OR Manager - March 2018 - 24

Total joint cases on firm footing after OR team huddles
Process improvement
ffective use of a daily huddle and
customized software for scheduling
have had a dramatic impact
on efficiency at NYU Langone Orthopedic
Hospital in New York City. Cancellations
on the day of surgery have
dropped from a rate of about 10% prior
to implementation of huddles to less
than 1%, according to Linede (Kandy)
Kraemer, MA, BSN, RN, CNOR, NE-BC,
CSSM, director of operating rooms.
" We've also seen increased compliance
with providing accurate and complete
information at the time of booking.
It's not perfect, but it's much better, "
she notes.
E
Kraemer manages 16 ORs at NYU
Langone Orthopedic Hospital, where
more than 12,000 orthopedic procedures
were performed in 2017, of which
more than 4,000 were total joints.
The daily huddle and the software-
the MEDTEL Platform, which connects
the vendors, surgeons, scheduling office,
central sterile processing, OR leadership,
and implant coordinators-have
been in place for the facility's total hips,
knees, and shoulder procedures for the
past few years.
More recently, the process and technology
have been explored by the spine
and sports medicine service lines, according
to Kraemer.
" We were looking at how to be more
efficient in every aspect of our patient
care, " Kraemer told OR Manager. Information
flows from the surgeon's office
to the scheduling office, supply chain
staff, central supply staff, clinical leadership
in the OR, and the vendors. " We
were looking for a way to be inclusive
so everyone was getting the same information
at the same time, so we could
reduce any errors that would impact
the patient on the day of surgery, " she
says.
In 2012, NYU Langone Orthopedics
adopted an electronic medical record
(EMR) that improved the scheduling process,
but there was still opportunity
for missing information, Kraemer ex24
OR
Manager | March 2018
Surgeon
compliance with
implant protocols
has increased.
plains. " Our surgeons were able to book
cases with little to no information-for
example, they might book a total hip
replacement without documenting which
vendor and system they were using.
As a result, we were unable to follow
our implant loaned process, leading to
potential delays on the day of surgery. "
Better communication
A new chief of adult reconstructive surgery,
Richard Iorio, MD, was hired with
a mandate to standardize the total joint
service.
Under Dr Iorio's leadership, and with
the help of a consulting firm, a daily
huddle was started to better plan for
cases in relation to instrumentation,
equipment, implant needs, and medical
clearance. All stakeholders-including
nurses, anesthesia providers, central
supply staff, staff from preadmission
testing (PAT) and the postanesthesia
care unit, and implant coordinators-
participate in the huddle.
Huddles are held at 11 am and last
anywhere from 20 to 45 minutes, Kraemer
says. Cases are reviewed 72 hours
in advance, with updates at 48 hours if
necessary.
The huddles are led by the chief of
anesthesia or his designee, Kraemer
says, and the EMR is checked to ensure
all cases are reviewed with the
PAT nurse practitioners. " Representatives
from support services also attend
to identify needs related to their areas
of coverage-for example, implant coordinators
contact vendors about implant
and instrument needs and the expected
start time of upcoming cases, " she
adds.
The huddle has facilitated communication
and improved the planning
process. " Many, but not all, implants
are consigned because of space constraints
and minimal use, " Kraemer
says. " We have to arrange for loaned
instruments to be delivered with enough
time for sterilization processing. Implant
components can be specific for right or
left, so it's crucial to document laterality.
If we have a last-minute change,
that's communicated to supply chain
and implant coordinators. "
The huddle has also helped staff
identify ways to improve clinical management
of cases, Kraemer notes. A
traditional total hip replacement, for
example, is booked as an " arthroplasty
hip total, " but unique procedure names
were created for robotic cases, with
titles specific to the equipment needed
for the case. " That way, we identify any
potential equipment conflicts and the
appropriate implants that are compatible
with the case, " she explains. " Robotic
cases also require larger rooms
because more equipment is needed. "
Slick new technology
The integrated software, which allows
for communication across departments,
is completely customized, and it's customized
for each individual surgeon's
office, according to Kraemer.
" They build a template specific to
each office and which vendors they
work with, " she explains. " The only information
that has to be typed in is patient
demographics, and everything else
is a checkbox. "
Minimal training was needed to learn
the software, she says.
Vendors have access to the software.
They are notified and required
to confirm equipment availability when
a surgeon books a case so they can
prepare to deliver the necessary equipment.
This
is especially important when
loaned trays are requested, which
avoids the need for reprocessing during
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OR Manager - March 2018

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