In the “early days” of our profession it was the respiratory therapist who hauled the oxygen cylinders from the loading dock to the patient rooms so that an oxygen supply was available at any given bedside. We assumed this “clinical privilege” because no one else (nurses) wanted it.

Who would have guessed that this man-machine interface would grow to include oxygen tents and IPPB machines and mechanical ventilators and pulse oximeters; then oscillators and ECMO pumps and … well, you get the picture. The respiratory care profession relies on technology to get the clinical work accomplished. We have been both victims of, and advocates for, advancements in technology. In shaping department budgets to account for the dollar tally of technology, RTs have provided the scientific basis that demonstrates the outcome of technology. As such, we are also stuck in the middle of the ethical controversies surrounding technology.

As managers of RT departments, we have had to establish a sophisticated approach to technology selection and utilization. The responsibility of a manager in the procurement of major capital equipment involves several steps, including team selection, justification, cost determination, vendor selection, regulatory considerations, clinical evaluation, purchase, implementation, and yes, “tsunami anticipation.” Here is a brief look at each of the steps and how they work together.

STEP 1: is the selection of a hospital-based team that can provide expert direction on the various components of the total process. Members of the team should include administration, medical direction, clinical engineering, purchasing/materials management, education, and your clinical “super-users.”

STEP 2: is justification of the purchase. This is the key step in receiving administrative approval for the purchase. The justification is also the ultimate test in accountability for the RT manager. An introductory narrative that justifies the purchase as an enhancement to the overall hospital initiative and strategic plan is an essential starting point.

STEP 3: is accurate determination of cost. The price and the cost of a major capital purchase are oceans apart. This step requires some steadfast attention to detail on the part of the RT manager. Miscalculations can lead to embarrassing budget overages, and that will not shine a favorable light on future requests or continued employment.

STEP 4: is selecting the competing vendors of the device being considered for purchase. First you must decide what you need as the user. Expand the generic specifications to include the functions that are necessary, desirable, irrelevant, and undesirable. Identify the patient populations that must be served and the value additions that should be considered for future patient populations. Interface capabilities with hospital information and clinical documentation systems also need to be a consideration for vendor selection. Review general budget caps, regulatory concerns, and benchmarking data to streamline the number of vendors to as few as possible.

STEP 5: is the clinical performance evaluation. In order to make the best decision and to be fair to each manufacturer, the RT manager must assure consistency and standardization throughout the total evaluation process. Identify the “rules of engagement” for the vendors.

STEP 6: is the decision and purchase of the device. Call the selection team members back together to assure that input for the final decision comes from multiple sources. The data collected by clinical engineering and by the respiratory users will be collated. External resources such as MD Buyline, ECRI, and the AARC can also be queried for information. The bids and service contracts will be compared at this step of the process. A consensus will be derived.

STEP 7: is the implementation step. Included in this step is the final signing of contracts between department, hospital, and manufacturers. Arrangements and timelines for the shipping, receiving, assembly, bench testing, and asset assignment of each new device will be determined. The inventory and ordering of accessories and disposable supplies are completed. The education and competency of the clinical staff are addressed in more depth at this time. A resource library of the operator manuals and a manufacturer hotline will need to be available. In addition, a daily mechanism for feedback should be put into action. This will become the central source of operational and clinical hot spots that need to be communicated from shift to shift and to manufacturers for policy and procedure development and for future training curriculums.

Editor’s note: To learn other ways to get more bang for your buck when purchasing capital equipment, go to the July 2006 issue of RT online.

STEP 8: involves anticipating the aftermath of a major capital purchase. This is important to your sense of well-being as an RT manager. Expect the unexpected, and you will not be surprised when and/or if feelings or perceptions change about your purchase. For example, the device you just purchased no longer performs as it did during the evaluation period and you find you know nothing about it; your idea of “ample space” for receiving and assembly and the hospital administration’s idea of “ample space” are worlds apart; your brand-new device fails right out of the shipping crate (pointing up the importance of bench testing prior to patient application); your staff has selective recall and overnight they have gone from love to hate; accessories and disposable supplies identified as essential are not available…the list goes on.

Finally, remember to give yourself lots of time and do not rule out the need for divine intervention.

Good luck with your next capital purchase.

Janice J .Thalman, MHS, RRT, is director, Respiratory Care Services, Duke University Hospital, Durham, NC.

Reprinted with permission from the Management Section Bulletin of the American Association for Respiratory Care. The AARC Management Section is the premier organization for managers of respiratory care departments and services.