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Received April 23, 2024, accepted November 13 2024, date of publication December 18 2024.

Original Research Article 

Assessment and Capital Planning of a Regional Clinical 
Engineering Department Test Equipment Inventory

Samantha Puin Avila*, Marie-Ange Janvier and Andrew A.M. Ibey

The Clinical Engineering Department, the Children’s Hospital of Eastern Ontario (CHEO), Eastern Ontario, Canada.

* Corresponding Author Email: SPuin020@uottawa.ca

ABSTRACT

The Clinical Engineering Department at the Children’s Hospital of Eastern Ontario (CHEO) in Eastern Ontario, Canada has 9 
distinct regional locations. CHEO’s regional program faces a challenge managing a fleet of 345 pieces of test equipment, mainly 
due to a lack of standardization. Distant regional sites share equipment, making coordination essential. This article presents 
three unique themes: (1) the introduction of technologist standard kits (e.g., multimeters, electrical safety analyzers, etc.) and 
site-based kits (e.g., ventilator, electrosurgical unit testers, etc.); (2) the optimization of kit allocation; and (3) a novel test equip-
ment replacement strategy using Reliability, Frequency of Use, Life Expectancy, and Usage Classification criteria. This needs as-
sessment for new equipment, and the replacement of aged equipment will ensure standardized and up-to-date test equipment 
that will, in turn, minimize equipment-related disruptions and improve technologist productivity.

Keywords—CMMS, Test equipment, Maintenance, Weighting factor, Reliability, Life expectancy, Usage classification, Fre-
quency of use, Inventory assessment.

Copyright © 2024. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY): Creative Commons - 
Attribution 4.0 International - CC BY 4.0. The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright 
owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduc-
tion is permitted which does not comply with these terms.

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25 J Global Clinical Engineering Vol.6 Issue 4: 2024

Avila, Janvier, Ibey: Assessment and Capital Planning of a Regional Clinical Engineering Department Test Equipment 
Inventory

INTRODUCTION

The Children’s Hospital of Eastern Ontario (CHEO) is 
an academic tertiary pediatric hospital in Ottawa, Ontario, 
Canada. This specialized hospital provides high-quality, 
standardized, coordinated pediatric health care to ap-
proximately 500,000 children and youth annually.1

CHEO operates a large regional clinical engineering 
department with over 50 staff members covering 15,000 
km2. This demands a highly organized team and extensive 
coordination to keep all the medical equipment up to date. 
Currently, CHEO oversees a fleet of 345 test equipment 
devices, valued at approximately CAD 900,000, distrib-
uted across nine regional sites, making proper inventory 
management crucial for ensuring compliance and directly 
impacting the quality of patient care.1  

Biomedical Engineering Technologists (BMETs) are the 
primary test equipment users, as they support medical 
device technology. They serve as clinicians’ first point of 
contact, spending substantial time on clinical floors to 
provide general device support advice. They adhere to 
rigorous maintenance schedules for medical devices and 
document their activities in the Computerized Maintenance 
Management System (CMMS) E-automate (ECI Software 
Solutions, TX, USA).2

To optimize resources and reduce costs, CHEO uses a 
hub and spoke model, where smaller hospitals such as 
Brockville, Pembroke, and Hawkesbury share specialized 
test equipment and reserve certain tools from CHEO, the 
main site, for preventive maintenance tasks on devices 
requiring annual or semi-annual servicing. However, the 
shared approach introduces challenges for technologists, 

particularly delayed work order completion in the CMMS 
due to scheduling and waiting for particular test equip-
ment. An example of a shared device would be the waste 
anesthetic gas analyzer. 

Additionally, borrowing test equipment from other 
sites increases the challenge, as technologists must 
specify the maintenance duration on an ad-hoc basis. 
This practice affects equipment availability and disrupts 
workflows when devices are not consistently returned to 
their original site, returned broken, or disappear. It can 
also reduce the equipment’s lifespan due to greater wear 
and tear and an increased risk of physical damage from 
handling, transportation, and potential rough treatment.

The use of older test equipment also affects CHEO tech-
nologists’ confidence in these aged, outdated, and out-of-
support devices, leading them to carry backup equipment 
as a precaution. This lack of reliance complicates their tasks 
and slows down workflow. In contrast, modern devices 
provide greater confidence in performance, improved 
technical support, and regular updates, contributing to 
smoother operations and timely completion of work.

To address these issues, this paper introduces an in-
ventory assessment system with a scoring criterion as the 
foundation for developing a strategic replacement plan. 
A needs analysis was also conducted to evaluate specific 
equipment requirements, challenges, and preferences 
for new devices. This combined approach aims to allevi-
ate equipment-related problems, allowing staff to focus 
more on patient care, ultimately improving productivity 
and job satisfaction.

METHODOLOGY

This project was developed in four phases:

Data Collection

An inventory assessment system was implemented 
using Excel (Microsoft Corporation, WA, USA), using a 
scoring criterion and data sourced from the CMMS. All 
regional CHEO sites were systematically organized and 
color-coded to enable easy differentiation (Table 1).

FIGURE 1. Test equipment distribution across regional sites.



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Avila, Janvier, Ibey: Assessment and Capital Planning of a Regional Clinical Engineering Department Test Equipment 
Inventory

TABLE 1. Eastern Ontario CHEO Sites.
Sites Column A

M Montfort SV Saint Vincent 
Hospital

CH CHEO Biomedical 
Engineering P Pembroke

B Brockville General 
Hospital Q Queensway 

Carleton

C Clinics Groups BR Bruyere

H Hawkesbury

Data Validation

After extracting CMMS data, a physical inventory was 
conducted, recording each device’s serial number, make, 
and model. Discrepancies between the physical inventory 
and CMMS were identified, and equipment was classified 
into three categories: physically found and recorded in 
the CMMS, physically not found and in the CMMS, and 
physically found and not recorded in the CMMS. 

A meeting with BMETs and the Clinical Engineering 
Manager validated the inventory against CMMS records, 
assessed equipment needs, and reviewed last year’s cali-
bration list to ensure accuracy. Standardizing CMMS names 
and adopting the Emergency Care Research Institute ECRI-
recommended nomenclature improved search efficiency, 
consistency, and categorization, providing clearer access 
to equipment details in healthcare settings (Table 2).

Data Analysis

 A new scoring system was introduced, incorporating 
four key categories to calculate the capital planning of 
test equipment: Frequency of Use, Usage Classification, 
Reliability, and Life Expectancy. 

Frequency of Use

The Frequency of Use definition indicates how often 
an individual utilizes a specific supply, categorized as 
daily, weekly, or monthly based on relevance.3 For medical 
devices and test equipment, it specifically refers to their 
usage by healthcare professionals or Biomed Technolo-
gists, which should be documented in the CMMS.

To enhance database accuracy, a Microsoft Forms survey 
was conducted across regional sites to assess the usage 
frequency of test equipment, categorizing it as regular 
(daily to weekly), occasional (monthly to bi-monthly), or 
rare (semi-annual to yearly). 

Table 3 summarizes the survey results, classifying 
equipment based on the highest number of responses, 
with ties resolved by recording the highest usage level.

Usage Classification

The term Usage Classification refers to categorizing 
test equipment based on its functionality, risk of use, or 
compatibility with medical devices. In Canada, medical 
devices are classified into four categories based on the 
risk level they possess to health and safety.4

• Class Ⅰ: Lowest risk (e.g., thermometers).
• Class Ⅱ: Moderate risk (e.g., diagnostic imaging 

equipment).
• Class Ⅲ: High risk (e.g., implantable devices).
• Class Ⅳ: Highest risk (e.g., pacemakers).

The alignment between Health Canada’s system and 
test equipment usage is determined by evaluating how 
often test equipment is used with various classes of medi-
cal devices. To accurately reflect the risk level of devices 
with which the test equipment is associated, a survey 
was conducted with technologists to identify the medical 
device class most frequently associated with each piece 
of test equipment.

Equipment used primarily with high-risk devices, such 
as Class Ⅲ medical devices, is assigned a higher weight 
than Priority Ⅲ equipment. If the device is used equally 
across different classes, it is classified according to the 
higher risk category as shown in Table 4.

Reliability

Medical device Reliability is the probability that devices 
will perform their intended function without failure for 
a specified period.5 In this context, Test equipment Reli-
ability similarly refers to consistent operation over time, 
ensuring accurate assessments of medical devices.



27 J Global Clinical Engineering Vol.6 Issue 4: 2024

Avila, Janvier, Ibey: Assessment and Capital Planning of a Regional Clinical Engineering Department Test Equipment 
Inventory

To evaluate Reliability, an equation was developed 
that inversely relates device age (A) to the frequency of 
corrective maintenance, using CMMS data. The formula 
includes a “+1” factor to account for the incoming inspec-
tion of the device.

Reliability is calculated using the formula:
• R=Reliability
• A=Age of the device
• M=Number of corrective maintenances

                                    

Reliability thresholds were established and points 
were assigned (Table 5):

Life Expectancy 

The FDA defines Life Expectancy broadly as the time a 
device remains functional with activities such as upgrades, 

maintenance, and repairs.6 In contrast, the Biomedical 
Engineering Advisory Group offers a more concise list 
of 16 factors that might affect useful life, such as user 
profile and business risks as well with an extense list of 
the recommended Life Expectancy of medical devices.7 

Despite these guidelines, deciding when to retire or con-
tinue using a device remains complex due to the absence 
of a universal standard for determining device lifespan.

In Ontario, medical equipment management is decen-
tralized, with hospitals making independent decisions. 

TABLE 2. Example of equipment descriptions and ECRI standardized nomenclature.

Equip ID Description ECRI ECRI Device Code Maker Model Serial Number

BM/1007 Test Equip Testers 11-399 BCGRO SA-2010S 13381

TABLE 3. Frequency of use categorization method.

Test Equipment Name Regular Use Occasional Use Rare Use Results

Test Equip Temperature Meter 3 3 0 Regular use

Test Equip Humidity Meter 3 2 1 Regular use

TABLE 4. Usage classification categorization method.

Test Equipment Name Priority Ⅰ Priority Ⅱ Priority Ⅲ Priority Ⅳ Results

Test Equip Meter Pressure 1 1 3 1 Priority Ⅲ

Test Equip Humidity Meter 2 2 1 1 Priority Ⅱ

TABLE 5. Reliability scale criteria.

Classification Reliability Score Points Assigned

R > 4 Reliable 1

4 ≤ R ≥ 2 Medium 2

R < 2 Unreliable 3



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Avila, Janvier, Ibey: Assessment and Capital Planning of a Regional Clinical Engineering Department Test Equipment 
Inventory

CHEO, a regional program, evaluates the replacement of 
medical devices based on long-term organizational goals, 
technological obsolescence, productivity impact, patient 
experience, and the adoption of new technologies and 
best practices. 

While these guidelines are designed for medical de-
vices, they can be used as a proxy for test equipment. 
The criteria for evaluating test equipment lacks detailed 
literature or guidelines from recognized biomedical and 
clinical engineering organizations, complicating the man-
agement of its lifespan and replacement.

The average Life Expectancy data for medical devices 
from the Biomedical Engineering Advisory Group’s rec-
ommended list and the CHEO database was utilized to 
estimate the Life Expectancy of test equipment. Since no 
specific guidelines exist for test equipment, these aver-
ages were applied to ensure consistency with the medical 
devices they support, enabling a practical approach to 
managing the lifespan of test equipment. As more precise 
methodologies are developed, opportunities to further 
refine these estimates will arise.

Weighting Factor

A Weighting Factor for each test equipment was de-
veloped based on:

• Reliability 25%
• Frequency of Use 20%
• Life Expectancy 35%
• Usage Classification 20% 

Table 6 is an example of the database of the test 
equipment. These criteria are grouped according to their 
importance, incorporating factors such as the age of the 

equipment, corrective maintenance records, and autho-
rization status from the Clinical Engineering Manager 
for retirement. 

A request for a quotation was made to segment test 
equipment by price. Devices over $5,000 were classified 
as major capital, while those under $5,000 were consid-
ered minor capital, each following different procurement 
pathways (Table 6).

Standard Kit

A standard kit was developed, incorporating a litera-
ture review and technologist input, to group essential 
test equipment into three categories: items for each 
technologist, items for each site, and optional site-specific 
items. To maintain its relevance, periodic reviews based 
on database weight and usage are recommended.

(a.) Technologists: Each individual should possess:
• Electrical Safety Analyzer
• Patient Simulator
• Multimeter
• Basic Toolkit

(b.) Each site should be equipped with: 
• Oscilloscope
• Pressure Meter
• Temperature Probe/Calibrator
• Vent Tester High Flow (Optional)

(c.) Each site should have if applicable:
• Defibrillator Analyzer
• Gas Flow Analyzer
• ESU Unit (if there is a surgical unit)
• Ultrasound Power Meter

TABLE 6.  Weighting factor.

Age Years CM Life Expectancy 
35%

Reliability 
20%

Frequency of 
Use 20%

Usage 
Classification 

20%
Price Weight

2009 14 8 2 3 3 3 $2,300 2.65

2011 12 7 2 3 3 3 $6,000 2.65



29 J Global Clinical Engineering Vol.6 Issue 4: 2024

Avila, Janvier, Ibey: Assessment and Capital Planning of a Regional Clinical Engineering Department Test Equipment 
Inventory

RESULTS

Data Analysis 

The survey results indicate a high frequency of test 
equipment use among technologists, with over half of the 
fleet utilized weekly or monthly: 60.8% used regularly, 
29.6% occasionally, and only 9.6% rarely (Table 7).

TABLE 7. CHEO test equipment Frequency of Use.

Quantity of Devices Frequency of Use %

210 Regular Use 60.8%

102 Occasional Use 29.6%

33 Rare Use 9.6%

Approximately half of the test equipment is centralized 
at CHEO, while the rest is distributed across eight other 
sites. Notably, Pembroke Regional Hospital (1.4% of total 
equipment), Hawkesbury & District General Hospital 
(1.7%), and Brockville General Hospital Emergency (8.4%) 
are significantly distant from CHEO, located 151 km away, 
respectively (see Figure 2 for a map). To mitigate these 
geographical challenges, it is recommended that each site 
be equipped with dedicated test equipment to minimize 
the need for sharing.

To optimize resource distribution, the following equip-
ment relocations are proposed:

• Laser auto magnetic: Relocate to Hawkesbury.
• Defibrillator testers: Allocate to Brockville and 

Hawkesbury.
• Test Equipment Gauge Force: Assign to Pembroke, 

Hawkesbury, and Saint Vincent Hospital.
• Temperature modules: Relocate to Pembroke and 

Hawkesbury.

In terms of Usage Classification, 60.8% of test equip-
ment is primarily associated with high-risk medical 
devices classified as Priority Ⅳ, highlighting the critical 
importance of maintaining their accuracy. Additionally, 
25.2% of the equipment is mainly used with Priority  Ⅲ 
devices, 10.5% with Priority Ⅱ devices, and 3.5% with 
Priority Ⅰ devices. This classification helps in optimizing 

resource allocation, ensuring that the most critical equip-
ment receives the necessary attention (Table 8).

TABLE 8. CHEO test equipment Usage Classification.

Quantity of Devices Usage Classification %

210 Priority Ⅳ 60.8%

87 Priority Ⅲ 25.2%

36 Priority Ⅱ 10.5%

12 Priority Ⅰ 3.5%

The Life Expectancy (Table 9) evaluation reveals that 
12.2% of the test equipment is over 15 years old, indicating 
that these devices are nearing the end of their operational 
life. Furthermore, 30.7% of the equipment falls within the 
8 to 15 year range, meaning that more than half of the 
fleet is approaching the end of its life cycle. In contrast, 
57.1% of the test equipment at CHEO is under 8 years old, 
demonstrating the hospital’s proactive efforts in acquiring 
new equipment over the years.

TABLE 9. CHEO test equipment Usage Classification.

Quantity of Devices Years %

42 R > 15 years old 12.2%

106 8 < R < 15 years old 30.7%

197 R < 8 years old 57.1%

Table 10 summarizes the Reliability of test equipment at 
CHEO, indicating strong performance consistency. Notably, 
76.2% of the devices score at the minimum level on the 
Reliability scale, while only 10.0% of the fleet demonstrates 
significant functional inconsistency. These results reflect 
CHEO’s strategic focus on acquiring test equipment that 
supports long-term workflows.



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Avila, Janvier, Ibey: Assessment and Capital Planning of a Regional Clinical Engineering Department Test Equipment 
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TABLE 10. CHEO test quipment Reliability.

Quantity of Devices Assigned Points %

37 3 10.8%

45 2 13.0%

263 1 76.2%

The Weighting Factor quantitatively reflects the 
health system’s priorities, assigning the highest weight of 
35.0% to the age factor, highlighting the critical need for 
a replacement plan. Reliability follows with a weight of 
25.0%, showing the importance of acquiring devices that 
maintain their functions over time to ensure patient safety.

The total cost of the test equipment fleet at CHEO is 
approximately CAD 863,025, with a calibration cost of 
$20,602 for 46 pieces of equipment in 2023 showing the 

hospital’s commitment to maintaining high operational 
efficiency and safety (Tables 11 and 12). 

FIGURE 2. CHEO sites distance.

TABLE 11. Test equipment above $5,000 (Capital).

Test Equipment Name Quantity Price

Test Equip ESU Unit 6 $6,000

Gas Flow Analyzer 1 $7,700

Test Equip, Test Lung 1 $5,000

Test Equip Defib/Pacemaker 2 $6,500

Test Equip, Simulator Patient 
Multiparameter 8 $9,000

Test Equip, Ventilator, High 
Flow 2 $7,700

Total 20 $149,100



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CONCLUSION

Implementing organized data collection and validation 
processes improved CHEO’s test equipment management. 
The structured data collection and validation approach 
has resulted in a fully up-to-date database that reflects 
the physical inventory, synchronized with the CMMS sys-
tem. The test equipment is now standardized using the 
ECRI-recommended nomenclature, ensuring consistency 
across all sites. Additionally, the color-coded system by 
site allows for easy filtering and quick location of devices. 
This organization reduces errors in test equipment loca-
tion and enhances overall workflow efficiency, minimizing 
disruptions to hospital operations.

The data on test equipment usage emphasizes the need 
for a well-distributed inventory to support high-demand 
devices. With over 60% of the equipment used regularly, 
there is an increased risk of wear and tear and potential 
physical damage from frequent handling and transport due 
to the long distance between the hospitals. Strategically 
redistributing these frequently used devices will enhance 
resource management and help ensure their longevity.

The Life Expectancy criteria demonstrate the hospital’s 
proactive approach to acquiring new technology, high-
lighting that over half of the test equipment is regularly 
used with high-risk medical devices. While Life Expec-
tancy accounts for 35% of the replacement decision, the 
remaining 65% is spread across other critical categories, 
ensuring a balanced evaluation of equipment prioritiza-
tion for replacement.

While there are precise methodologies for calculating 
medical device Life Expectancy, limited literature on test 
equipment highlights the novelty of this article’s scoring 
system for capital planning in the field. This innovative 
approach provides valuable insights into managing re-
sources and lays the groundwork for future methodologies 
to enhance evaluation processes. As the field evolves, we 
expect to integrate factors like wear and tear and calibra-
tion, along with more accurate Reliability calculations, to 
improve our assessment and prioritization of test equip-
ment in healthcare settings.

CONFLICTS OF INTEREST

 The authors declare they have no competing interests.

ETHICS APPROVAL

Not applicable.

CONSENT FOR PUBLICATION

Not applicable.

REFERENCES

1. Children’s Hospital of Eastern Ontario (CHEO). Avail-
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2. Greenwood, K., Janvier, M., Zhang, Y. R., et al. The divi-
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TABLE 12. Test equipment under $5,000 (Minor).

Test Equipment Name Quantity Price

Test Equip Safety Analyzer 6 $2,300

Test Equip, NIBP 2 $3,200

Test Equip Simulator SpO2 3 $1,000

Multimeter 5 $500

Test Equip Meter, Pressure 1 $2,100

Test Equip Tachometer contact 1 $450

Optical Power/Energy meter 1 $1,250

Test Equip, Simulator, Patient 
Multiparameter 1 $800

Total 20 $30,300

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