Publish Date: November 27, 2019
While ASCs may seem a natural fit for robotics — considering that the price to purchase some systems has come down in recent years and more complex procedures that can be performed using this advanced technology are increasingly shifting to ASCs — there is still tremendous risk in taking the robotics plunge. This makes it even more essential for surgery centers to understand what is required to launch a successful robotics program.
"Even with reductions in price, the cost to invest in a robot and all of the supplementary supplies and services is still quite substantial," says Andrea Lessner, BSN, RN, CNOR, total joint coordinator for surgical services at North Valley Surgery Center in Scottsdale, Ariz. "The good news is that, as an ASC like ours and others have shown, that investment can prove worthwhile and deliver significant clinical and financial benefits."
Lessner, who has extensive outpatient and inpatient robotics experience and helped launch North Valley Surgery Center's robotics program in early 2019, says the following are five keys to successfully adding robotics to an ASC.
- Surgeon leadership. Without surgeon leadership committed to robotics, a program is destined to struggle, Lessner says. "You shouldn't move ahead with buying a robot for surgeons who are on the fence as you run the risk of them doing one or two cases and then switching back to manual surgery. You need surgeon leaders who philosophically believe in robotics and will do as many of their cases with the robot as possible. That 'gung-ho attitude' is essential to getting the most out of the robot and ultimately achieving a positive return on your investment."
- Strategic alliance with the vendor. In most instances, the purchase of a robot from a vendor is accompanied by many other — and often ongoing — purchases from the same vendor. "These include implants, disposables and maintenance agreements," Lessner says.
Considering you will spend significant capital with this single vendor, approach the relationship as a more strategic alliance rather than just a series of transactions, Lessner advises. "Get close to this vendor and the representatives you will be working with. Become familiar with the vendor's portfolio and engage in regular discussions about opportunities to build the relationship, such as by expanding usage of the robot for other specialties. Determine how you can achieve savings and earn rebates as your spend with this single company grows over time. You're looking at building an alliance around quality, quantity and savings."
- Clinical integration plan. The time between when North Valley had its robot delivered and completed its first cases was just six days. This was possible because the ASC developed and then executed a clinical integration plan.
"We knew we weren't just buying a robot; we were getting into the business of robotics," Lessner says. "We did a significant amount of pre-planning so we could comfortably start performing cases not long after the robot arrived. This effort was coordinated with our strategic vendor partner and included extensive clinical staff education and on-boarding "
Also vital to safely streamlining integration: staff members with robotics experience. "While having a team less experienced in robotics does not preclude you from adding robotics, it will take you longer to clinically integrate it into your operating rooms," Lessner says.
- "Owning" the robot. While you should develop a close relationship with the robotics vendor and its representatives, do not use them as a crutch, Lessner advises. "You need to remember: It's your robot, not the vendor's or a rep's robot. Act like you 'own it.' That means setting up and sticking to a plan for pulling the robot out for staff in-services every month. Become comfortable getting the robot calibrated, running the diagnostics, setting up the handpieces and doing everything else necessary without a rep in the room."
Such an approach has come in handy for Lessner. "I was doing an in-service one day and we had a huge lineup of robotics cases the next day. As part of the in-service, I was testing the robot in front of the staff, showing them how to set up the handpieces and going over the parameters that needed to be met before bringing the patient into the room. Unfortunately, the robot wasn't passing the tests. Fortunately, I had time to figure it out what was wrong and correct the problem before we needed to make any changes to our surgical schedule."
She continues, "Strive to make your staff so knowledgeable in how to use the robot that everyone who interacts with it can identify when there is a problem and what to do, which will hopefully help you avoid encountering many issues at inopportune times."
- Building on excitement. Robotics in ASCs is still a relatively new concept, Lessner says. Leverage this when launching your program.
"Take advantage of the robot as a differentiator for your ASC," she says. "Encourage your surgeons to talk with their peers and let them know about the robot. Invite surgeons in to watch cases using the robot. Run practice labs and give prospective surgeons an opportunity to interact with the robot. You can also do outreach events and invite members of the community in. We have used virtual reality to give community members an opportunity to experience what it's like to use the robot. Generating positive buzz will help attract surgeons and get even more patients asking about robots for their procedures."
Free Resources for Members
AORN Journal CNE Articles
Robotic Emergencies: Are You Prepared for a Disaster? Grace Carlos, May Saulan; November 2018, Vol. 108, No. 5