Ready for Handover

What We Do

Medelis offers equipment consultancy, planning and inspection services to architects, consulting engineers, construction companies, healthcare management and healthcare providers.

We are entirely independent and have no financial or commercial connection with any manufacturer or supplier. Neither do we supply equipment or act as an agent for any product.


The range of services offered new hospital projects would typically include:-

1) Feasibility studies, including consideration of viability, initial budgeting, staffing requirements etc.

2) Assisting architects with overall hospital and departmental fundamental designs.

3) Room-by-room consideration of equipment requirements, based on current practice and the specific needs of the client.

4) Detailed budgeting and the perceived effect of change on present and future requirements.

5) Development of bills of quantities and equipment specifications to achieve a "best buy" for the client.

6) Production of tender documents, room-by-room listings etc.

7) Production of layout drawings, typically at 1:50 scale, showing equipment positions.

8) Planning of equipment installation and utilities requirements.

9) Detailed review of contractors' proposals and submittals (for conformance with contractual requirements etc.).

10) Liaison with suppliers on detailed layout, services and installation requirements.

11) Inspection of equipment arriving at site. Checks for damage, completeness, functionality and conformance with approvals.

12) Supervision of placement, installation, commissioning and handover of equipment at site.

13) Final inspection of installed equipment and acceptance on behalf of the client.

14) Review and checking the compilation of equipment operating and maintenance documentation.


Services for existing facilities can include:-

1) Condition surveys and valuation of existing equipment.

2) Advising on equipment upgrading, refurbishment, maintenance etc.

3) Planning and implementation of maintenance schemes.

4) Spare parts planning ... etc.

Nearing Completion

The Art of Medical Equipment Consultancy

1) The challenge is to establish what the client really wants!

2) Four factors define a project:-

Scope
Budget
Time Schedule
Desired Quality

The consultant must retain influence over at least the last named of these to avoid an endless battle for control of the work.

3) A hospital is a building where the sick, victims of trauma, and the physically indisposed seek cure, repair, relief and comfort. It should not be just another "monument to engineers and architects"!

4) The whole point of the exercise is healthcare - meaning "positive patient outcomes". Continually ask the question "How will this benefit the patient"?

5) This is a business too serious to be left in the hands of "experts" such as architects or doctors!

6) The hospital should be regarded as a system for the delivery of services aimed at bringing patients to full health. Patients are cared for by nurses, not beds! We are dealing with:-

The delivery of health services
Health services are about people
Delivered to people by people

7) The role of the architect and engineer is to provide an environment in which people can deliver health services to people in need; that environment should be:-

Safe
Functional
Comfortable
Pleasant

... in that order

8) What seems clever now may not seem so in ten years time. We seek simplicity, utility and function. Remember (as Mies van de Rohe quite rightly said), often "less is more"!

9) Mechanical and electrical services are provided to bring required services to the places where they are needed to deliver healthcare.

10) The consultant should think like a consultant, not a technician. He should always consider added-value for the client.

11) Always bear in mind the three goals of medicine:-

To cure sometimes
To relieve often
To comfort always

12) Clinical conditions must prevail! But, "Primum non nocere" (first, do no harm!).

Managing and Problem Solving

"An Engineer is someone who can do for a dollar what any damn fool can do for ten!"

When facing a crisis

1) Identify the problem (really identify it; define it, write it down)
2) Focus all attention on it
3) Solve it
4) Then leave it alone (don't "tinker" with it)

Real objectives

1) What's the objective?
2) Is it profitable?
3) Is it clear?
4) Is the proposition attainable and practical?
5) Is the anticipated result measurable?
6) Do you have the facts - all the facts?
7) Are they reliable?
8) What are the options?
9) Have other options been thoroughly considered?
10) What would happen if you did nothing?

The Engineering Approach

1) Define the problem
2) Use fundamentals to analyze and understand it
3) Determine and evaluate possible solutions
4) Implement the best
5) Repeat steps if possible gain seems worth the cost in time and effort

Four Aspects of Project Management

1) The work to be done
2) The resources available to do it
3) Timescale in which to complete the work
4) Finance available to fund it

Cost Effectiveness

Doing the best you can with the money you have

Productivity

Doing the best you can with the time you have

Al-Ahmady

Hospital designed by Mohammad Wasim (with input from Geoff) for Mr. Al-Ahmady in Qatif (1996). As usual I had started with 1:100 plan-view sketches of the operating theatres and clean to dirty flow routes from CSD (adjacent to the theatres) out through to "dirty disposal". We also looked at dirty linen chutes down into the basement laundry but this was not taken up during construction.

Another view of the Al-Ahmady Hospital. With the pre-cast panels in place, it almost looks finished. But in actual fact it was little more than a shell at this stage (1996). The water table was only a metre or so below the ground at the site ... and yet the client insisted on underground parking! A hostage to fortune? A never-ending commitment to pump maintenance at the very least!

Circulation and Capacities Studies

CAN INCLUDE:-

HOUSEKEEPING

1) Location of Janitors' Closets
2) All areas to be covered
3) One in each clinical department
4) One in each ward etc.

KITCHEN

1) Flow of incoming food all the way to consumption
- Receipt
- Storage - refrigeration
- Preparation
- Holding
- Meal preparation - line conveyor
- Delivery to wards
- Serving at restaurant - serving line
- Collection and disposal
- Garbage system

2) Racking

3) Range and capacities of kitchen equipment

4) Tableware

LABORATORIES

1) Numbers expected
2) Range of tests required

LAUNDRY

1) Distribution of linen
- Circulation within wards
- Collection of dirty linen from ward to laundry

2) Circulation of linen within laundry
- Arrival sorting
- Sorting washing
- Washing drying
- Drying ironing and/or pressing
- Ironing storage

3) Issuing of clean linen from laundry to wards

4) Issuing of linen to other areas - eg, towels to physiotherapy

5) Range and capacities of laundry equipment

MEDICAL RECORDS

1) Storage
2) Distribution

OFFICES

1) Distribution of mail

OUTPATIENTS

1) Expected numbers
2) Pharmacy, physiotherapy, x-ray etc.

PATIENT TROLLEYS

Eg, "stretcher trolleys"

PHARMACY

1) Distribution of medication

PORTERAGE

1) Scope and positioning

STERILE SUPPLIES

1) Capacities of sterilizers and washers
2) Distribution and circulation
3) Range and quantity of surgical instruments

STORES

SURGERY

1) Day surgery
2) Expected numbers
3) Types of operations

TOILETS

1) Disabled access ("full access toilets")
2) Patients (grab bars etc.)
3) Staff
4) Visitors

VISITORS

WASTE DISPOSAL

1) Bag system
2) Trolleys, bins etc.


Consistent use of terminology:-

Trucks-v-Trolleys-v-Carts
- trucks have a handle (or towing bar)
- trolleys are either tall or long
- carts are small and low (hip height)

Scrub Suits

There may be a need to consider colour-coding of scrub suits (or "theatre clothing"). Operating theatre staff are not allowed to leave the OR suite in scrubs (and, of course, no-one is allowed to enter the suite without first changing into scrubs). However, other scrub-suit wearers (eg, A&E/ER staff) are often to be seen roaming around the hospital (and even outside). There is a danger that such a person could wander right into the OR without being challenged. There is a case, then, for OR staff proper and visitors to the OR suite to have a scrub suit of different colour to the others, so that interlopers may be readily identified and scrub discipline maintained.

Hospital Housekeeping

The rule in housekeeping (Feldman's Rule) is to use the largest and most rugged machine that can do the job!

Mycology and Tuberculosis

Mycology is the study of fungi.

There are 3 levels of mycobacteriology laboratory service:-

Level 1 : responsible for collecting and shipping specimens. If bio-safety requirements are met, Level 1 labs may also prepare smears and acid-fast stains (AFB - acid-fast bacilli) for microscopy.

Level 2 : performs Level 1 services and recover organisms by culture, identify isolates of m.tuberculosis and refer non-m.tuberculosis isolates of mycobacteria to Level 3.

Level 3 : performs all Levels 1 and 2 services, identify all species of mycobacterium and perform drug susceptibility tests.


Tuberculosis

Symptoms include persistent cough, fever, weight loss.

Confirmation is by tuberculin skin test, chest x-ray.

Definite diagnosis is made after isolation and identification of infecting organism in the lab:-

1) Decontamination, digestion, concentration of specimen
2) Microscope examination for acid-fast bacilli (AFB) on smears
3) Isolation by culture
4) Tests to identify recovered bacilli
5) Tests for drug susceptibility

M.tuberculosis notes:-

1) Culturing and identification is a long process. May take many days to report.
2) There are 25 species of mycobacterium, of which m.tuberculosis is one of the five most frequently encountered pathogenic species.
3) M.tuberculosis is transmitted by droplet. Therefore breaking or leaking during centrifuging is a hazard.
4) Bio-safety Laboratory Practice 3 (BSL-3) must be followed. Aerosol-generating procedures should be done in Class I or Class II biological safety cabinets, and centrifuging in aerosol-free cups.
5) Laboratory layout should provide separate areas for different activities.
6) BSL-2 space for preparing material and handling cultures and specimens.
7) BSL-3 space for manipulating cultures and specimens.
8) BSL-3 has safety cabinet and centrifuge, non-permeable walls and surfaces, low air pressure, air-lock, and HEPA filters direct to atmosphere.
9) Technicians should wear protective clothing and respirators. A changing room is therefore needed.

Equipment Project Terminology

Project Terminology (as used in the Spex database)

Room Codes

H ..... building code eg, "Hospital"
H1 .... floor level
H1-RAD .......... department code
H1-RAD-014 .... room within department
H1-RAD-014-008 .... room type number

Item Codes

BFX ... "Package" grouping code
BFX-028 ... serial number


Item : a line item of equipment of any kind appearing in a list.

Item No. : a reference code to an Item.

Position : quantity of an Item in a specific (Room) location - ie, Room->Item->Qty (... what you see when looking at the Spex Master List form).

Instance : a single example (Qty = 1) of each Item in a specific (Room) location. Total number of Instances is the sum of List Qty's.

Category

A : "High-tech" equipment
B : "Low-tech" powered equipment
C : Non-powered technical item
D : Non-technical item

The Royal Hospital

The Royal Hospital in Oman nearing the end of construction (1987). Those were the halcyon days of Healthtec Ltd.

The Spex Packages codes are central to the system. Master Specification numbers are based on these.

Specification Package Groups

The 62 equipment specification package groupings as used in Spex:-

Code : Package

ARC Architect Selected Items
AVE Audio-Visual and Entertainment Equipment
BFX Building Fixtures and Fittings
COM Communications Equipment
CSW Casework Items
DMC Domestic Equipment
ELE Electrical
FRN Non-Medical Furniture
GEN General Equipment
GSW Glassware
HEP Hospital Engineering Plant
HKP Housekeeping Equipment
HVP HVAC and Plumbing
KTN Kitchen Equipment
LDY Laundry Equipment
LIN Linen Items and Fabrics
MAN Anaesthesia Equipment
MBN Medical Burns Equipment
MBT Medical Beds Carts Tables and Transports
MDL Medical Dental Equipment
MDN Medical Diagnostic Equipment
MDS Medical Disposables
MED General Medical Equipment
MEN Medical ENT Equipment
MES Medical Endoscopy Equipment
MFN Medical Furniture
MGE Medical Gas Equipment
MHD Medical Haemodialysis Equipment
MIM Medical Imaging Equipment
MIP Medical Infusion Pumps
MLB Medical Laboratory Equipment
MLI Minor Laboratory Items
MLP Medical Lamps
MME Medical Monitoring Equipment
MMI Medical Minor Items
MNN Medical Neonatal Equipment
MOP Medical Ophthalmology Equipment
MOR Medical Operating Room Equipment
MPR Medical Plastic and Rubber Goods
MPY Minor Physiotherapy Equipment
MRH Medical Rehabilitation Equipment
MRP Medical Respiratory Equipment
MRT Medical Radiotherapy Equipment
MSI Medical and Surgical Instruments
MSP Medical Suction Pumps
MSS Medical Stainless Steelware
MSZ Medical Sterilization Equipment
MTE Medical Therapy Equipment
MTY Mortuary Equipment
MXR Minor X-Ray Equipment
OFC Office and Commercial Equipment
OMI Other and Miscellaneous Items
PHT Photographic Equipment
PMY Pharmacy Equipment
REC Recreational Equipment
RFR Refrigerators and Freezers
SGH Storage and Goods Handling Equipment
STW Sanitary Ware
TEA Teaching and Educational Aids
TKU Tableware and Kitchen Utensils
VEH Vehicles
WTE Workshop and Engineering Equipment

Equipment Specifications Formats

1) Descriptive
2) Generic (...brief, able to be met by many manufacturers)
3) Manufacturer (..."shall be by Siemens" ... etc.)
4) Origin (..."shall be made in USA" etc.)
5) Performance (...shall be able to ....)
6) Reference (...to standards etc.)

...can be a composite of any or all of the above.

Specification writing

Twenty specs per writer per day is attainable (ten per day is better would result in better quality). So 100 per week can be achieved if pushed (ie, 20 specs/day x 5 days), but 50 per week is much better (that is, about one an hour).

Typical hospital may need 800 specs. So at least 8 weeks (2 months) are needed for complete the job of spec writing (but note that 4 months would be more comfortable)!

Specifications style options

1) Good specs should be generic and brief. They should not be geared to any particular manufacturer or supplier.

2) "...suitable for use..." eg:-
- in a hospital
- in an intensive care unit
- in an operating theatre
- by an executive manager ...etc.

3) Chair: Managers
...suitable for use by a manager.

4) MME-044 Monitor: NIBP: ECG: Portable

For monitoring of vital signs whilst patient is in transit. Powered from mains and internal battery. Compact, lightweight and able to be hung on patient trolley when necessary. Parameters to be monitored shall include:- ECG, heart rate, NIBP, SpO2 and temperature. Complete with bracket for mounting on IV pole, two sets of 3-lead ECG cables with clip-type leads, two sets of adult cuffs and tubing, one child cuff and tubing, two sets of adult SpO2 pick-up sensors, one child SpO2 sensor, one adult temperature sensor, one child temperature sensor, and start-up pack of disposable electrodes. (as written by for Al-Hasa Day Surgery 05-Mar-00).

Another specification model

1) What it is
2) Technical detail sufficient to "pin it down"
3) Relevant codes and standards

Laundries

You can clean up on laundries! This apparently dull and mundane area is actually quite interesting once you get "stuck in".

Laundry Studies

Distribution of linen
- circulation within wards
- collection of dirty linen from ward to laundry

Circulation of linen within laundry
- arrival -> sorting
- sorting -> washing
- washing -> drying
- drying -> ironing and/or pressing
- ironing -> storage

Issuing of clean linen from laundry to wards

Issuing of linen to other areas
eg, towels to physiotherapy

Range and capacities of laundry equipment

Water consumption
- rinse water recycling

Casework

You can make a federal case out of casework! ... but the inspections are very tedious. Better to let other inspectors (eg, architectural) take care of them if you can!

Six basic types of casework:-

General casework
Laboratory casework
Pharmacy casework
Radiology casework
Reception stations
- department reception stations
- information stations
- nurses stations
- security stations
Special casework
- admissions
- appointments ... etc.

Early-on some basic decisions need to be taken, such as:-

Wooden or steel ?

Kitchens

Spot the snag with this vegetable preparation table!

You can really make a meal of kitchens! At the 250 bed SANG hospital at Al-Hasa, review of the kitchen layout and equipment packages (190 items) from four prospective suppliers took one month to complete. And that did not include tableware and kitchen utensils (which were not included at Al-Hasa). Remember Don Laing at the Saudi MOH in the 1980's!

Kitchen studies can include:-

Flow of incoming food all the way to consumption

- Receipt
- Storage - refrigeration
- Preparation
- Holding
- Meal preparation - line conveyor
- Delivery to wards
- Serving at restaurant - serving line
- Collection and disposal
- Garbage system

Racking

Range and capacities of kitchen equipment

Tableware