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Currents To Medical Center Employees: Several years ago the Medical Center adopted customer service as one of our organizational priorities. We have made good progress in implementing various customer service-related initiatives. For instance, we developed a customer service policy (see Medical Center policy A-72), included customer service as a key component of job descriptions and performance evaluations, and added customer service as a new hire general orientation topic. We enhanced our customer satisfaction survey reporting through a contract with the National Research Corporation (NRC,) and an electronic overview of these reports is now provided monthly to managers and others. We improved the procedure for addressing patient and family concerns with creation of the Patient & Family Liaison Program and we designated patient satisfaction as one of the staffing effectiveness measures.  Also, at the beginning of Fiscal Year 2002/2003, we kicked off a training program through a contract with The McNair Group (TMG), a local firm that specializes in customer service and management development training. To date, approximately 154 managers have completed 30 hours of training focused on a variety of management development topics and customer service. The management team continues to have quarterly customer service refresher sessions, which serve to concentrate on how to improve customer service and our work environment. Additionally, more than 900 nurses, clinical associates and others have participated in training focused on communication, customer service, team building and on generation of ideas to improve customer service. The training sessions have been very well received according to evaluations completed by attendees. Another 900 or more employees will have the opportunity to take part in the training program over the course of Fiscal Year 2003/2004. While the training program requires a time commitment, attendees should find it fun, not torturous. Our plan is to keep the focus on making customer service a top priority in making the Medical Center a better place to work. Everyone’s continued support will be greatly appreciated. Thanks to all for a job well done.  W. Stuart Smith Vice President for Clinical Operations and Executive Director, MUSC Medical Center   STAR Productions presents, ‘Medical Equipment Management’ Stan Trojanowski, Biomedical Engineering manager, presented information to managers on current JCAHO and Medical Center standards concerning medical equipment management. Medical equipment consists of all patient care equipment (hospital owned, leased, rented and personally owned), user/operator competency, and vendor installation, service and training. The Medical Center’s current inventory asset value is $99 million, with 50 percent of that value placed in imaging systems. The average age of Medical Center equipment is 5.4 years. According to JCAHO and MUSC policy, medical equipment management must support a safe and effective patient care and treatment environment by managing risks associated with the use of clinical equipment technology. The Medical Center must select and purchase clinical equipment that is appropriate to the scope of services and meets the needs of patient care providers, ensures operational reliability and functionality of clinical equipment through programmed maintenance, reduces incidents which result in unplanned failures, identifies opportunities to improve clinical equipment performance, and identifies opportunities to increase productivity through equipment selection, configuration, and prompt repair. Trojanowski mentioned some challenges in meeting equipment maintenance goals like difficulty in locating equipment in need of repair, difficulty in yielding equipment for maintenance, a very large inventory, continuous renovation and new projects. New inspection stickers will better inform users if and when to expect future maintenance inspections. The UHC SafetyNet reporting tool created some difficulty in locating and identifying potentially dangerous equipment that requires special investigation per Medical Center policy A-48 and FDA regulations. To alleviate this problem, Trojanowski distributed yellow equipment tags to attach to each piece of equipment reported via SafetyNet. Several operator problems in medical equipment management were noted. Error and mishandling rates are tallied monthly by device type and are available in top 20 lists reported monthly to the Environment of Care Committee and Clinical Services Education.  Hospital beds constitute the single largest operator problem group and are believed to have four root causes including poor bed plug design, high mobility of beds used for transport, the operator group is split between Environmental Services and nurses, and both operator groups could use more training. Custom modification of all bed plugs will help alleviate a good portion of these problems. Infusion Devices constitute the largest known but poorly documented operator problem area, captured primarily through Safety Net reports. Lack of a clear tracing system between reported operator problems and respective corrective actions presents a challenge in management of equipment user skills. With few exceptions, Biomedical Engineering must individually check new equipment before use on a patient. Exceptions belong to a lower-risk group and must gain approval as a new class or group. Medical equipment is evaluated based on a risk assessment scale. That scale is attached to a device’s functional classes (ECRI classification used) and to its environment of use (general level of acuity is attached to a patient care unit). A final decision regarding the mode of inventory tracking and maintenance approach is based on a combined risk score and criteria like device level, environment, maintenance history, incident history, manufacturers’ maintenance recommendations, and users’ skills. Periodic maintenance inspection schedules consist of individual item tracking (repetitive), group tracking (visual environmental sweeps), planned or predictive maintenance (based on known equipment life cycle facts), as needed, and user maintenance. Non-inventoried equipment groups are inventoried and tracked as a class or group and receive service on an as needed basis, during annual environmental sweeps, or daily by users. Only new models and distinct types of equipment require evaluation and assessment by Biomedical Engineering regarding inventory inclusion and mode of maintenance. (They will not require Biomed Control Tag or an inspection sticker.) This group includes electronic probe thermometers, patient TV sets, surgical tools, endoscopes and others. Inventoried, non-scheduled equip-ment groups are classified to receive service from Biomedical Engineering only on as-needed basis, via annual inspections, as components of respective systems, or are maintained by users/operators or vendors. (They will require a Biomed Control Tag and only a one-time initial acceptance inspection.) This group includes equipment like automatic defibrillators, new generation electrocardiographs, hospital beds, and others. For information on this topic or to obtain equipment tags, contact Trojanowski at 792-3988 or trojanst@musc.edu. Graduate Medical Education Update Frank Medio, Ph.D., Graduate Medical Education, reviewed changes and information concerning resident duty hours regulations. On behalf of George Arana, M.D., Graduate Medical Education associate dean and ACGME designated institutional official, Medio stated residents are allowed a maximum of 80 hours per week averaged over four weeks unless an exemption for an additional eight hours has been approved. In-house moonlighting must be included in this total, as well as all required activities except reading and studying and time spent in the hospital during at-home on-call time. Residents may spend 24 hours maximum on continuous on-site duty with up to six additional hours permitted for patient transfer and other activities defined by each specialty. No new patients are to be given to residents after the 24-hour time period and in-house on-call duty must be limited to no more than one night every three nights. Residents are required to take 10 hours “off” for rest and personal activities between duty periods and after call with one free 24-hour period from the program every seven days, on average. Medio reminded managers and directors that it is the program directors duty and the duty of the institution to monitor resident duty hours and respond immediately to correct any violations of these regulations. Policies should be adopted to prevent and handle the effects of fatigue among residents. Medio also mentioned the ACGME six general competencies as the driving curricula of MUSC’s residency programs, including patient care, medical knowledge, interpersonal and communication skills, professionalism, practice-based learning and improvement, and systems-based practice. Concerning faculty supervision of residents: an attending physician must be present and directly involved in patient care/procedures, present in the operative/procedural suite or unit and immediately available for consultation, immediately available in the facility or on campus, or available by telephone when off-site with a maximum response time of 30 minutes. Medio presented managers with the fall schedule for the MUSC Office of Graduate Medical Education Core Curriculum Lecture Series. For more information or to register, call 792-9304. Blood Donation Update According to Annie Lovering, American Red Cross, from July 1, 2002 through June 30, 2003, 1,065 people gave or attempted to give blood at MUSC, and their donations resulted in 2,049 gifts of life. Of these generous donors, 41 gave six times and five gave seven times including Darby Brass, Pathology and Lab Medicine, Ruben Colon, Financial Systems Services, Kathleen McGreevy, Physical Therapy, Donna Poyer, Pediatric Cardiology, and Dennis Ward, Pharmacy Services. These five donors potentially helped 105 patients during the year. Entering the second year of the team competition, donors are welcome to join existing teams or start new ones. To ensure that each team is credited when donations occur, donors must record their team name on the sign-in sheet when giving blood. In place of quarterly winners will be semester winners, so employee and student competitions will end simultaneously.  The student team with the most presenting donors for the Summer semester was the Bloodbournes (College of Graduate Studies), led by captain Kelly Guyton, who received movie tickets. The winning employee team for the Summer semester was Doing IT for Life (CCIT), led by captain Susan Day, and they received a goodie bag donated by various South Windermere merchants.  “Enthusiasm is contagious, and our goal is to encourage others to give,” Day said. The fall semester competition runs from Aug. 25 to Dec. 31. For more information, call Lovering at 792-0219 (press #2) or email at loverina@musc.edu. Policy Update Rosemary Ellis, Quality director, presented the latest policy changes and updates. They are the following: A-2 Administrative Call Roster. Reviewed with no revisions to content. Contact Chris Malanuk, Strategic Planning director at 792-1477. A-30 Interpreters- Foreign Language. Revised to reflect current method to obtain interpreters for patients with language barriers. Contact Karen Rankine, Clinical and Patient Education coordinator at 792-5078. C-26 Medication Samples. Revised to reflect current method of obtaining, distributing, and tracking medication samples provided to patients. Contact Paul Bush, Pharmacy Services director at 792-5691.   Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to petersnd@musc.edu or catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Community Press at 849-1778.