Engineering a solution for bladder scanning

(Spectrum - Biomedical and Clinical Engineering Association of Ireland - April 2020)

Brian Turvey, clinical sales director, Cardiogenics Ltd, outlines important considerations for practical partnerships in healthcare delivery, reflecting his company’s substantial experience in bladder scanner technology and the evolution, use and management of this technology in Irish hospitals

As modern healthcare organisations focus on providing solutions for patient care, the development of products and services will need to constantly realign with the demands of busy hospitals and their clinical and support teams. Such a focus has helped develop patient care systems such as the provision of the latest

bladder scanning technology for Irish hospitals. Healthcare institutions have very different and individual demands in areas including patient care, staffing, skills, safety, training, equipment management, service, administration and of course, cost.

As technology evolves, the new solutions must be designed with the above demands to the fore and with the most successful ones demonstrating efficacy without compromise.

‘Bottom-up’ design

The design of a best solution for hospitals will always be led by the importance of patient care. Specifically designed to measure bladder volumes of patients, ‘bladder-scanning’ is developing as a key process for the care of hospital inpatients as well as within its natural and more historical environments within urology and outpatient clinics.

For the inpatient, the bladder scanner helps to avoid catheter-associated urinary tract infections (CAUTI) by offering nursing teams a simple alternative to catheterising in respect of determining residual bladder volumes and assessing urinary retention. It’s non-invasive and can also be used to aid diagnosis of certain conditions 1,2

The value for clinicians will demand that it must be intuitively simple to use and be able to seamlessly integrate with existing and familiar systems and systems-management processes. Charging the battery, generic and familiar consumables, small footprint, printout, electronic-healthcare record compatibility, etc.

Additionally, the bladder scanner must offer users a verification of the scan, ensuring user-confidence and efficacy of use. With the advent of all new technologies, comprehensive user-training is vital and in too many cases training is accepted as ‘adequate’, rather than being both comprehensive and replicable.4

For the support teams including biomedical engineers, there will be key attributes, such as reliability, affordability, limited downtime, robust design, rapid unit diagnostics, future-proofing with recognised and familiar operating standards and offering the potential for inevitable and simple upgrading of hardware and software. It would be very unusual to come across hospitals with identical medical-device management systems, so the move to tailored service options that suit different processes is something

that adds real value for biomedical engineering teams, including optional manufacturer-certified training for self-servicing.

A holistic view

In addition to the importance of their presence in the Urodynamics and Urology Departments, the ideal scenario would be to have a bladder scanner in every hospital ward – offering clinical teams an easy, rapid and accessible facility to determine bladder volume in a patient and avoiding the trip to another ward to borrow a unit or worse, having to catheterise the patient unnecessarily.

The business model demonstrates the financial saving for hospitals in respect of avoiding unnecessary catheterisation, but the practical reasons for the widespread availability of bladder scanners are also of utmost importance. It’s not unusual to see them hidden, locked away or chained to walls in a ward setting.

The Liam Neeson poster that went viral throughout online nursing networks said it all, in respect of the reluctance and problems associated with borrowing units and having to share them across different hospital wards, increasing the possibility of misuse and the spectre of cross-contamination between wards.5

The Irish hospital experience would show that it’s more likely that bladder scanners are shared between two to three inpatient wards and on the same level or floor – this is not ideal, particularly in busy nursing and post-surgical environments.

Value-based systems

Key to the overall value of bladder scanners, their affordability will be a crucial consideration for procurement and contract teams in our hospitals. With the rapid

advancement of all modern technologies, ‘future proofing’ is also important when replacing and investing in devices which provide important clinical solutions for hospitals. The dizzying advancement in artificial intelligence and the implications of Moore’s Law means that the impending obsolescence of even your latest investment begins the day that it is commissioned. Therefore, it is worthwhile aligning the hospital’s device management plans with suppliers and products that demonstrate an agility to keep with the times and preferably offering software and hardware upgrades to help keep pace with benefits and challenges that the inevitable advancements will present.

But, incremental steps through advanced technology must be relevant and affordable. Even with simple measuring and diagnostic equipment, it’s easy to be distracted by the bells and whistles of add-ons and potentially irrelevant features for your hospital’s needs. Advancements must provide efficacy, efficiency and reliability for patient and user and also for the management of equipment.

Affordability must be at the centre of any development, especially for the pressurised budget constraints that our country’s healthcare system endures. Equipment distributors should be very focused on their offerings and the overall cost to hospitals, working with them to ensure that they become valuable partners to healthcare organisations by assessing the needs, reviewing the opportunity and then producing product and service solutions that don’t just ‘tick the box’ but exceed expectations.

Technologies that are created for a specific use are often adapted to a much broader spectrum of uses,3 but best value will principally be demonstrated by ‘best outcomes at best cost’, which is a formula that should align throughout the healthcare ‘supply chain’ and must provide a focus for hospitals and distributors alike.

Practical solutions

The concept of building products and services that integrate smoothly with plans, processes and practices of clinical and engineering teams is the ideal sweet spot, but a spot that needs to be continually reassessed, fine-tuned and developed as required. A ‘one-size-fits-all’ offering will not suit our healthcare systems in Ireland and agility is a key

component for effective and sustainable solutions. As much as the biomedical engineers need to be involved in designing solutions, their involvement in a close working partnership with manufacturers and distributors means that specifically designed solutions can be tailored to meet the needs of their individual users and equipment managers.

Strategic alignment with vendors in respect of lifetime solutions is something that might sometimes ‘inadvertently’ evolve in the healthcare industry, but it should also be a principal consideration when assessing technology and preparing your hospital for lengthy partnerships with manufacturers and distributors alike.

The user should be fully appraised of the limitations and possible end-of-support dates for all technology and equally should be a substantial contributor in respect of evolution and innovation of the next generation of equipment and other solutions.6 Accordingly, manufacturers and distributors need to be able to add extra value by working to understand the constraints and challenges that clinical and biomedical engineering teams endure on a daily basis, supporting them with updates about relevant information, case history and solutions that address the needs of patients, clinical teams and supporting services.

References

1. Venkatesan M, Nasto L, Tsegaye M, Grevitt M. Bladder

scans and postvoid residual volume measurement improve

diagnostic accuracy of cauda equina syndrome. Spine 2019;

44(18): 1303-1308

2. Goonewardene SS, Pietrzak P, Albala D et al. Basic urological

management – diagnostic pathway for acute urinary

retention, Springer, 2018

3. Feeney D, Guyatt G, Tugwell P. Healthcare technology –

effectiveness, efficiency and public policy. A study sponsored

by the Canadian Medical Association and the Institute for

Research on Public Policy, 1986

4. Park YH, Ku JH, Oh SJ. Accuracy of post-

void residual urine volume measurement using

portable ultrasound bladder scanner with real-time pre-scan

imaging. Neurourology and Urodynamics 2011

5. Pyrek KM. Portable medical equipment: a significant source

of transmission. Infection Control Today 2018

6. David Y, Jahnke EG. Planning medical technology in a

hospital. Global Clinical Engineering Journal 2018

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Cardiogenics Ltd, Robertson House, 49 Grange Avenue, Baldoyle Industrial Estate, Dublin, D13 H2N2   01-6978528