OR Manager - January 2018 - 25

Technology
no longer viable to maintain a focus on
the fixed costs of the operating room.
We expanded our view to the entire
patient care experience to fully appreciate
the cost benefits of robotic surgery.
Furthermore, we did not want operating
room costs to impede the care of patients
who would benefit from a robotic
approach, " he explains.
" Once the technology is in-house,
maximizing operational efficiency requires
a continuous effort, " Brumit
says. " For example, when we first purchased
the robot, many services were
vying for time. The perception was that
there was never enough time to use the
robot, even though monthly utilization
was sitting at 50%. By developing and
maintaining an assignment schedule
(service and surgeon), we have elevated
perceptions as well as utilization. "
Another difficulty in the early years
of the robotics program was matching
staff to demand, Brumit says. " A variety
of service-specific nurses supported
robotic cases. We found that it was difficult
for some nursing teams to keep
their robotic skills sharp if their service's
robotic case volume was low, " he
explains.
In addition, robotic surgeons said it
was difficult for them to complete cases
efficiently without consistent, dedicated
support in the OR. In response, a dedicated
group of registered nurses received
training for robotic cases done
from 7 am to 7 pm on weekdays.
" Thus, procedure times were reduced,
and additional cases could be
added with confidence knowing that
trained support staff were available, "
Brumit says.
" Building a successful and scalable
robotic program takes time and
effort from a multidisciplinary team. Surgeons,
nurses, and perioperative administrative
staff must work together to
get the most out of the technology (optimize
utilization, improve case length,
create and maintain an educational environment,
and such), " Brumit says.
www.ormanager.com
" We've found it beneficial to have both
a larger working group to discuss and
resolve operational challenges, as well
as a smaller steering committee to govern
and guide the program.
" The Robot Working Group meets
biannually to discuss challenges and
drive strategy, " he explains. " During
these meetings, we present monthly
and quarterly metrics relevant to the
robot so that the entire community is
aware of the program's strengths and
opportunities. We maintain a distribution
list to ensure that all members of
the community are well informed regardless
of their attendance.
" The Robot Executive Committee
meets biannually to develop the program's
direction and definition. It also
provides perioperative and surgical leadership
to discuss how the MGH robotic
program fits into the various other robotic
programs across Partners Healthcare, "
he says.
Lutheran Medical Center
experience
Deborah
Hedrick, MA,
RN, NEA-BC
Lutheran Medical Center's
259-bed community
hospital in Wheat
Ridge, Colorado,
brought robotic surgery
on board in 2010, when
it opened a new OR, according
to Deborah Hedrick,
MA, RN, NEA-BC,
director of perioperative
services. Their business case was
strongly driven by local competition and
surgeons.
" We live in a very competitive market
here in the Denver area. There are more
than 20 hospitals, and we are all competing
for each other's business. So we
weren't ready to lose volume to another
hospital, " she explains. " Everyone here
was getting robots, so we got the da
Vinci Si Surgical System, mainly for GYN
and urology procedures. "
The business case for purchase of
a second robot-another Si Surgical
System-just 2 years later, was based
on analytics provided by Intuitive Surgical
and Lutheran Medical's business
development team. " We looked at the
market and trends in our volume, and
analyses showed that within a matter of
6 months, the number of patients would
exceed time available. That meant that
my surgeons would go elsewhere, " Hedrick
explains. " We were just booming,
with a high volume of robotic hysterectomies. "
A
da Vinci Xi Surgical System, a
new platform with greater arm mobility,
was purchased in 2016. " We have
a colorectal surgeon who is medical
director of our colorectal cancer program,
and he performs numerous cancer
cases, " she explains. " He needed
the Xi, which enables multiquadrant procedures. "
Lutheran
Medical has designated
rooms for robotic procedures. Rooms
are scheduled on a first-come, firstserved
basis. " Currently we staff two
RNs and a surgical technologist for
each robotic case, but we plan to reduce
that to one RN and one surgical
technologist, " Hedrick says.
All staff must complete Xi and Si
robotic educational modules, which are
provided by Intuitive, and all new employees
must be supervised by a preceptor
for a couple of cases, she adds.
Lutheran Medical has been collecting
data to track return on investment.
Between 2015 and 2016, the proportion
of operations done robotically increased
from 7% to 9%, and the actual
number of cases increased from 387 to
521, according to Anna Hooker, MBA,
MS, the center's perioperative business
manager. That growth appeared to be
attributable to a doubling of the volume
in general surgery and OB-GYN. For
colorectal operations, length of hospital
stay is about 7 days for open and laparoscopic
procedures combined, but just
4 days for Xi robotic procedures.
Continued on page 26
OR Manager | January 2018 25
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