A careful assessment of equipment prior to purchase translates into enduring positive outcomes for each patient.

by Larissa Swan, MS, OTR, CLT, and Jim Graham

When Vicki woke, she heard her husband making coffee. As the faucet continued running, she began wondering if something was wrong. She found Eric on the kitchen floor, awake, but unable to respond to questions or express himself. Her husband was a healthy 45-year-old, seemingly too young to suffer a stroke; that morning he managed to survive three. Weeks later, Eric arrived at Rehabilitation Hospital of Indiana (RHI) to begin an intense course of therapy that carried him from an inpatient stay to outpatient services. During his therapy regime, he would sample more than a dozen forms of technology, all designed to enhance recovery, each developed within the previous 5 years. Eric’s determination as a patient was awe-inspiring. He deserved the same effort from the RHI organization to redefine what is possible for rehabilitation patients. As part of this effort, every piece of equipment that was used in Eric’s recovery was assessed for benefit, cost, support of organizational goals, growth opportunity, evidence-based support, and staff knowledge and training.

An Organized Approach
Organizational equipment requests can come through multiple avenues. Therapists, physicians, and other members of the rehabilitative team may submit requests for equipment based on prior knowledge, experience, recent research findings, or recommendations from other institutions and/or colleagues.

An organized approach for the submission of requests assists the organization in prioritizing and justifying facility-based purchases. When a request is initiated, required information includes the equipment request (general, not manufacturer specific), any research or literature supporting the efficacy of the modality, and a brief statement as to the benefit to the patient, program (clinical or research), as well as the organization.

Occasionally, patients and family members actively research and make suggestions for equipment. If the requests come through previous or current patients, a staff “champion” provides the requested information, again promoting staff commitment. Once the requests are submitted, an identified committee reviews and prioritizes based on support of mission/vision, support of program goals, growth, and identification of return on investment through a business analysis and proposal.

A review of established strategic goals provides direction when prioritizing facility acquisitions. An example may be improving outcomes for patients affected by brain injury. Cognition is identified as an area of focus; therefore which tools support this goal?

For instance, tablet computers with applications that can be utilized throughout a patient’s course of treatment at a relatively low cost would be prioritized over a complicated computer system. Such larger systems are used by a small percentage of patients during an inpatient stay, require intense staff training, and cannot be easily incorporated into a patient’s life following discharge. Although both are useful, the tablets are easily the most effective and efficient way to support this goal.

Evidence and Impact
A focus on outcomes, quality care, and fully developed continuum of services in a reality of decreased visits and stringent reimbursement criteria can impact how organizations view large equipment purchases. Evidence and impact on outcomes are strong arguments in support of new technology. Established companies that provide these data points have the upper hand when identifying vendors from whom to purchase equipment.

The initial cost of the item is only one aspect considered when reviewing a system. The reality is that technology changes quickly. Software and hardware flexibility is necessary to avoid obsolescence and updates with training should be included in the services provided. The organization should decide what type of support best fits their system and discuss expectations with the vendor to ensure a strong working relationship. The company should be able to provide billing information and guidelines, and contacts at similar facilities where the same equipment is used.

There are instances when comparative data do not exist, and the organization decides to become an early adopter of a piece of equipment or system, often submitting data for or conducting research to support the acquisition. This is a risk for organizations, one that RHI weighs heavily in the decision process. Until recently, early adoption of advanced technology has not been the common practice at RHI. Having strong physicians and skilled staff focused on the growth and development of the facility’s programs has enabled a look at new technology and development of timelines for purchase. Currently, RHI is researching companies for robotic walking systems. The advanced technology could facilitate growth in the spinal cord injury program by providing clinicians and patients the opportunity for research, and offering a unique modality to persons with spinal cord injury in Indiana.

Partnering for Growth
One avenue for securing equipment has been to partner with the RHI Foundation, which raises philanthropic donations to support RHI facilities, programs, and research. There are numerous local and national foundations as well as individuals from whom private gifts and grants can be solicited to support equipment purchases. The foundation’s role is to match opportunities for new equipment with the priorities of grant-making foundations or individual donors.

The facility’s new driving van, one of the top 10 most sophisticated training vans in the country, was purchased through a $95,000 campaign that included a $35,000 matching grant from a local private foundation started through a successful auto dealership business. All of this information, with funding sources and timelines, is collected into a business assessment and submitted for approval. However, to make a program not only be successful, but flourish, the development and engagement of staff is critical.

Replace, Repair, or Maintain?
Once equipment is purchased and in use, the decision to replace, repair, or maintain will ultimately be presented. Basic therapy staples such as mat tables are a prime example. No therapy gym is complete without an array of mat tables. Most are adjustable height, some fold into the wall, depending on need and space limitations.

The upkeep of these mat tables should be considered when purchased, and a preventative maintenance plan developed. Re-upholstering and repairing mechanics are generally less expensive than replacing; however, there are instances where therapy needs change, and therefore a replacement mat table may support a new organizational opportunity.

Pain management modalities are often required during a patient’s course of treatment. The modalities utilized are dependent upon the diagnosis, type of pain, response to modality, and expertise of the therapist. TENS units, iontophoresis, electrical stim, and ultrasound machines are often employed as an adjunct to clinician therapeutic interventions. TENS units and other modalities can be used by the patients at home or off-site. For this reason, ease of use, application, and reported results are important when deciding which type to acquire.

United from the Start
Staff from all disciplines should be brought into the decision-making process from the beginning. These individuals will be using the equipment with the patients and can provide insights from both perspectives. At RHI, therapy clinicians look to the physicians and to each other for information. Literature reviews and discussion are part of program development when looking at new technology. These reviews can focus on research findings and clinical applications of these devices.

There are times when education and training are customized to the needs of the staff and developed after acquisition. The return-to-driving vehicle is one example. The van has multiple computers, hand controls, and lifts, and is one of the more sophisticated vans in the nation. Our organization sent therapists to an out of state rehab facility to learn about their driving program and equipment, and a few months later we had a driving rep from their facility come to meet our clinicians and teach them the intricacies of using the van in treatment. Ongoing collaboration with local vendors for training and equipment needs has helped support the driving program’s growth and allowed us to expand our service to patients with significant spinal cord and brain injury. Thanks to RHI donors and staff dedication, we have every faith that Eric will someday soon be relearning to drive and on his way to returning to his life. RM

Larissa Swan, MS, OTR, CLT, is the executive director of Therapies at the Rehabilitation Hospital of Indiana (RHI). Swan received her undergraduate degree in Movement and Sports Science from Purdue University, and a Master of Science degree in Occupational Therapy from the University of Indianapolis. She provides leadership through program development, strategic, and fiscal oversight for RHI’s inpatient and outpatient therapy services.

Jim Graham is executive director, RHI Foundation (RHIF). He received his BA from Vanderbilt University, and an MA from the University of Iowa. Graham coordinates development, fund raising, and planned giving activities. For more information, contact [email protected].