An Indicator to Prioritize the Mechanical Ventilators Replacement in a Secondary Care Hospital in Mexico.

This paper presents a practical application of health technology assessment for 21 mechanical ventilators, located at a secondary care Hospital in the State of Mexico, Mexico. A global indicator is obtained, by using a mathematical tool, which involves 14 variables grouped into three partial indicators: technical, clinical and economic. The final aim of this approach is to provide evidence for decision-making, in order to prioritize the replacement of medical equipment, taking into consideration its performance features, the needs of demand for care, and the economic implications for the Hospital.Clinical Relevance-Invasive Mechanical Ventilation (IMV), is a clinical procedure which implies a total or partial replacement of lung function. Given the life support implications, it is important to assure security and reliability in medical equipment intended for this therapy. Therefore, in order to keep updated the IMV devices, in addition to requiring preventive maintenance programs, medical technology replacement programs are necessary.

Performance Evaluation of a Magnetic Resonance Imager with Evidence-Based Decision Making Tools.

Evidence-based decision-making tools were used to evaluate the performance of a 16-year-old 1.5T Magnetic Resonance Imager (MRI) that has been fully dedicated to clinical service in a public hospital in Mexico. The MRI age highlights the importance of regular performance evaluations to ensure that the equipment is still functioning optimally, even when the system went through an important software and hardware updated. The use of Multiple-Criteria Decision-Making is an effective method to evaluate the performance of complex systems like MR imagers. A technical global indicator was set, revealing that only 50% of available time has been used is interesting and could be further investigated to determine if there are any factors limiting the usage of the system. The good performance indicators in terms of productivity, availability, and technical aspects are encouraging and suggest that the updated software and hardware have had a positive impact on the overall performance of the system.Finally, the use of evidence-based decision-making tools to evaluate the performance of the MR imager was a successful approach and can serve as a model for other healthcare facilities to follow.Clinical Relevance- MRI is a non-invasive diagnostic test that uses a magnetic field and radiofrequency waves to obtain detailed images of internal structures of the body. Unlike X-rays and CT scans, which use ionizing radiation, MRI does not expose patients to harmful radiation, making it a safe option for diagnostic imaging. The use of MRI a valuable tool for characterizing lesions, detecting abnormalities, and monitoring disease progression and it is widely used in several medical fields, including neurology, oncology, and orthopedics, among others. Therefore, ensuring that the MRI system is working optimally is crucial for providing reliable and accurate results, which can lead to timely and appropriate treatment for patients.

A Method to Identify New Needs for Medical Equipment.

This paper presents a Method to identify new needs for medical equipment based on the Availability Matrix proposed by the World Health Organization. This Matrix is an instrument to map new medical devices for the care of high incidence diseases. The Method considers information on the epidemiology of the patients attended, the demand for health care services and the available medical equipment. It was applied to the main cause of morbidity: congenital malformations, deformities, and chromosomal abnormalities, attended at the National Institute of Pediatrics from Mexico for 2014-2018 period. The four diseases with the highest incidence were chosen. The Method identified thirteen new medical equipment for the care of such diseases. Three for diagnosis and ten for rehabilitation.Clinical Relevance-Medical equipment purchase must solve clinical needs related with the highest incidence diseases. This is translated into effective and safe care for a greater number of patients with such diseases, and the hospital will have the most appropriate medical equipment to take care of patients with the best health technology.

An index to prioritize the preventive maintenance of medical equipment.

We propose an index to prioritize preventive maintenance for medical equipment. Our index considers seven variables: type of equipment, equipment function, maintenance requirements, calibration, equipment age, equipment location, and equipment hazards. We developed a mathematical model using these variables, and its result is interpreted as an index of equipment maintenance priority. The numerical output of the index was classified into three categories: high, medium, and low priority. We proposed our index model to technical staff at the Department of Biomedical Engineering of the National Institute of Respiratory Diseases in Mexico as a protocol for scheduling appropriate preventive maintenance for medical equipment during the year. The index was tested in a sample of 16 different medical equipment. Our model provides a guide to define the priority and the number of preventive maintenance routines required for medical equipment per year.

An indicator to estimate the access to imaging services in the Costa Rican public health system.

The aim of this work was to develop an indicator that estimates the population's access to imaging services (IS) of health care facilities in the Costa Rican Public Health System, taking into account five aspects: (a) health care facilities infrastructure, (b) capacity of the IS according to the installed technological resources, (c) epidemiological aspects, (d) demographic aspects, and (e) location of the health facility in relation to the Capital. To achieve this, 14 variables and 7 indicators were defined. These indicators were integrated into a mathematical function which resulted in a global indicator that throws quantitative data that represents the level of access of a population to the IS in their geographic region of influence. The application of the indicator was performed in eight health facility sub-networks with defined geographical regions within the territory of Costa Rica. The level of access to the imaging service of the inhabitants of the eight sub-networks results that three of them obtained a bad access, located in east and north-central of the country; other three sub-networks obtained regular access, located in the west; and the last two who obtained a good access are located in the center of the country. The results showed that the imaging services are not equitable in each sub-network. Knowing this, it is possible to work on healthcare technology management proposals in order to strengthen the regional imaging services, contributing to decentralizing the services of the general hospitals located in the Capital.

Sigma level performance of the innovated process in the imaging department at a Mexican health institute.

The National Institute of Respiratory Diseases is a third level public hospital in Mexico City, which in 2007 acquired an RIS-PACS to be implemented at its Imaging Department (ID), with the objective to enhance its service. This department attends an average of 3,500 patients per month developing different image modalities. The objective of this work was to determine the overall sigma level performance of four processes of the ID: reception, X-ray, computed tomography, and radiologist diagnosis, considering process analysis and innovation through Six Sigma methodology, measuring the innovation effectiveness by means of indicators and learning curves. Initially, a first measurement (M 1) of the original processes was determined; once 13 innovations were implemented in a pilot program, two more measurements were done, 15 days after (M 2) and 30 days after (M 3), in order to know the impact of the innovations in the ID processes. The initial sigma level of the ID before innovations was σ 1 = 2.0, which means that there were 36 patients per day with a process defect during their stay at the ID. In the two following measurements, σ 2 = 2.2 which means that there were 28 patients per day with a process defect, and σ 3 = 2.3 with 24 patients per day with a process defect. These results demonstrate that the percentage of performance enhancement between the original process and 15 days later was 23 % and 30 days later an enhancement of 15 %. In total, an overall enhancement of 38 % was obtained at the ID of the institute.