(Providenciales, Turks and Caicos Islands – Wednesday 06th February, 2019): Similar to other major service providers across the country, InterHealth Canada – Turks and Caicos Islands Hospital received significant damages during the hurricanes in September 2017. These included latent damages to the electrical circuitry of medical equipment that only became apparent over time. The total cost of repairing the damages to the hospital’s infrastructure and medical equipment is estimated to be USD$16 million.
The majority of the equipment in the hospital is highly sophisticated and extremely sensitive. The environment of CT, MRI and Mammography machines require tight control over temperature and humidity. An independent review of the Diagnostic Imaging infrastructure at Cheshire Hall Medical Centre was conducted by XRCT Limited, a physics consulting company based in Ontario.
The report stated: “In the wake of the storms, the lack of air conditioning lead to ambient air temperature and humidity conditions within the facility that were outside of the manufacturer requirements. This created a severely hazardous environment for electronic components. In addition, the restoration of power to the island created multiple daily power outages, surges and brownouts. All of these conditions, when combined have led to premature component failure, significant increase in downtime and potentially shortened the expected lifecycle of the diagnostic imaging equipment.”
INTERIM CORRECTIVE MEASURES
Biomedical Engineers employed at the facility assisted by overseas specialists worked assiduously to resolve any emerging technical issues. To date, all diagnostic imaging machines are fully operational. The intermittent downtime experienced in previous months with CT and Mammography machines were minimal. The MRI machine was operational, but with limitations on the type of radiological scans that could be performed at the time.
“Despite the high temperatures and lack of humidity control present in the facility, the records show the hospital continued to make every effort to operate the equipment under these extreme conditions in the interest of providing vital and medically necessary patient care,” stated XRCT Consultants in an official report. These efforts sought to ensure the continuity of high-quality care and to minimize the number of patients who require treatment abroad. Patients were categorized based on clinical priority and the equipment up-times were maximized by increasing the volume of radiological scans performed per day.
THE MAINTENANCE PROCESS
CT, MRI and Mammography machines generate significant heat while in use and at rest. Therefore, operating temperatures within these areas are closely monitored, checked and reviewed regularly to ensure temperature and humidity is within the guidelines established by the manufacturer. Any changes in these precise specifications can create the risk of overheating and damage to internal components. Monitoring the relative humidity of MRI rooms is also crucial to avoid the risk of moisture damage to very delicate electronic components such as electronic expansion boards, cables, and connectors.
XRCT Limited also performed an extensive review of the service records for the Diagnostic Imaging department and stated: “Over the months/years preceding the storms in 2017, the service history for all the equipment was excellent. In fact, with the exception of a few random downtime events and planned maintenance, the uptime of all clinical systems was quite good, in excess of 99%.” Based on these expert findings, the technical issues experienced over previous months were evidently not attributed to inefficiencies in the maintenance or management processes established by InterHealth Canada, but were connected to acts of nature, beyond human control.
THE COMMUNICATION PROCESS
InterHealth Canada has continued to abide by the terms of the Project Agreement and meet the extensive reporting and service standards detailed in the contract. As partners in health care, InterHealth Canada is contractually mandated to submit monthly reports to the Turks and Caicos Islands Government (TCIG) related to over 48 clinical key performance indicators, including Diagnostic Imaging services. These key performance indicators seek to demonstrate how effectively the management company is achieving pre-established targets. InterHealth Canada fully supports and complies with these accountability mechanisms.
The TCI Government via the Contract Management Unit has been kept informed, at all times, where services have required expansion or, where challenges such as the 2017 hurricanes have caused damage to equipment, resulting in some delays to services. Representatives of TCI Government’s Contract Management Unit and Fortis TCI also conducted a physical inspection of the UPS and surge protectors in the Diagnostic Imaging Department.
THE LIFE CYCLE PROGRAM
Managing the lifecycle of medical equipment from planning to purchase, installation, operation all the way through decommissioning and disposal helps medical institutions improve operational efficiency, enhance quality and reduce service-related cost.
The purchase of capital equipment is covered under a life-cycle program, which is a reserve fund established under the contract between TCI Government and InterHealth Canada for equipment replacement. The decision to purchase equipment involves several key considerations. These include: Equipment Specifications and Suitability, Procurement and Logistics, Available Financial Resources, Prospects for Maintenance, Repair and Life expectancy.
InterHealth Canada has filed a short term and long-term recovery plan with TCI Government and are actively considering replacement possibilities for key modalities in diagnostic imaging. Negotiations are also underway with the insurance companies relative to the damages ensued.