The supply of the best possible service ever, focused on the patient care is the main goal of the Healthcare system. Technological evolution is the key word about Healthcare 4.0, and it has to be constantly updated due to the the rapid technological development. The innovation readiness of the hospital structure must be evaluated in order to get to a digital Healthcare. The starting point is focused on the renewal of the existing machines, evaluating the status of each medical device to act accordingly on the management of the Investment Plan. The purpose of this work is to obtain an assessment of replacing urgency of all the medical equipment in the Fondazione IRCCS Istituto Nazionale dei Tumori, the hospital where the internship was done over a period of 6 months. This goal was achieved through the use of a model capable of drawing up a Substitution Priority Index (IPS) for all medical devices of the hospital. The evaluation of the machines obsolescence was conducted in two distinct and separate phases, which were linked only at the end of the two, in order to validate the first. The first step of evaluation, the assignment of a technical IPS to each equipment, is based on a structured assessment that takes into account several objective factors which were possible to extract from the personal, economic and maintenance data of the devices. The assignment of the degree of urgency replacement is carried out with the help of an Excel spreadsheet, to make the calculation more precise, simple and semi-automated. The final output of this first phase has divided the medical devices into three ranges of urgency, based on the value of technical IPS: the higher it is, the higher the degree of urgency for replacement is. Taking the ideas from the article "Index of Priority of Substitution of biomedical 2 instrumentation" by C. Cammi (1) , the judgment based on subjective parameters is the second phase of evaluation, giving greater importance to the clinical opinion. With the same approach, in this phase the variables are collected to calculate a clinical IPS, which was implemented on a part of the machines, unlike the model created in the first phase, because it was used for the validation of the Technical IPS calculation. The calculation model of the Technical IPS was tested on the entire fleet of machines under the purchase status of INT, which appears to be 9632 medical devices. The result of the first phase led to the following classification: - 8.759 devices were evaluated by the model in good condition, therefore no type of intervention is necessary; - 844 devices have been evaluated by the model as critical, therefore needing a more careful evaluation; - 29 devices were rated by the model as very critical, requiring urgent replacement. For the second evaluation phase, only 873 devices in the “critical” and “very critical” classification were selected. They have reasonably suffered a reduction, confining the assessment of the second phase only to the departments defined as the most critical and tothe types of equipment defined with a greater importance of criticality. The skimming has undergone further cuts as some devices with very urgent technical IPS were already being replaced, confirming the correctness of the IPS value that the model assigned. The final sample is about 30 medical devices, which is part of the second phase. The subjective information necessary to calculate the value of the clinical IPS were retrieved by filling in questionnaires administered to healthcare personnel, in order to detect their opinion. The calculation of the clinical IPS has validated the correctness of the result of the technical IPS, which was possible to affirm by comparing the two models of the two phases. A percentage of 80% presents two opinions in agreement between the technical model and the clinical model, which is why the judgment of urgency replacement assigned by the value of technical IPS was considered correct. This demonstrates an excellent condition of the INT machines, the success of the model developed in this thesis work and also provides a useful tool to support the detailed and careful management of medical equipment carried out by the INT clinical engineers.
La Sanità è soggetta ad un rapido sviluppo tecnologico, fondamentale da a seguire per mettere al primo posto l’erogazione del migliore servizio possibile, incentrato sulla salute del paziente. L’ evoluzione tecnologica è la parola chiave per poter parlare di Sanità 4.0. Il punto di partenza, per procedere al cambiamento tecnologico, si focalizza sul rinnovo del parco macchine presente, valutando lo stato di ogni dispositivo per agire poi di conseguenza sulla gestione del Piano di Investimenti (PdI). Lo scopo dell’elaborato è quello di ottenere una valutazione di urgenza di sostituzione di tutte le apparecchiature mediche presenti nel parco macchine della Fondazione IRCCS Istituto Nazionale dei Tumori (INT), struttura dove è stato condotto il tirocinio per una durata di 6 mesi. Tale obiettivo è stato ottenuto tramite l’utilizzo di un modello in grado di redigere un Indice di Priorità di Sostituzione (IPS) per tutti i dispositivi medici presenti in ospedale. La valutazione dell’obsolescenza del parco macchine è stata condotta in due fasi distinte e separate, che sono state unite solo al termine delle due, per poterne validare la prima. La prima fase di giudizio, che vede l’assegnazione di un IPStecnico ad ogni apparecchiatura, si basa su una valutazione strutturata che prende in considerazione fattori oggettivi estraibili dai dati anagrafici, economici e di manutenzione dei dispositivi. L’assegnazione del grado di urgenza di sostituzione viene svolta tramite l’aiuto di un foglio di calcolo Excel, per rendere il calcolo più preciso, semplice e semiautomatizzato. L’output finale di questa prima fase ha suddiviso le apparecchiature in tre range di urgenza, i quali vengono assegnati in base al valore di IPStecnico: più risulta elevato più è alto il grado di urgenza di sostituzione. Prendendo spunto dall’articolo “Indice di Priorità di Sostituzione della strumentazione 1 biomedica” di C.Cammi (1) , si è deciso di far coincidere con la seconda fase di valutazione un giudizio basato su parametri soggettivi, dando maggior rilievo al parere clinico. Anche in questa fase vengono raccolte le variabili, questa volta soggettive, per dare vita ad un IPSclinico, che è stato sviluppato solo su una parte del parco macchine, a differenza del modello creato nella prima fase, in quanto è stato utilizzato per la validazione del calcolo del primo IPS, l’IPStecnico. Il modello di calcolo dell’IPStecnico è stato testato su tutte le apparecchiature del parco macchine di proprietà di INT, il quale risulta essere di 9632 apparecchiature medicali. Dalla prima fase si è ottenuta la seguente classificazione: - 8759 dispositivi sono stati valutati dal modello in buone condizioni, perciò non necessario nessun tipo di intervento; - 844 dispositivi sono stati valutati dal modello critici, perciò che necessitano una più attenta valutazione; - 29 dispositivi sono stati valutati dal modello molto critici, che necessità una sostituzione urgente. Per la seconda fase di valutazione sono state selezionate solo le 873 apparecchiature nella categoria di classificazione “critica” e “molto critica”. Esse hanno ragionevolmente subito una riduzione, confinando la valutazione della seconda fase solo ai reparti definiti più critici e alle tipologie di apparecchiature con maggiore criticità. La scrematura ha subito ulteriori tagli in quanto poiché, da un confronto con gli ingegneri clinici, alcune apparecchiature con IPStecnico molto urgente sono risultate già in fase di sostituzione, confermando la correttezza del valore di IPS che il modello ha assegnato. Il campione finale, facente parte della seconda fase, è risultato essere di 30 dispositivi medici. Le informazioni soggettive necessarie per calcolare il valore dell’IPSclinico sono state recuperate tramite la compilazione di questionari somministrati al personale sanitario, in modo da rilevarne il loro parere. Il calcolo dell’IPSclinico ha validato la correttezza del risultato dell’IPStecnico. Una percentuale del 80% presenta due giudizi concordi tra modello tecnico e modello clinico, motivo per il quale si è ritenuto corretto il giudizio di urgenza di sostituzione assegnato dal valore di IPStecnico. Ciò dimostra un’ottima condizione del parco macchine di INT, la buona riuscita del modello sviluppato in questo lavoro di tesi ed inoltre fornisce uno strumento utile a supporto del lavoro dettagliato e attento di gestione delle apparecchiature mediche condotto dagli ingegneri clinici di INT.
Valutazione dell'obsolescenza del parco macchine tramite lo sviluppo di un modello di indice di priorità di sostituzione
PRANZO, REBECCA
2019/2020
Abstract
The supply of the best possible service ever, focused on the patient care is the main goal of the Healthcare system. Technological evolution is the key word about Healthcare 4.0, and it has to be constantly updated due to the the rapid technological development. The innovation readiness of the hospital structure must be evaluated in order to get to a digital Healthcare. The starting point is focused on the renewal of the existing machines, evaluating the status of each medical device to act accordingly on the management of the Investment Plan. The purpose of this work is to obtain an assessment of replacing urgency of all the medical equipment in the Fondazione IRCCS Istituto Nazionale dei Tumori, the hospital where the internship was done over a period of 6 months. This goal was achieved through the use of a model capable of drawing up a Substitution Priority Index (IPS) for all medical devices of the hospital. The evaluation of the machines obsolescence was conducted in two distinct and separate phases, which were linked only at the end of the two, in order to validate the first. The first step of evaluation, the assignment of a technical IPS to each equipment, is based on a structured assessment that takes into account several objective factors which were possible to extract from the personal, economic and maintenance data of the devices. The assignment of the degree of urgency replacement is carried out with the help of an Excel spreadsheet, to make the calculation more precise, simple and semi-automated. The final output of this first phase has divided the medical devices into three ranges of urgency, based on the value of technical IPS: the higher it is, the higher the degree of urgency for replacement is. Taking the ideas from the article "Index of Priority of Substitution of biomedical 2 instrumentation" by C. Cammi (1) , the judgment based on subjective parameters is the second phase of evaluation, giving greater importance to the clinical opinion. With the same approach, in this phase the variables are collected to calculate a clinical IPS, which was implemented on a part of the machines, unlike the model created in the first phase, because it was used for the validation of the Technical IPS calculation. The calculation model of the Technical IPS was tested on the entire fleet of machines under the purchase status of INT, which appears to be 9632 medical devices. The result of the first phase led to the following classification: - 8.759 devices were evaluated by the model in good condition, therefore no type of intervention is necessary; - 844 devices have been evaluated by the model as critical, therefore needing a more careful evaluation; - 29 devices were rated by the model as very critical, requiring urgent replacement. For the second evaluation phase, only 873 devices in the “critical” and “very critical” classification were selected. They have reasonably suffered a reduction, confining the assessment of the second phase only to the departments defined as the most critical and tothe types of equipment defined with a greater importance of criticality. The skimming has undergone further cuts as some devices with very urgent technical IPS were already being replaced, confirming the correctness of the IPS value that the model assigned. The final sample is about 30 medical devices, which is part of the second phase. The subjective information necessary to calculate the value of the clinical IPS were retrieved by filling in questionnaires administered to healthcare personnel, in order to detect their opinion. The calculation of the clinical IPS has validated the correctness of the result of the technical IPS, which was possible to affirm by comparing the two models of the two phases. A percentage of 80% presents two opinions in agreement between the technical model and the clinical model, which is why the judgment of urgency replacement assigned by the value of technical IPS was considered correct. This demonstrates an excellent condition of the INT machines, the success of the model developed in this thesis work and also provides a useful tool to support the detailed and careful management of medical equipment carried out by the INT clinical engineers.File | Dimensione | Formato | |
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https://hdl.handle.net/10589/166072