A Multi-Criteria Decision-Making Framework for Fleet Sizing and Replacement Age of Critical Medical Equipment to Support Crisis Resilience: Application to ICU Ventilators

Background: In health crises, the readiness and availability of equipment are not always achievable. The increasing number and complexity of medical devices require hospitals to establish medical equipment management strategies. In this paper, we define a methodology to help decision-makers select the preferred replacement strategy for critical equipment fleets, such as ICU ventilators, which are life-support equipment whose availability is critical for seriously ill patients. Methods: We present an illustrative case study to identify a preference for a replacement strategy regarding a hospital’s ventilator fleet to ensure the health facility’s routine functioning and resilience to crises. This requires considering multiple factors in a complex environment. In this context, Multi-Criteria Decision Analysis methods are practical tools for assessing each criterion’s impact on the decision process and for objectively evaluating and selecting alternatives. A hybrid Analytic Hierarchy Process (AHP) and additive value model is chosen to perform pairwise comparisons of criteria and evaluate alternatives based on fleet size and replacement period. Results: The results show that it is possible to design a ventilator fleet management strategy that considers the following criteria: service rate in crisis, total cost, staff satisfaction, sensitivity to obsolescence, and ease of procurement and logistics. Among the 12 alternatives, a 9-year replacement period with a 45-unit fleet ranked first, followed by a 15-year policy with the same fleet size. The first rank proved sensitive to the cost weight and the qualitative scores. Conclusions: Effective criteria ranking, score assignment, and the definition of alternatives help develop a consistent decision-making tool that guides decision-makers to the best option for equipment management in normal and critical situations.