Pattern of radiological

equipment management in
some tertiary health
2004/128960
Supervisor: Agwu K.K. (PhD)

institutions in South-West
February 2010.

Nigeria and its economic

implications.
 Introduction

Equipment in the hospital setting means any instrument, apparatus, tool, appliance, machine or any
q

other related device used for preventive, diagnostic, radiotherapeutic, supportive and control
procedures for day to day patient care activities
Expenditure in the purchase or acquisition or radiological equipment is not without economic
q

implications. Again, the utilization, maintenance, and breakdown of these equipment also have
economic implications (profits and satisfaction derived from the utilization of radiological equipment)
This research was carried out to study the pattern of radiological equipment management in some
q

tertiary health institutions in southwestern Nigeria and its economic implications. Results will help
identify recommendations that will help in maximal utilization of radiological equipment , the output
of high quality work and increased revenue generation from the radiology department
 Statement of problem

Ø Casual visits to radiology departments in health institutions across south-east reveal abandoned, unserviceable and obsolete imaging equipment. Causes of these

are not known. The economic implications have also not been investigated.

Ø There are oral reports of long equipment downtime which is associated with irregular services in most public owned radiological centres.
 General objective of study

• To determine the pattern of management of radiological equipment

and its economic implications.

 Significance of study

ü Improved quality of service rendered by the radiology department

ü Reduced risk of excessive radiation dose to patient and personnel

ü Increased revenue generation by the department which would as well add to net profit made by the health

institution
 Limitations of study
1. Some of the respondents declined giving information (via the questionnaire) to the researcher on the grounds that the study would expose sensitive information concerning their department to the public

2. The questions contained in the questionnaire may not have been properly structured to elicit the necessary information from the respondents. Again, this may further be complicated by the fact that the questionnaires were not administered on the respondents by the researcher himself

3. Information regarding issues of equipment status at the time of procurement may not be valid, as the researcher did not demand evidence such as receipts or commissioning papers from respondents
 Review of related literature
q Similar work carried out in Enugu metropolis, Delta state and India were reviewed.

q Other related articles from relevant government agencies in the United States of America and Nigeria were also reviewed. WHO recommendation on equipment life cycle was also reviewed.

q Areas of equipment management reviewed include acquisition, installation, departmental QA practices, maintenance, breakdown and utility.
 Research methodology
v Research design: non-experimental, cross-sectional design.

v Study is descriptive and prospective.

v Target population: some tertiary health institutions in south-west Nigeria.

v States covered: Oyo, Edo, Ogun, Osun and Ekiti.

v Institutions: four teaching hospitals and one federal medical centre.

Sampling method: convenience sampling

•

method.
 Tool for data collection
q Semi-structured questionnaire used due to geographical distribution of respondents and their tight work schedules

q Designed according to specific objectives of study

q Ten copies mailed electronically to trained assistants for administration on departmental management: heads-of-department and radiographers-in-charge.

q Return rate of 80% recorded

 Analysis of data

q
Data was manually analyzed

q
Data was categorized according to specific objectives of the study

q
Percentages and areas on charts were obtained manually
Presentation & discussion of
findings
• Data was arranged and discussed according to the specific objectives of study.

• Data is presented in tables and charts as presented and discussed below.

 Table 1: Distribution of medical imaging equipment in THIs
and their functional status

MIE
Conv. Fluoro. CT U/S MRI Mobile Total
THI F NF F NF F NF F NF F NF F NF F NF

UCH 4 0 1 0 2 0 3 0 1 0 1 0 12 0
OAUT 2 1 0 1 0 1 5 2 - - 0 1 7 6
H
UBTH 3 3 0 1 1 0 1 2 - - 1 3 6 9

FMC 1 0 - - - - 3 0 - - - - 4 0

q F- Functional, NF- Not functional

q All MIE in 50% of the THIs are functional.

q 46.2% to 60% of MIE are not functional in the others.

 Table 2: Method adopted in purchasing medical imaging
equipment (MIEs)

METHOD METHOD ADOPTED

THI Committee of The Hospital Government

users and hospital management directly supply
management alone

OAUTH 2

FMC 2

UBTH 1 1

UCH 2

Total 4(50%) 3(37.5%) 1(12.5%)

q Committee comprising of users and hospital management purchase MIE in most

(50%) of the THIs.

Most (represented by 180 degrees) of the respondents are
o

usually informed before new MIE are purchased and are asked
to give specifications for the MIE to be bought.
 CT MRI U/S Conv. Fluoro Mobile Total
MIE Bn Rf Bn Rf Bn Rf Bn Rf Bn Rf Bn Rf Bn Rf

THI

OAUT Ns Ns 0 0 6 1 2 1 Ns Ns Ns Ns 8 2
H
FMC 0 0 0 0 3 0 1 0 0 0 0 0 4 0
UBTH 1 0 0 0 3 0 6 0 Ns Ns Ns Ns 10 0

UCH 2 Brand0 new, 1Rf- Refurbished,

qBn- 0 3 0 Not sure.
Ns- 4 0 1 0 1 0 12 0

q Most (94.4%) of the MIE were purchased and installed as brand new equipment.

q This may not be true as researcher did not obtain proof from respondents.
 MAINTENANCE PROTOCOL OF THE DEPT

THIs Regular intervals When faults are reported by

staff

OAUTH 2

FMC 2

UBTH 2

UCH 2

Total 4(50%) 4(50%)

q Maintenance is an important aspect of equipment

management.

q 50% of the THIs reported that MIE are maintained at

regular intervals. Same proportion reported that

Table 5: Practice and frequency of quality assurance (QA) tests
carried out by the THIs

THIs QA TESTS CARRIED OUT FREQUEN

CY OF
Option B Options A Options A, Options B, None of the TEST
and D B, C and E C and E above

UCH √ Not
regularly
OAUTH √ √ Regularly

UBTH √ Nil

FMC √ Nil

A- Exposure timer, B- X-ray output and

beam quality, C- Light/x-ray field
congruence, D- Thickness of cut, E- System
q
resolution,
Only one F- None
THI regularly ofout
carries theQA
above.
tests on their MIE.
q Lack of QA programme in 50% of the THIs.
 Table 6: Frequency of equipment breakdown in the
THIs

THI FREQUENCY OF EQUIPMENT BREAKDOWN

Quite often Rarely

OAUTH 1 1

FMC 2

UBTH 2

UCH 2

Total 5(62.5%) 3(37.5%)

q Frequent equipment breakdown was reported by 62.5% of respondents.

q The same proportion reported downtime of ‘a few days’ in table 7.

q Regular equipment maintenance may therefore not be the only factor influencing equipment breakdown.
Table 7: Equipment downtime
in the THIs
THI EQUIPMENT DOWNTIME

A few days A few weeks

OAUTH 1 1

FMC 2

UBTH 2

UCH 2

Total 5(62.5%) 3(37.5%)

o 87.5% (represented by 315 degrees) of the respondents reported that their

maintenance are always available at the time they are needed.

o This could be responsible for short downtime.

 Table 8: Functional MIE and average number of
patients examined daily

TERTIARY HEALTH NO. OF FUNCTIONAL AVE. NO. OF PATIENTS

INSTITUTION MIE EXAMINED DAILY

FMC 4 36

UBTH 6 85

OAUTH 7 57

UCH 12 110

q Average workload ranges from 36 patients on 4 functional MIE to 110 patients on 12 functional MIE.

q Increasing patient throughput without commensurate increase in number of functional MIE may be

responsible for frequent equipment breakdown.

 Table 9: Daily generated revenue and average number of patients
examined daily

TERTIARY HEALTH DAILY GENERATED AVE. NO. OF PATIENTS

INSTITUTION REVENUE EXAMINED DAILY

FMC N 36,000:00 36

UBTH N 313,000:00 85

OAUTH No idea 57

UCH N 575,000:00 110

q Revenue generated daily increased in direct proportion as average number of

patients examined daily.

q Revenue lost would be proportional to duration of downtime.

 Other implications of MIE
breakdown.
ü Deprivation of radiological services to patients and referring physicians.

ü Delayed patient management which could have dire implications such as death and other complications

of delayed management of patient’s condition.

Summary of findings
• Majority of the departments had many functional MIE.

• MIE are purchased by a committee comprising of end-users and hospital management in most of the departments.

• Heads of department and radiographers in charge are informed and do give specifications before new MIE are procured.

• A good number of the MIE were installed as brand new ones.

• Fifty percent of the THIs service their MIE at regular intervals.

Summary of findings

• Quality assurance programme is not in place in a good number of the THIs while it is not regularly carried out in some of
the departments where the programme is in place.

• Majority of the THIs experience frequent equipment breakdown with downtimes lasting only a few days.

• Maintenance personnel are always available in the departments at the time they are needed.

• Revenue generated daily by the departments increases in direct proportion as the patient throughput.
 Conclusion

v Problems encountered by departments are in second phase of equipment life cycle recommended by WHO, i.e. after equipment has been put to use.

v QA programme is overlooked by most of the THIs.

v
More equipment could become non-functional due to increased usage, frequent equipment breakdown and functionality of few MIE.
 Recommendations

v New MIE should be purchased to reduce stress on few functional MIE and boost number of functional

MIE.

v Introduction and proper implementation of QA programme to be overseen by a QA committee.

 Area of further study

Ø Current study, as shown by results, is filled with bias.

Ø Same study could be carried out

Ø Other staff of radiology department should be introduced to eliminate management bias.

Ø Other measures to eliminate bias should be introduced.

 The end

Thanks for listening.