OR leaders spend much of their day ensuring the surgery schedule runs smoothly, a task that depends on the teams within each of the ORs. Highly functioning teams produce optimal results, including good patient outcomes, satisfied surgeons, and efficient use of resources. But developing a highly functional team with good synergy can be challenging, particularly as new staff are added into the mix.
A new tool can help OR leaders meet that challenge. ExplORer Surgical is an interactive surgical playbook that promotes teamwork. It uses data analytics to keep surgical teams organized and coordinated during a procedure, which reduces disruption as well as wasted time and supplies.
The playbook displays on a tablet the specific, role-based information that each member of the OR team needs to know, and a master display shows items of interest to the entire team, such as the overall progress of the case. ExplORer Surgical, created by Chicago-based ExplORer Surgical, also uses data analytics and artificial intelligence, which can help OR managers track case progression in real time and forecast room utilization, staffing, and equipment use.
Monitoring supply use
"ExplORer is an electronic checklist, but with all the bells and whistles," says Dimitrios Stefanidis, MD, PhD, professor of surgery at Indiana University (IU) School of Medicine in Indianapolis. "It provides a lot of data, which helps you make decisions." Dr Stefanidis, chief of minimally invasive and bariatric surgery at IU Health North Hospital, and vice chair of education for the IU school of medicine department of surgery, adds that data collected by ExplORer Surgical can be used to identify which steps of a procedure have the most variability. "If a process step is very variable, it might not be very well orchestrated and can be streamlined better," he says.
OR Manager spoke with Dr Stefanidis and two nurse leaders at IU Health North Hospital in Carmel, Indiana, where a study of ExplORer Surgical is being conducted to gain a better understanding of its potential in the OR, including the effects on team function and patient outcomes.
"Benefits include that it's able to be kept on the sterile field and eliminates paper waste. Updates take effect immediately, and photos are available," says Susan Beck, MBA, BSN, RN, operating room and endoscopy clinical manager at IU Health North Hospital. "Only supplies that are needed are opened, so it saves money, and it's a great tool for those who are less experienced with a particular case."
Currently six surgeons at the hospital are using ExplORer Surgical for open ventral hernia repair and robotic gastric bypass as well as the following laparoscopic procedures: appendectomy, cholecystectomy, bilateral inguinal hernia repair, left/right inguinal hernia repair, sleeve gastrectomy, paraesophageal hernia repair with Nissen Fundoplication, gastric bypass, and ventral hernia repair.
A coordinated approach
Common sources of delays in the OR are lack of the right supplies because of outdated preference cards and new staff uncertainty about next steps in a procedure. ExplORer Surgical incorporates the surgeon's and anesthesiologist's preferences and protocols for a procedure and provides role-specific information for each step of the case to each surgical team member. "ExplORer takes the preference card to the next level," Dr Stefanidis says. Surgical technologists, for example, can see photographs of what is needed to set up the tray (photo at left).
"It's up to the surgeon to define the steps," Dr Stefanidis says, but adds that ExplORer Surgical staff have a library of surgical cases to use as a starting point, so the surgeon simply needs to adjust as needed. Example steps are anastomosis and closure. IU Health North Hospital also provided ExplORer Surgical with existing preference cards to be entered into the system.
During the procedure, a designated team member advances the master display through the steps, but each person on the team (surgical technologist, circulator, anesthesia provider) can independently advance to the next step on his or her own screen to better anticipate what will be needed.
Onboarding and education
One of the biggest benefits of ExplORer Surgical is shortening orientation time for new staff. "Having pictures and videos can accelerate orientation because a lot of us are visual learners," Beck says. For example, instead of reading a description of how to position a patient for a complicated procedure, staff can see a photograph.
The educational opportunities with ExplORer Surgical also can help save staff time, says Sondra Jones, MSN, RN-BC, CNOR, CRCST, clinical educator for surgery at IU Health North Hospital. "They can review a video of the procedure the night before," she says. Staff will know what instruments, supplies, and equipment are needed and what to expect, particularly for procedures with which they are less familiar.
Up and running
"It takes about 6 weeks for people to get comfortable with [ExplORer Surgical]," Dr Stefanidis says. Before the first case, staff had 4 days to practice with the system and ask questions of company representatives. In addition, staff from the company were onsite for the startup, and Jones provided in-services.
Because of the ongoing research project, currently the only fee is for keeping the information updated, Beck says.
The research project for ExplORer Surgical is expected to end in the summer of 2019. After that, the team plans to evaluate its future role. "The healthcare industry is ever changing, and new technology like ExplORer Surgical helps us to advance our thinking and continue to improve," Beck says. ✥
Cynthia Saver, MS, RN, is president of CLS Development, Inc, Columbia, Maryland, which provides editorial services to healthcare publications.