As the COVID-19 pandemic starts to subside in its second year and elective and backlogged surgical procedures begin to resume, surgeons need the right tools, technology and space on their floors and in their hands ramp up and return to service.
Consequently, when surgeons and clinical teams don’t have the critical resources they need then they may experience staff and patient injuries and infections, increased costs or other harmful out-comes.
Making investments in operating room (ORs) and other surgical environments ultimately may im-prove surgical workflows, procedures and conditions and enhance patient care, safety and outcomes.
Current state of surgical care
The COVID-19 public health emergency, now in its second year, certainly has disrupted the flow and volume of care in many hospitals and healthcare facilities.
How are OR and surgical teams handling cases and ensuring efficiency, effectiveness and safety in proce-dures?
They are playing catch-up with fewer staff and less support in care, observes Anthony Fernando, President & CEO, Asensus.
“After the reduction in elective procedures during the COVID-19 pandemic, hospitals have a backlog of procedures now,” Fernando noted. “Remember, ‘elective’ doesn’t mean unnecessary; patients still need care for serious conditions. Hospitals and surgeons are going to be stretched more thin than they already were. Because of this, it may be difficult for providers to go back to the way it was. We are seeing a cautious and prioritized approach to working down the back-log of cases.
“There are many pressures on hospitals, surgeons and OR teams:
· The first pressure is to reduce surgical variability. Technology needs to help reduce this variability. In terms of variability, surgical procedures are limited by human ability – surgery is an art that is influenced by experience and training. Skill variability and discrepancies across surgeons and facilities can lead to a wider gap in sur-gical outcomes.
· Second, is the rising pressure around cost. Value-based healthcare means delivering the best clinical outcomes relative to the optimal cost of care.
· Finally, hospital CEOs certainly lose sleep over the impending surgeon shortage. This is no small matter – the Association of American Medical Colleges forecasts that there will be a deficit of over 33,000 surgeons and specialists by 2030¹.”
Equipment that is non-modern or not properly maintained poses possible danger risks to staff and patients, explains Howard Higgins, Senior Marketing Manager, Dräger.
“If you picture the current status of many ORs across the country, they are still relying on mobile equipment carts and wall mounted electrical and gas outlets for providing services,” Higgins pointed out. “This now antiquated approach can be fraught with problems, such as inconsistent medical equipment and supply placement among facility ORs negatively impacting work efficiency; staff fatigue from having to reach to connect sockets; staff trip hazards from floor run lines/hoses; and significant challenges with keeping surfaces disinfected to help pre-vent hospital-acquired infections.”
Electrical instruments, in particular, come with their own sets of benefits and challenges, addresses Kevin Anderson, Clinical Coordinator, Clinical Affairs, Healthmark Industries.
“It is commonplace to use electrical instruments and devices in the operating room today,” Anderson stated. “These electrical devices have made less invasive procedures possible all while limiting the amount of blood lost, which leads to better outcomes for the patients. But there is a potential threat with these electrical instruments that has become increasingly evident as time goes on.”
“When there is a defect or breakage in the insulation layers of the instrument, this allows the electricity to escape the instrument from areas where it is not intended to. When this stray electrical activity occurs during surgery, the potential for adjacent organs and tissues can and have been burnt. Some burns have been so severe that they lead to surgical-site infections, prolonged hospital stays or even additional surgery. Sterile processing techs can help combat this problem by checking these insulated instruments for damage each time they are processed.”
OR practice, workspace adapt
Even during such a cata-strophic crisis like COVID-19, OR surgeons, surgical staff and facilities press on with innovation in care.
What new devices, technology, techniques and settings are teams using in order to achieve good surgical out-comes and prevent complications for patients?
Peter Veloz, CEO, UVDI, for example, observed, “In a time of great change, a constant is a continued focus on operational efficiency through innovation practices. A pioneering example of this is a new study from the University of Siena recently presented at SHEA 2021 confirming UV decontamination of operating rooms between surgeries in only six minutes. In addition, facilities are looking more than ever to standardize products and manufacturers across Infection Prevention practices, and especially now for both surface disinfection using UV devices and air disinfection with UV-C technology installed in HVAC systems.”
OR workspaces, as another example, are moving forward with changes and improvements, adds Veloz.
“More broadly, we are on the cusp of a wave of new construction and retrofitting to ‘future proof’ the operating room – with a primary focus in creating modular operating room spaces to accommodate different procedures and patients, as well as for new technologies, robotics and equipment,” he explained. “For UV room disinfection, devices that are easy to maneuver in tight or unique spaces – with a minimal footprint and is lightweight – can drive operational efficiency.”
With regard to care and workflow improvements, Dräger’s Higgins points to “hybrid operating rooms that enable the ability to conduct complex minimally invasive or open cavity surgical procedures guided with advanced imaging feedback to achieve precision and eliminate the critical time delay by having to image the patient in another department.”
Fernando further highlights a shift toward guided and robotic surgery support.
“Through a new era in surgery called Performance-Guided Surgery, surgeons can achieve more control through digitization and tackle some of the biggest issues facing surgical outcomes,” he observed. “Surgical robots not only improve the ergonomics of surgery, they can also reduce surgeons’ cognitive load. What this means for our healthcare system is better outcomes and reduced surgical variability.”
Additionally, telepresence is aiding surgical teamwork, education and procedures, notes Keith Griffis, Executive Director of Marketing for Surgical Endoscopy and Systems Integration, Olympus America Inc.
“One of the greatest needs is to limit the number of people in the OR while still being able to communicate and collaborate in real time with people outside of the procedural space,” he explained. “Telepresence solutions are being used to further life-saving medical device innovation. Telepresence technology allows physicians to broadcast procedures to other clinicians, as well as to medical students, fellows and other trainees anywhere in the world for the purpose of proctoring, consultation and clinical education.”
Technology, devices develop
Technology also continues to forge ahead to shape outcomes in surgical suites and care, says Higgins.
“There is constantly evolving medical technology being introduced to the OR to address new advanced therapies and medical technologies, while also minimizing the impact and damage to tissue allowing for much quicker recovery and hospital discharge,” he stated. “In the recent period there is more focus than ever on flexible ceiling supply unit designs (booms) for the OR and the positive impact they can have on overall workflow. This pertains particularly to the areas of staff efficiency, ergonomics, patient and staff safety, and infection prevention.”
Further, Higgins points to decreased size and increased visualization with surgical instruments.
“Laparoscopic surgical instruments, for example, keep shrinking in size and require fewer entry points via trocars (in some cases it’s now down to one entry point),” he explained. “The use of flexible endo-scopes allows lower impact visual diagnosis and surgical procedures utilizing the body’s natural openings without requiring traditional open surgery.”
Fernando additionally highlights precision of surgery and devices.
“Over the last three decades, surgery has evolved and patients have benefited from this evolution,” he shared. “Open surgery was the ‘go to’ modality for most general and gynecologic procedures. Laparoscopy allowed surgeons to perform the same procedures, but with much smaller incisions; this allowed less pain, less scarring, and quicker recovery. Then laparoscopy was digitized; this allowed for the integration of augmented intelligence, the practical use of 3mm instruments, and force-sensing at the incision site. As a result, patients are leaving their procedures with a better overall experience. [For example], a recent study published in the Journal of the Society of Laparo-endoscopic Surgeons showed that among a cohort of patients who received Senhance surgery, patient satisfaction with their procedure was 98%. Among this same group, patient satisfaction with scarring was 100%.”
As Fernando sees it, “Next-level technology completely changes the idea of what’s possible. As technology enhances and changes the world we live in, the OR can move beyond inefficiency, unpredictability and outdated technology. By digitizing surgery and building machine learning algorithms and AI, surgeries become smarter and more instinctive and result in better patient outcomes.”
Reference:
1. Source: Association of American Medical Colleges. The Complexities of Physician Supply and Demand: Projections from 2016 to 2030. March 2018.
Advancing OR surgeries, outcomes and safety
As the COVID-19 crisis begins to wane this year, operating room (OR) surgeons and teams are busy performing procedures for patients. HPN spotlights some of the latest electronic and digital platforms, medical devices and surgical space expansions in ORs, hospitals and other medical care facilities.
Surgical observation
“COVID-19 brought digital collaboration to the forefront of surgical procedures. In response, Asensus launched a telemonitoring platform called Senhance Connect that brings surgical peers together. Senhance Connect allows surgical peers from around the world to remotely observe a surgical case being conducted on Asensus’ Senhance Surgical System via cameras and communicate with an expert surgeon about the most advantageous practices. The Senhance Surgical System has an added layer of security for the patient – haptic feedback – which could reduce variability. Haptic feedback heightens the surgeon’s sense of feel and tension by issuing alerts if the surgeon reaches the force threshold during a procedure.
“To provide a more ergonomic experience, the surgeon console of Senhance allows the surgeon to remain seated throughout the surgery. And robotic-assisted arms eliminate the need for a surgeon to maintain awkward instrument positions and static stances. Senhance also leverages augmented intelligence through the Intelligent Surgical Unit (ISU) to increase surgeon control. Among its benefits, the ISU provides the surgeon with the ability to control his or her visualization with an eye-tracking camera control that frees surgical staff’s hands for other in-room activities. We’re able to do all of this without adding significant per-procedure costs over traditional laparoscopy.”
Anthony Fernando, Asensus
“The Olympus MedPresence platform facilitated the first use in the U.S. of a novel intracranial vascular implant for treatment of a brain aneurysm. A proctor in Canada with extensive experience placing the implant was able to remotely supervise the procedure taking place in the neuroangiography suite at a hospital in the U.S. MedPresence is valued for providing the highest quality imagery for use in procedure and case management, telepresence, training, teaching, and mentoring. Nearly 5,000 Olympus medical recording units are being used by physicians to capture procedural images and video, which are then routed to patient electronic medical records (EMRs).”
Keith Griffis, Olympus America Inc.
Olympus MedPresence telecollaboration solution
Ceiling boom systems
“Standardization of the boom system allows duplication in each of the facility’s ORs, helping improve staff efficiency by having equipment and supplies always in the same spot, reducing time and effort to locate what’s needed regardless of which OR they’re in. At Dräger, we offer boom designs that are scalable and flexible to adapt to changing needs over time. In addition, we collaborate with multiple imaging vendors to develop new room configurations that provide for optimal workflow in specialties like hybrid ORs.
“The ability to provide service outlets and fully customize the mounting of equipment attachments and work surfaces at optimal positions for the staff addresses ergonomic considerations, minimizing the need to bend, stretch or reach while performing the same or similar tasks repetitively. When it comes to staff safety, getting equipment and lines up off the floor eliminates the risk of accidental tripping, or unexpected impact with rolling carts or stands. For patient safety, booms allow equipment to be placed so it’s ideally positioned and locked where it needs to be for the procedure yet can be quickly relocated around the patient in an emergency response situation. Of course, also impacting patient safety are boom designs that are easier to clean and disinfect, helping reduce the incident of hospital-acquired infections. A well-designed boom has minimal gaps, exposed screws, and device cabling.”
Howard Higgins, Dräger
OR fitted with Dräger boom system
Robotic-assisted surgery
“Reston Hospital Center, a part of HCA Virginia Health System, announced…plans to invest nearly $20 million to expand and enhance its surgery department. The investment will bolster Reston Hospital’s surgical service, which features one of the region’s most comprehensive robotic-assisted surgery programs. The project will include construction of four new, larger operating rooms and modernization of existing suites to provide added capacity to Reston’s robust surgical offering, which performs over 10,000 surgeries annually. In total, the surgical facility will undergo a major renovation of over 22,000 square feet.
“The new and upgraded operating suites will help improve patient outcomes through the adoption of emerging technologies and innovative surgical approaches to help reduce hospital stays and lessen recovery times. The added capacity will allow Reston Hospital’s care teams to treat more patients needing complex spine care, orthopedic care, and minimally invasive surgery across a range of surgical specialty areas such as bariatric (weight loss), colorectal, general, hepatobiliary, gynecologic, thoracic (lung), and urologic surgery….The surgical expansion project design phase will kick-off this summer.”1
Communication, privacy, safety
“Aiphone…has installed its IX Series intercom system, complete with a custom door station, at MarinHealth Medical Center, a state-of-the-art medical facility in Northern California. The 327-bed, independent medical facility serving the North Bay community, opened Oak Pavilion, a 260,000-square-foot, four-story cutting-edge facility focused on patient-centric care and sustainable building design.
“An integral part of the $535 million expansion included the addition of intercom systems through its medical and surgical rooms, waiting rooms, intensive care units (ICUs), and newborn intensive care units (NICUs). In addition, the facility installed customized door stations for 30 anterooms – an area that act as containment barriers, separating patient rooms from visitor walkways.
“In addition, each of the units in the new pavilion – including the emergency department, intensive care unit, maternity ward, surgical center and neonatal intensive care units – required a system allowing doctors, nurses and other staff to travel freely between patient areas and waiting areas. The intercom stations in these areas also provide video, which allows for additional monitoring in cases of suspicious activity, and the ability to make duress calls in the event of an emergency.”2
AI-assisted hospital operations
“Since 2020, Hospital IQ has grown its customer base by 50% garnering 14-times adoption rates of its operations management platform among hospitals and health systems. Using artificial intelligence (AI) to anticipate and direct actions, the platform enables health systems to achieve and sustain peak operational performance to improve patient access, clinical outcomes and financial performance.
“Over the past year or so, Hospital IQ developed new collaborations to achieve improved levels of performance excellence with multiple provider organizations including Hospital for Special Surgery (HSS), PIH Health and Adventist Health. Hospital IQ also expanded its footprint across multiple hospitals including University Hospitals, Sarasota Memorial Hospital and Health First, driving peak operational performance to improve patient access, care delivery and staff productivity.”3
Electrical instruments testing
“The McGann insulation tester is a great example of a simple technology that technicians can use to inspect these instruments, whether it is a laparoscopic dissector, a bipolar forcep, or even a cautery cord. This tester has all the accessories necessary to test all the various types of insulated instruments. The McGann insulation tester allows the technician to find breaks in the insulation that may not be detectable by the unaided eye. Instruments that fail this insulation test can be removed from service and sent for repair. This is a way to proactively remove instruments from service that are a potential source of unintended harm to the patients.”
Kevin Anderson, Healthmark Industries
Insulation Tester from McGann, courtesy Healthmark Industries.
Bipolar energy procedures
“Ethicon, part of the Johnson & Johnson Medical Devices Companies,…announced the launch of the ENSEAL X1 Curved Jaw Tissue Sealer, a new advanced bipolar energy device that increases procedural efficiency. The device is indicated for colorectal, gynecological, bariatric surgery and thoracic procedures.
“The ENSEAL X1 Curved Jaw is the first of several new advanced laparoscopic bipolar devices the company plans to launch in the coming months as it expands its extensive energy portfolio, which includes market-leading HARMONIC ultrasonic devices and MEGADYNE core electrosurgical tools.
“Among the ENSEAL X1 Curved Jaw’s new features are separate seal and cut capabilities, a 360-degree continuous shaft rotation that enables easy access to targeted tissue and Ethicon’s Adaptive Tissue Technology, which enables the device to continuously sense changes in the condition of tissue and respond accordingly with the optimal amount of energy to minimize lateral thermal spread. These features, including improved ergonomics and a one-handed operation, combine to offer precision, a secure seal and a more intuitive and simplified use that may deliver greater efficiency in the operating room.”4
References:
1. Reston Hospital announces $20 million surgery expansion project, https://hcavirginia.com/about/newsroom/reston-hospital-announces-20-million-dollar-surgery-expansion-project
2. MarinHealth Medical Center installs IX Series to increase communication, privacy, https://www.aiphone.com/home/News/marinhealth_pr
3. HOSPITAL IQ BUILDS UPON RECORD GROWTH YEAR OF DOUBLED REVENUE AS INTELLIGENT AUTOMATION PROVES CRUCIAL FOR HEALTHCARE, https://www.hospiq.com/about-us/press-releases/hospital-iq-builds-upon-record-growth-year-of-doubled-revenue-as-intelligent-automation-proves-crucial-for-healthcare/
4. Ethicon Expands Advanced Biopolar Energy Portfolio With Launch Of Enseal X1 Curved Jaw Tissue Sealer, https://www.jnj.com/ethicon-expands-advanced-biopolar-energy-portfolio-with-launch-of-enseal-x1-curved-jaw-tissue-sealer
Ebony Smith
Ebony Smith was previously Managing Editor for Healthcare Purchasing News.
