DEPARTMENT OF THE MONTH

The Houston Methodist Biomedical Engineering Department

BY K. RICHARD DOUGLAS

Houston, Texas is one of the bestknown cities in America. The city and surrounding communities form a metropolis that extends to the Galveston Bay. With a population exceeding 2.3 million, it is the fourth largest city in the U.S., covering 637 square miles. Houston was founded in 1836 and offers attractions like Space Center Houston, the largest fine arts museum in the Southwest and the downtown aquarium.

A city of this size depends on health care systems with the capacity to serve such a large population. That capability is embraced by Houston Methodist Hospital, affiliated hospitals and other facilities scattered across the Houston metro area. We recently profiled a small two-technician department, but it takes a biomed department at the other end of the spectrum to manage medical devices for such a large-scale health network.

With eight hospitals, an academic institute and 2,509 operating beds, Houston Methodist includes 27,947 employees, with many working in biomed. The 85-member biomedical engineering department is led by System Director Anthony Maroulis. Other members of leadership include Campus Director of Clinical Engineering Marc Bateman, Managers of Clinical Engineering Terresa Everhart, Javier Ruiz, Miguel Meza and Coreaun Jackson and Program Coordinators Brandon Hight and Nathan Stathos.

Leadership is part of GE Healthcare.

The team’s clinical engineers include Zach Smith, Cristian Delgado, Bailyn Piecewicz and Hani Khalil. The department also consists of two administration assistants, five biomed equipment tech leads, 23 biomed equipment tech IIs, 23 biomed equipment tech IIIs, 15 biomed equipment tech Is, 4 biomed radiology service engineers and 1 data entry specialist.

Bateman says that the biomed team services more than

91,000 medical devices in-house thanks to the exceptional training options available to the department’s technicians.

In addition to managing equipment at the eight hospitals, the large biomed team also serves more than 20 orthopedic and sports medicine locations offering physical and occupational therapy across the Greater Houston area.

They are also responsible for equipment at the Specialty Physician Group with 848 physicians at 191 locations and the Primary Care Group with 169 physicians at 42 locations.

The hospital is affiliated with Weill Cornell Medicine, NewYork-Presbyterian Hospital and the Texas Annual Conference of the United Methodist Church. The Houston Methodist Academic Institute, which is a research and education institute, has a faculty of 742, with 2,110 credentialed researchers.

BIG TEAM, BIG PROJECTS

The challenges to address COVID-19 surges taxed the resources of health care facilities across the nation, but it required innovation on a grand scale for the biomed team at Houston Methodist.

“At the onset of the COVID-19 pandemic, there was a glaring need to reduce exposure to patients within the hospital for our RT department. Thankfully, our Hamilton G5 ventilators have a detachable interaction panel. RT asked to have vents inside the COVID room and place the interaction panel outside to minimize exposure for the RT therapist to go inside the room. The interaction panel was attached to a table outside the patient room and we had to do this for 90-100 G5 patient rooms,” Smith says.

He says that together with the IT medical device integration team, they successfully opened a virtual ICU (vICU). “We had a key role to play in ensuring the patient physiological monitors were capable of being used in this new, innovative setting,” Smith says.

The team tackled many other projects related to the vICU to meet the needs of patients and visitors during the pandemic. Another project was centered around Alaris pump interoperability and tying them to patient records.

“Pharmacy, nursing, biomed, multiple IT groups, and the manufacturer have worked together to automate the delivery of IV drugs across the system,” Smith says.

He says that the result of the project is that a nurse at the bedside can now scan barcodes on the drug, patient, pump channel which will program the pump with the physician order. It also automates the charting of drug delivery in the patient record in the EHR.

“Another benefit is that there is now a standardized drug library used at all hospitals, so a standard of care is met as well as contributing to the system ISO certification,” Smith adds. The team has also worked to improve asset equipment disposition.

“We have taken the manual process of gathering signatures from department leaders to retire no longer needed equipment from our inventory to a system that leverages the platform Docusign. Using Docusign, we have saved time and resources by going digital, allowing time for other tasks,” Smith says.

The biomed team has also handled its share of problem solving, including automated notifications when defibrillators have been put into service.

“In order to adequately service our automated external defibrillators (AEDs) located throughout the hospital, we have worked with our RTLS vendor, GE, to send an email notification each time it is moved from its glass-protected case and put in use. This way, we can make sure it is inspected by our technicians after use,” Smith says. Realtime location systems (RTLS) have not only been used by the team with the defibs, but has also been a valuable tool for locating ER pumps.

“Leveraging RTLS, we created par level of IV pumps in our ER and were able to locate them to bring them back. This helped solve the issue of idle pumps and the shortages that incurred. The RTLS beacons on the pumps could help pinpoint where the IV pumps were so they could be gathered and returned in the ER,” Smith says. Team members also solved a problem that resulted from power outages.

“Our Da Vinci robots used in our ORs took a significant time to reboot when there was a power blip. In ORs that do not have a built-in UPS, we added an external UPS and it solved this issue – the Da Vinci now stays up and running when there is a sudden outage,” Smith says. Another project related to defibs provided valuable data to clinicians.

“Our hospital code blue committee wanted to find a way to transmit their code files from all our defibs in the hospital after code blue (cardiac arrest) events. We worked with our defib vendor, Zoll, and added WiFi cards to each of our defibs, allowing us to transmit data for our clinicians to review after each code. This was done for over 250 defibs. This has helped them further educate the code blue team,” Smith says.

Away from the workplace, team members remain involved in the HTM community.

“There is an assortment of professional associations that our biomed technicians are involved in. AAMI and ACCE for example. Some are also active in the local HTMA Texas and we also have a biomed instructor that serves at a local community college,” Maroulis says.

“Partnering with GE HealthCare we have implemented an apprentice program. The apprentice program has been a big success at Houston Methodist. We have used the talent pool to shape future careers, and at the same time, create a workforce that we can hire. Students from local colleges spend 12 months working with senior BMETS, where they gain a lot of experience,” Maroulis says.

With big responsibilities and big challenges, this talented team of technicians and engineers has solved problems and addressed pandemic-related trials to the benefit of patients and clinical staff. They are also partnering to train the next generation of biomeds learning in an ideal environment.