Centralized equipment allocation in a large tertiary hospital: Operational and economic outcomes of a hub-based coordination model

Equipment utilization in hospitals often remains below 60% due to departmental fragmentation and information asymmetry. Hospitals of all sizes face pressure to optimize equipment investments, yet coordinated sharing mechanisms remain underutilized. We evaluated an equipment allocation center (EAC) that combines centralized coordination with economic incentives to improve equipment sharing across departments. We analyzed equipment sharing data from a 560-bed tertiary hospital in eastern China for the calendar year 2024. The EAC maintains 120 pooled devices while providing real-time tracking of 1367 items across 29 clinical departments. An economic mechanism charges borrowing departments depreciation-based fees while crediting lending departments with 80% of these fees as revenue. We assessed operational performance, network topology, and economic outcomes stratified by department size and specialty. The EAC coordinated 1558 equipment transactions with 100% departmental participation. Equipment utilization improved from 52.3% to 78.6%, a gain of 26.3 percentage points. Average response time was 40 minutes for routine requests; emergency fulfillment reached 98.5%. Annual direct benefits totaled 1.36 million Chinese Yuan (CNY), with estimated procurement avoidance of 5.09 million CNY. The network showed hub-spoke topology; without the central hub, 17 of 29 departments would lose sharing access entirely. Small departments achieved the highest benefit-per-bed ratios: the intensive care unit with 16 beds realized 5600 CNY per bed annually. Centralized equipment coordination with economic incentives markedly improves utilization and yields considerable financial returns. The model particularly benefits smaller departments by enabling equipment access without ownership requirements. Hub-based architecture creates operational efficiency but also coordination dependency requiring contingency planning.