J Global Clinical Engineering Vol.6 Issue 4: 2024 24 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. http://www.globalce.org http://globalce.org http://globalce.org mailto:SPuin020@uottawa.ca https://creativecommons.org/licenses/by/4.0/ https://creativecommons.org/licenses/by/4.0/ 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. J Global Clinical Engineering Vol.6 Issue 4: 2024 26 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 J Global Clinical Engineering Vol.6 Issue 4: 2024 28 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. J Global Clinical Engineering Vol.6 Issue 4: 2024 30 Avila, Janvier, Ibey: Assessment and Capital Planning of a Regional Clinical Engineering Department Test Equipment Inventory 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 31 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 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- able online: https://www.cheo.on.ca/en/about-us/ about-cheo.aspx. 2. Greenwood, K., Janvier, M., Zhang, Y. R., et al. The divi- dends of an effective clinical technology management program. J Clin Eng. 2014;39(1):28–32. https://doi. org/10.1097/JCE.0000000000000010. 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 https://www.cheo.on.ca/en/about-us/about-cheo.aspx https://www.cheo.on.ca/en/about-us/about-cheo.aspx https://doi.org/10.1097/JCE.0000000000000010 https://doi.org/10.1097/JCE.0000000000000010 J Global Clinical Engineering Vol.6 Issue 4: 2024 32 Avila, Janvier, Ibey: Assessment and Capital Planning of a Regional Clinical Engineering Department Test Equipment Inventory 3. Griffin, Z.M. Frequency of Meaning Use for Ambiguous and Unambiguous Words. Behav Res Methods Instrum Comput.1999;31(3):520–530. https://doi.org/10.3758/ bf03200731. 4. Health Canada. Guidance on the Risk-based Classi- fication System for Non-In Vitro Diagnostic Devices (non-IVDDs). Available online: https://www.canada. ca/en/health-canada/services/drugs-health-products/ medical-devices/application-information/guidance- documents/guidance-document-guidance-risk-based- classification-system-non-vitro-diagnostic.html. 5. Abd Rahman, N.H., Ibrahim, A.K., Hasikin,K. et al. Critical Device Reliability Assessment in Healthcare Services. J Healthc Eng. 2023;2023:3136511. https:// doi.org/10.1155/2023/3136511. 6. Food and Drug Administration. Guidance Document: Medical Device Tracking Guidance for Industry and FDA Staff. Available online: https://www.fda.gov/ MedicalDevices/DeviceRegulationandGuidance/ PostmarketRequirements/MedicalDeviceTracking/ default.htm. 7. Biomedical Engineering Advisory Group. Life Span of Medical Devices Guidance Paper. Available online: https://www.academia.edu/10481813/Biomedi- cal_Engineering_Advisory_Group_Guidance_Paper_ Life_span_of_Biomedical_Devices_Background. https://doi.org/10.3758/bf03200731 https://doi.org/10.3758/bf03200731 https://www.canada.ca/en/health-canada/services/drugs-health-products/medical-devices/application-information/guidance-documents/guidance-document-guidance-risk-based-classification-system-non-vitro-diagnostic.html https://www.canada.ca/en/health-canada/services/drugs-health-products/medical-devices/application-information/guidance-documents/guidance-document-guidance-risk-based-classification-system-non-vitro-diagnostic.html https://www.canada.ca/en/health-canada/services/drugs-health-products/medical-devices/application-information/guidance-documents/guidance-document-guidance-risk-based-classification-system-non-vitro-diagnostic.html https://www.canada.ca/en/health-canada/services/drugs-health-products/medical-devices/application-information/guidance-documents/guidance-document-guidance-risk-based-classification-system-non-vitro-diagnostic.html https://www.canada.ca/en/health-canada/services/drugs-health-products/medical-devices/application-information/guidance-documents/guidance-document-guidance-risk-based-classification-system-non-vitro-diagnostic.html https://doi.org/10.1155/2023/3136511 https://doi.org/10.1155/2023/3136511 https://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/PostmarketRequirements/MedicalDeviceTracking/default.htm https://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/PostmarketRequirements/MedicalDeviceTracking/default.htm https://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/PostmarketRequirements/MedicalDeviceTracking/default.htm https://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/PostmarketRequirements/MedicalDeviceTracking/default.htm https://www.academia.edu/10481813/Biomedical_Engineering_Advisory_Group_Guidance_Paper_Life_span_of_Biomedical_Devices_Background https://www.academia.edu/10481813/Biomedical_Engineering_Advisory_Group_Guidance_Paper_Life_span_of_Biomedical_Devices_Background https://www.academia.edu/10481813/Biomedical_Engineering_Advisory_Group_Guidance_Paper_Life_span_of_Biomedical_Devices_Background