MED.
  • Our research is also the basis of a new approach to evidence-based procurement being used. It involves proactively analysing error logs of existing devices to determine their strengths and weaknesses and so provide evidence for future decisions.
  • CHI+MED research is not only preventing patients being unnecessarily harmed, but also saving staff time working with hard to use technology, so ultimately saving money.

Background
Buying medical equipment for a hospital is complex, with those responsible having to balance competing needs such as cost, physical safety, how easy it is to clean and maintain, whether the parts can be bought, dealing with the fact that similar equipment will need to be used in different ways in different parts of the hospital, ability to train staff, and so on. Given all these demands, weighing up how easy a device is to use safely, compared to others has often been lost. It is only after incidents happen that this comes to the fore. CHI+MED research has had a direct impact on the way devices are bought in at least two major UK health boards, showing it has potential to have a similar effect more widely in the future.

Avoiding number entry problems
We have worked closely with Paul Lee, based at Morriston Hospital, Swansea, throughout the project. He is the Medical Devices Training Manager of the ABM University Health Board, one of the largest health boards in Wales. Through Paul, CHI+MED influenced a major procurement decision that he was involved with.

"We have better front panels on our devices due to CHI+MED work. --- We had to change machines … so in the procurement process we specifically asked for machines with chevron based front panels, not decimal, since CHI+MED research was pointing toward decimal front keyboards being error prone. None have a decimal keyboard anymore; all have a chevron interface. That was a £2.5M project and we have machines as a direct result of that CHI+MED work. I had the papers and the evidence and we used that in the procurement process and we scored chevron fronts better than others." - Paul Lee, Medical Devices Training Manager.

This decision was based directly on a multidisciplinary strand of CHI+MED work studying the design of number entry interfaces. It showed that digit keypads are more likely to lead to large mistakes in numbers entered. Such errors result in, for example, dangerous overdoses of drugs being given to patients. The project provided solid research-based evidence about problems that front-line staff already suspected. Without evidence, however, hospital staff were unable to influence the decisions about what to buy. By asking key questions about the device designs, and then giving solid answers, CHI+MED filled this gap.

"CHI+MED definitely raised lots of questions on design features. … Some of the early research coming from CHI+MED, like buttons, shape and order – we thought [that design] was wrong and now we know it is wrong … the robustness of having CHI+MED evidence helps. Thirty years ago we bought equipment at NHS because it looked nice; it was foisted on the workforce; they complained and did work-arounds. People never really looked at the things CHI+MED did" - Paul Lee, Medical Devices Training Manager.

Taking account of hazards
CHI+MED work has also been directly used by the University College London NHS Foundation Trust to improve their procurement process for infusion pumps, where we have collaborated with David Cook and Alyte Podvoiskis from the Medical Physics and Biomedical Engineering department.

In particular, the trust was developing a new set of requirements to be used when buying infusion devices. CHI+MED advice was directly incorporated into the Human Factors section of this specification. The CHI+MED team had identified over 50 potential hazards found in existing devices linked to unsafe behaviour when data is being entered. Examples include devices erroneously ignoring decimal point key presses for certain range of numbers, or unexpectedly jumping from the minimum value to the maximum value with a single button press. As a result of the new specification medical devices with these safety problems will not be bought in future procurement rounds.

CHI+MED research has also helped change their way of approaching human factors issues with medical devices. They are actively requesting that manufacturers address safety concerns around use error around design, rather than just dismissing them as a problem for the people operating devices. They also now attach the same weight to human factors issues as they do to the functionality of infusion devices. They are now actively arguing that clinical engineers can drive change by including human factors issues such as these into the specifications for new devices.

Evidence-based procurement
CHI+MED has also given a new depth to the way procurement decisions can be made. This new approach is being followed by the welsh board. This is based on the use of error logs combined with usability studies of existing machines to analyse the life costs of those products.

"In my organisation, we are using CHI+MED work to measure how expensive products are. We look at the whole process. [For instance we will be] downloading error logs off our machines and we will analyse usability data contrasted to previous machines – that has never been done. … Up until 5-7 years ago, we never had machines recording (a hangover from when memory chips were expensive in the 80s), whereas now it is cheap and we could track information, so see usability—but very few people were looking at it."- Paul Lee, Medical Devices Training Manager.

The Department of Health and MHRA only look at errors reported to them. This is the tip of the iceberg. CHI+MED has championed the idea of more post-market review of usability. This involves proactively looking at device use and usability, not only when mistakes are made, but as a matter of course so that the good can be determined as well as the bad. This understanding can then feed into future decisions. It also means problems can be found before they lead to patients being harmed. "We are now looking at usability which may for may not lead to error. … looking at propensity for errors … has really opened up a can of worms, in a good way".

By spreading understanding about the research on CHI+MED, this work has the potential to not only save lives but also save money most notably by saving the time of frontline staff, battling with technology that is not well-designed to fit the actual work they do.

Publications
Paul T. Lee, Laura R. Meagher and Paul Curzon (2015) Impact on procurement and training by research on the interaction design of medical devices. In Proceedings of the 5th EAI International Conference on Wireless Mobile Communication and Healthcare, October, London, UK. ACM.

David Cook, Alyte Podvoiskis, Chris Vincent, Paolo Masci and Ann Blandford (2015), Beyond "Easy to Use": the importance of human factors in Clinical Engineering. Presented at the IPEM Medical Physics and Engineering Conference, September.