Stakeholder challenges in purchasing medical devices for patient safety.

OBJECTIVE: This study identifies the stakeholders who have a role in medical device purchasing within the wider system of health-care delivery and reports on their particular challenges to promote patient safety during purchasing decisions. METHODS: Data was collected through observational work, participatory workshops, and semi-structured qualitative interviews, which were analyzed and coded. The study takes a systems-based and engineering design approach to the study. Five hospitals took part in this study, and the participants included maintenance, training, clinical end-users, finance, and risk departments. RESULTS: The main stakeholders for purchasing were identified to be staff from clinical engineering (Maintenance), device users (Clinical), device trainers (Training), and clinical governance for analyzing incidents involving devices (Risk). These stakeholders display varied characteristics in terms of interpretation of their own roles, competencies for selecting devices, awareness and use of resources for purchasing devices, and attitudes toward the purchasing process. The role of "clinical engineering" is seen by these stakeholders to be critical in mediating between training, technical, and financial stakeholders but not always recognized in practice. CONCLUSIONS: The findings show that many device purchasing decisions are tackled in isolation, which is not optimal for decisions requiring knowledge that is currently distributed among different people within different departments. The challenges expressed relate to the wider system of care and equipment management, calling for a more systemic view of purchasing for medical devices.

Initial phase modelling in numerical explosion applied to process safety

The utilisation of computational fluid dynamics (CFD) in process safety has increased significantly in recent years. The modelling of accidental explosion via CFD has in many cases replaced the classical Multi Energy and Brake Strehlow methods. The benefits obtained with CFD modelling can be diminished if proper modelling of the initial phase of explosion is neglected. In the early stages of an explosion, the flame propagates in a quasi-laminar regime. Proper modelling of the initial laminar phase is a key aspect in order to predict the peak pressure and the time to peak pressure. The present work suggests a modelling approach for the initial laminar phase in explosion scenarios. Findings are compared with experimental data for two classical explosion test cases which resemble the common features in chemical process areas (confinement and congestion). A detailed analysis of the threshold for the transition from laminar to turbulent regime is also carried out. The modelling is implemented in a fully 3D Navier-Stokes compressible formulation. Combustion is treated using a laminar flamelet approach based on the Bray, Moss and Libby (BML) formulation. A novel modified porosity approach developed for the unstructured solver is also considered. Results agree satisfactorily with experiments and the modelling is found to be robust. © 2013 The Institution of Chemical Engineers.