This article is intended to guide stakeholders in developing sustainable solutions and to serve as a foundation for discussions with hospital executives, healthcare technology managers, patient safety officers, and risk managers. The framework is not intended to be prescriptive but rather a guide for continuous improvement efforts to reduce nonactionable alarms of all types originating from medical devices. High rates of false and nonactionable alarms have made it difficult for clinicians to effectively redirect attention to truly hazardous events.
Safety reports related to products and devices used in health care have demonstrated that not all items can be considered equal in terms of usability, compatibility, and functionality, which can result in patient safety concerns. Hospital systems use a wide variety of products when providing care to patients. This variability may contribute to purchasers failing to fully understand and define the needs for these products. In addition, it is necessary to define what a high-quality product is, including what minimal technical requirements it must meet. The Veteran’s Health Administration (VHA) is the largest health care system in the United States; as such, it possesses the ability to learn from a large group of health care providers as well as a great deal of purchasing power. Purchasing for Safety is a procedure for investigating medical devices or products with an end goal of improving the purchasing decision. Purchasing for Safety can help hospitals and health care systems to systematically evaluate medical products and devices for issues that may lead to patient safety concerns. By conducting careful testing and documenting methods and findings, the test team can assist stakeholders in making purchasing decisions that may ultimately result in better patient care. The greater formality introduced in Purchasing for Safety will help hospitals justify purchasing decisions, and the thoroughness of the investigation will promote patient safety.
The 1990 Clean Air Act amendments require the U.S. Environmental Protection Agency (EPA) to set guidelines for states to follow in designing and running vehicle inspection and maintenance (I/M) programs. Included in this charge was a requirement to implement an on-board diagnostic (OBD) test for both basic and enhanced I/M programs. This paper provides the results to date of an ongoing EPA study undertaken to assess the durability of the OBD system as vehicles age and as mileage is accrued. The primary results of this effort indicate the points described below. First, the majority of high-mileage vehicles tested had emission levels within their certification limits, and their malfunction indicator light (MIL) was not illuminated, indicating that the systems are capable of working throughout the life of a vehicle. Second, OBD provides better air quality benefits than an IM240 test (using the federal test procedure [FTP] as the benchmark comparison). This statement is based on greater emissions reductions from OBD-directed repairs than reductions associated with IM240-identified repairs. In general, the benefits of repairing the OBD fails were smaller, but the aggregate benefits were greater, indicating that OBD tests find both the high-emitting and a number of marginally high-emitting vehicles without false failures that can occur with any tailpipe test. Third, vehicles that truly had high-tailpipe emissions as confirmed by laboratory IM240 and FTP testing also had illuminated MILs at a statistically significant level. Last, field data from state programs have demonstrated MIL illumination rates comparable with those seen in this work, suggesting that the vehicles sampled in this study were representative of the larger fleet. Nonetheless, it is important to continue the testing of high-mileage OBD vehicles into the foreseeable future to ensure that the systems are operating correctly as the fleet ages and as changes in emission certification levels take effect.
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