OR Manager November/December 2021 - 20

Scheduling
Block time strategies help maximize robot utilization, service line
mproving patient outcomes and
providing a superior experience for
patients were at the forefront of
the decision to grow the robotics service
line at Northeast Georgia Medical
Center (NGMC), Gainesville.
I
Expanding from one da Vinci S
system by Intuitive and six robotics
surgeons covering five specialties in
2008 to four da Vinci Xi systems and
27 robotics surgeons covering seven
specialties in 2020 impacted not only
operating time, but also staffing, room
availability, and standardization.
The formation of a robotics steering
committee and support from Intuitive's
Ecosystem, including the Genesis team,
were catalysts for change and instrumental
in developing block time strategies
so that all robotics surgeons had
access to the robots for their patients.
The Genesis team is
a group at Intuitive that
is dedicated to understanding
the strengths
and opportunities for
improvement in a hospital's
robotics program.
" Intuitive and the Genesis
team came to the
table with the steering
committee, and gave us
Sarah
Hepburn,
MSN, RN,
unbiased suggestions that were invaluable, "
says Sarah Hepburn, MSN, RN,
CNOR, OR manager at NGMC. " Whether
or not a hospital decides to use the information
the Genesis team gives them
is completely up to them, " she adds.
Robotic steering committee
" At the beginning of our robotics
journey, we realized that we not only
wanted to provide an exceptional experience
for our patients, but we also
wanted to improve patient outcomes, "
Hepburn says.
Members of the robotic steering
committee were chosen to facilitate
those objectives that align with
the " Quadruple aim: Improve health
outcomes, lower total costs, better
20
OR Manager | Nov/Dec 2021
patient experience, and improved physician
satisfaction. " They included a
medical director and an anesthesia provider
to help guide practices for optimal
patient outcomes, as well as operational
leadership (OR manager or director),
a robotics coordinator, surgeon
champions overseeing each service
line, and an Intuitive representative.
The chief operating and chief financial
officers also lent their support as executive
sponsors.
The steering committee identified
challenges and developed an action
plan. A key challenge was that crucial
data they would need for surgeon buy-in
was not available because they had not
adopted an electronic medical record. In
addition, there was no standardization
of work in the robotics room. Team A
would do things one way, and team B
would do things another way.
" It was just chaos, " notes Hepburn.
Because of the disorganization, the
robotics team did not finish cases until
10 pm. Some of the areas of opportunity
the steering committee identified
were:
* defining robotics block time
* determining total robotic utilization
* delineating turnover times
* looking at the types of procedures
being performed in the robotics
room
* committing the surgeons to using
their robotics block as robot time
and nothing else (ie, surgeon stacking,
defined under the section " Management
of block time scheduling " )
* processing robotic instruments in a
timely manner (eg, there was only
one ultrasonic cleaner)
* detailing par level spending (eg, how
frequently instruments are being
used, getting broken, etc).
Maximizing available resources
To maximize available resources, the
steering committee and robotics team
members reviewed key performance
indicators (KPIs) such as turnover time,
which included docking and undocking,
and they marked key data to collect for
tracking improvement.
They studied LEAN methodology and
standard work to identify ways to standardize
day-to-day processes within the
robotics service line. " We thought that if
we could make our processes standard,
and they were reproducible, maybe we
could make our robotics service line
more efficient, " says Hepburn.
Next,
the team looked at each
segment of care included in the total
procedure and how much time it took
to do each of those processes. Then
they created a standard for those
processes. This led to the standardization
of surgeon preference cards and a
reduction in the number of instruments
being opened for a case.
The surgeons actually recorded
their own procedures to find ways to
operate more quickly and use fewer
Efficiency KPIs tracked for continuous improvement
22minutes
In Pre-Op
to
In Room
13minutes
Anesthesia
Ready
To Incision
28minutes
Incision
to Close
9minutes
Out of Room
To
In PACU
72minutes
In Facility
to
In Room
To
In Pre-Op
118minutes
Anesthesia Ready
16minutes
In Room
to
Incision
109minutes
Source: Sarah Hepburn, MSN, RN, CNOR. Used with permission.
www.ormanager.com
Close
to
Out of Room
2minutes
In PACU
to
Criteria Met
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OR Manager November/December 2021

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