Feature | December 17, 2007 | Maureen Leahy-Patano

Going Digital in the OR Reaps Suite Rewards

In healthcare, as in any industry, the ability to stay competitive involves proper protection and management of assets. Outside of its personnel, one of a hospital’s biggest assets — and a major contributor to the facility’s bottom line — is the OR. As a result, many hospitals are redesigning workflow, automating processes and integrating equipment in order to optimize efficiency, safety and productivity in the surgical suite.

Digital and wireless solutions are key elements of the high-tech ORs of today and beyond. Imagine being able to access information and control equipment in the OR at the touch of a button or at the sound of your voice, essentially customizing the suite to your requirements. Solutions that allow OR staff to do that, and more, provide the necessary tools to meet today’s workflow and patient care needs, while anticipating tomorrow’s trends.

Customized Care

Important considerations to keep in mind when installing a digital OR system are the size and needs of your hospital or outpatient surgical center, advises Earl McFadden, M.D., director, Orthopaedic and Neuro Spine Institute, Providence Hospital Northeast, Columbia, SC.

“A true digital OR, with all the bells and whistles, is not intended for every facility,” he explained. Dr. McFadden recommends buying only the digital pieces that you need from a solution that allows you to “add as you go.”

The Smith & Nephew Digital OR, which the institute installed about four years ago, allows facilities to do just that. This scalable solution can be customized to a facility’s individual needs with features such as monitoring, teleconferencing, integration of equipment including microscopes, C-arms and the hospital’s PACS, and booms to consolidate and protect vital equipment.

Locating OR equipment on booms keeps the equipment in better condition and lasting longer, and the booms can be easily pushed away when not needed. However, Dr. McFadden believes they are only necessary for larger surgical suites — those with five or more ORs. For an outpatient surgery center, having the equipment on independent towers is just as efficient, he says.
Perhaps the single-most effective component of the digital OR for contributing to a surgical suite’s efficiency is the system’s monitoring capabilities. “Putting cameras in each of the ORs facilitates more rapid turnover and allows for efficient use of the OR — you can monitor and observe the surgical progress without having to call into the room and disturb the operating personnel,” Dr. McFadden said. The cameras are also great teaching tools that allow you to interface with residents when necessary without “breaking scrub” and leaving your own OR, he says. In addition, he believes Smith & Nephew’s monitoring capabilities are unique because the cameras can be positioned to give observers three different perspectives: they can see how the patient is positioned, they can watch the surgeon’s hands, or they can see inside the body.

Dr. McFadden also finds audio/visual technology abundantly helpful for teaching a variety of different skill levels ranging from surgeons, to physical therapists, to students. He believes down the road, much of the “on-the-job training” required of OR techs will be accomplished by teleconference observation, thus allowing them to expedite their proficiency.

When Poudre Valley Hospital, Fort Collins, CO, wanted to transform their outdated, cumbersome ORs into integrated minimally invasive surgery (MIS) surgical suites, they chose CompView Medical’s NuBOOM system. The NuBOOM all-in-one equipment management and visualization system features cabinets and shelving for medical and video equipment and two 9-foot booms with 35-inch extension arms for six-axis positioning. The digital operating control system (DOCS) touch panel control system allows the user to easily select the video source for each monitor. Its open architecture design supports multiple inputs, including endoscopic video, fluoroscopy, PACS, RIS, EMR and the Internet.

At the time, Poudre’s extremely busy OR was averaging 50 cases per day and downtime to do a remodel was not an option.

“We were able to install two NuBoom rooms and three DOCS in one weekend,” said Steve Stout, RN, BSN, surgical services business associate. “We uncrated the NuBooms on Friday evening, worked with the anesthesologists and general surgeons on Saturday to determine the location of the booms, did a little bit of tweaking on Sunday, and by Monday morning we were operational,” he explained.

Poudre made their ORs safer and more efficient by replacing cluttered rooms crammed with carts and electrical cables with NuBOOMS that house ergonomic equipment safely out of the way.
Essentially, CompView has brought their audio/visual management expertise to the OR and the result has been a versatile, reliable, affordable system with service that is second to none, says Stout. Their engineers listened to our surgeons’ ideas and made adjustments based on those suggestions. And they are working on a new monitor arm for the system that incorporates even more end-user feedback, he added.

Camino Medical Group SurgiCenter’s recently opened facility in Mountain View, CA boasts the integrated OR solution from ConMed, which locates nearly all the equipment in the OR onto a boom suspended from the ceiling. The equipment is then controlled from a digital touchscreen monitor located at the nurse’s station in the corner of the room.

“Minimally invasive surgeries involve a lot of technology and visually assisted procedures,” said Director Melody States. “This solution gives the physicians and nurses control over where, how and when they want to view the various images being created. In addition, the solution’s audio/visual conferencing capabilities allow for an image to be routed to a different OR or procedure room for a second opinion, if necessary.”

Documented Success

IT systems manage the flow of patient information throughout the hospital, making it available when and where its needed. This is especially important in the OR where real-time access to data allows the surgeon to make informed decisions without missing a beat. Automated documentation solutions have the added potential to streamline productivity, reduce costs and increase patient safety.

Camino Medical Group SurgiCenter acquired the Picis CareSuite total perioperative automation system in 2006 and spent nearly a year developing the user-defined system to meet their particular needs. They created a system comprised of multiple, different modules that documents every step of the perioperative process from pre-admission to recovery, including a robust reporting system.

“In the OR, vital signs information from various patient monitors are automatically dumped into the EMR so the anesthesiologist no longer has to do manual documentation,” States said. “The nurses then document their notes into a separate module. A big advantage is that the modules have the ability to connect, with the result being one streamlined medical record that staff can look at during any point in time during the patient’s stay.”

“The Picis system allows caregivers to focus more on patient care because it enhances the whole continuity of care,” she continued. “As the patient moves among care providers, all documentation is available at their fingertips.”

“The automated reports have reduced the amount of time and money we have put into reporting and collecting information, and have allowed us to reduce documentation errors,” added Daniel Basinger, clinical systems analyst, Camino Medical.

While digital OR solutions may be unique in nature and design, their purpose is universal: outfitting surgical suites with the digital tools necessary to optimize their patient care and workflow needs, today and into the future.

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