ECG recorder distribution and hospital utilization.

Although use of the portable ECG recorder is commonplace, information on actual daily use in an acute care hospital is scarce. To determine whether machines are efficiently used, we attached timers to ECG recorders in 17 wards and clinics to collect data on the time of actual use. Usage ranged from 31 min/day in the coronary care unit to 0.7 min/day in the postpartum ward, and averaged 8.0 +/- 8 min/day for all locations. Seventy-five percent of the recorders were used less than 10 min/day and 25 percent of the recorders were used less than 2 min/day. On a per-bed basis they were used 0.8 +/- 1.4 min/day. Almost no correlation was found between the number of portable ECG recorders and number of beds in 20 teaching and 23 nonteaching hospitals. The number of beds ranged from 11 to 70 per ECG recorder in teaching hospitals and from 14 to 122 in nonteaching hospitals. Nonteaching hospitals averaged 59 +/- 26 beds per recorder; teaching hospitals averaged 34 +/- 17 beds per machine. Some ECG recorders seem to be markedly underutilized and some hospitals seem to be oversupplied with these devices. To reverse this, establishing an equipment committee to see that equipment is efficiently used is recommended.

In-house medical device maintenance.

The establishment of a medical engineering department in this 600-bed institution has proved to be cost-effective and has improved the hospital's environment.

Problems with telemetry monitoring systems.

The purchaser of telemetry monitoring systems for operating and recovery rooms has little information available on the practical aspects of ownership and usage. To explore this problem, we recorded 76 telemetry failures (both operator and machine failure) occurring over six months among 18 telemetry channels located in operating and recovery rooms. We experienced approximately one telemetry failure every three days or every 60 surgical procedures. Factory repairs were required on 29 transmitters and 19 receivers during a two-year period. We observed that 28% of the failures were attributable to lead and electrode problems, 25% to battery depletion, 22% to mechanical or electronic component failures, 12% to inappropriate control settings and frequency mismatching, and 13% to miscellaneous difficulties. The following problems were observed. Transmitters were dropped frequently and occasionally immersed in liquids. Thus, waterproofing is recommended for OR use, and lead-failure warning circuitry is mandatory. Inappropriate control settings and frequency mismatching led to a previously unrecognized hazard: that is, it is possible to receive and display ECG data from the wrong patient located in a distant room. (Stethoscopic monitoring can be used to confirm that the data being displayed are from the correct patient.) Battery failure can occur at inopportune times, e.g., during cardiac arrest. Transmitters are frequently "lost" because of their small size and high mobility. This study indicated to us that, in the operating room, telemetry is not desirable because of its high cost compared to hard wired systems, poor reliability, and the possible hazard of displaying data from the wrong patient if improperly used.