orm_november-2023 - 29

Technology
Surgery Growth
Source: Inova Health System. Used with permission.
modules for sterile processing. Second
is hands-on training of the skills they
learned in the modules, including placing
instruments in the robotic arms.
Third is a checklist that has evolved into
a hospital competency for each staff
member who works with the robot.
The fourth step is training with the
surgeons. The coordinators and sales
representatives accompany the surgeons
to the porcine or cadaver lab, where they
learn to use the robot. " This is helpful
for both sides, " says Hill. " The surgeons
feel supported, and it is good for the
staff to see the training the surgeons go
through. "
Standardization creates
efficiency
" Efficiency is key, " says Hill. This involves
reviewing instrument utilization on
the online portal. The portal shows how
many of each instrument is used, how
many lives each one has, and whether
there are instruments that are not used
and should not be ordered again.
Efficiency also involves streamlining
the instrument trays. In the beginning
of the program, there were separate inwww.ormanager.com
strument
trays for every procedure. For
example there was a bariatric surgery
tray, general surgery tray, and gynecologic
surgery tray. " That was a waste
of sterilization time, and they took up a
lot of space, " says Hill. Presently, she
says they have moved to mostly singlewrapped
peel-packed instruments so
just the instruments needed for a case
are opened. They still have trays for trocars
and cords.
Having the same room layout for each
procedure adds to standardization and
efficiency; however, the same room layout
isn't always possible because room
size and door positions aren't always the
same, says Hill. The Xi robot has made
room layout easier, she says, because of
the boom. The robot can be left on one
side of the room and moved into position
with the boom when the case starts.
Surgeon's preference cards should
be updated regularly and the changes
shared with the staff. This can be done
at regular staff meetings or steering
committee meetings. Hill notes that she
learned early in her career that staff and
surgeons have great suggestions on
how to make a case more efficient.
Standardizing block management results
in higher utilization, more efficient
surgical time, and ultimately increased
return on investment. " One thing we
all face is when open cases go into
robot rooms and hinder the schedule, "
says Hill. Once a surgeon's block is released,
she says coordinators together
with schedulers can move open cases
out of a robot room and let surgeons
know the robot room was available.
" This is very helpful for increasing utilization, "
she says.
Standardization of turnovers began
early on when there were only four staff
members doing robotics, and the sooner
the cases finished the sooner they could
go home, says Hill. The team pulls the
robot out of the way and undrapes it
as soon as the surgeon is done with
it, starts bagging the trash and linen,
and then starts disassembling the
back table while the assistant is closing.
The scrub nurse sets up a closing
Mayo tray with suture, knife, scissors,
and sponges, and then helps in breaking
down the back table. " When the
drapes came off, everything is pretty
much done, " says Hill. " Having all team
OR Manager | Nov/Dec 2023 29
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