Connected Care: How OR Integration Is Redefining Surgery

Here’s more about what it takes to upgrade your ORs to take advantage of cutting-edge digital capabilities.

“It feels like you are in a spaceship,” says Ally Silver, FACHE, MPH, assistant vice president of surgical services operations at Stony Brook (N.Y.) Medicine, of the health system’s hybrid ORs. “It really does offer something that no other room can offer.”

That something is the scalability, minimalism and high degree of technological usability that integrated ORs provide to surgical centers. These advanced ORs allow teams to easily adapt from routine, minimally invasive procedures to highly emergent cases, all within the same room. At Stony Brook, there’s no longer a need to bring different monitors, test results and specialists in and out of the room. Simply stated, the OR experience has become much more efficient and streamlined at the facility.

This level of integration provides numerous benefits, including quicker procedure times, patients spending less time under anesthesia, decreased lengths of stay, reduced risk of communication-related errors, enhanced workflows and an overall better work environment for surgical staff.

And there’s one more thing these advanced ORs have brought to Stony Brook Medicine: increased revenue.

Hybrid ORs vs. integrated ORs

The terms “hybrid OR” and “integrated OR” might be regarded as interchangeable by some. While both represent an upgrade over the traditional OR, there are in fact differences between the two. Hybrid ORs, like those at Stony Brook Medicine, typically involve a combination of two surgical services working in the same space. A common example is a hybrid cardiovascular OR, in which a patient doesn’t need to be transported from a cath lab to an OR because they’re both in the same room, says Suraj S. Soudagar, MS, MBA, LEED AP, senior principal and project executive at IMEG, a design consulting company. Hybrid ORs can include a fixed imaging system with an advanced, fixed surgical table that can support a variety of different procedures. Hybrid ORs provide the flexibility for a speedy transformation from case to case that maximizes room use and efficiency. An integrated OR, meanwhile, features a heightened level of technological capabilities. It may include video, lighting, robotics, recording and information-sharing equipment, all seamlessly integrated via a central integration component. Integrated ORs save providers time through their ergonomically-enhanced layouts and cohesive control systems.

There are different levels of integration, says Keith W. Mignault, MSBE, senior medical equipment planner at IMEG. Some centers need only video, while others also have audio streaming. The concept brings all the sources together into one integrated unit to make the OR run as efficiently as possible.

Hybrid and integrated ORs achieve the same goal of delivering seamless, cutting-edge technology that meets the evolving needs of a facility. The design and planning of these ORs are highly customizable. As technology continues to improve and advance, demand for better functionality will continue to increase, as will the demand for a higher level of integration in the OR environment. These next-generation surgical “spaceships” are a growing market and complement traditional ORs, improving the overall capabilities of a surgical center.

“The idea about integrated ORs is to get all the decision-making tools closer to the surgical field, so that the surgeon is making as informed a decision as possible for the best outcome of the patient,” says Mr. Soudagar.

Stony Brook’s story

SMARTLY CONNECTED Benefits of an integrated OR include the ability to pull patient records from remote EHRs and a decluttered workspace free of tripping hazards.

Six years ago, Stony Brook University Hospital installed two fully equipped hybrid ORs, each roughly twice as large as a traditional OR, that house a suite of very sophisticated imaging technology. These hybrid ORs required four years of planning before they were operational.

That’s not an unusual lead time. Mr. Soudagar says hybrid ORs generally take two to four years to complete, depending on the size and type of facility, and the number of ORs being upgraded. Due to New York’s certificate of need process, Stony Brook’s hybrid implementation had to be phased, which meant finishing one hybrid OR to provide the state’s health department time to survey the space before the start of construction on the second hybrid OR.

This staggered, yearslong process had its perks, says Ms. Silver. It allowed personnel at the facility to get their feet wet with a hybrid OR and work out all the kinks in terms of learning the new equipment and practicing setups and turnovers.

I think the hybrid ORs are essential for the high-level work that we and many other organizations are doing.
Ally Silver, FACHE, MPH

The new hybrid ORs were designed to work within Stony Brook’s existing workflow. Patients come in and out of the hybrid ORs the same way as patients who are treated in the facility’s traditional ORs. They go to the same PACU as well, and some of the equipment and storage rooms serve all the ORs, no matter if they are hybrid or traditional.

The hybrid ORs are usually scheduled like traditional OR rooms. However, if a particular surgeon has two cases that really require the hybrid environment and one case that doesn’t, the third case will be scheduled in a traditional OR. Having more than one hybrid OR also means that when one closes for repair or upgrades, the second remains open, allowing the facility to maintain a high level of care.

Stony Brook has dedicated surgical teams that run the hybrid ORs, and a dedicated team on call in radiology and nursing. That’s because they aren’t really turnkey operations.

“The hybrid ORs are very complex. They’re hard to use. They’re a little hard to set up,” says Ms. Silver. “It’s important that it’s managed and run by the same team consistently every day who really know how it works and is set up.”

While integrated and hybrid ORs provide important benefits for patient care, they also offer advantages for improving the competitiveness of a surgical center.

“I think the hybrid ORs are essential for the high-level work that we and many other organizations are doing,” says Ms. Silver. “Once a surgeon comes from somewhere with that image quality, support and real-time navigation, it’s hard to give up. And the more minimally invasive a procedure is for the patient, the better the outcome. The length of stay should be better. The recovery should be better.”

With all of the planning and training now in the rearview mirror, the two hybrid ORs have been a hit with Stony Brook’s providers. Due to that success, the facility plans to add more forward-thinking ORs. In the case of these additional new rooms, however, they will be of the fully integrated variety.

Integrated OR planning

There are many nuances to planning an integrated OR that ensure it can adapt over time to different needs and technological updates. For example, IMEG is already incorporating the functionality for 8K video technology into its OR planning, even though this technology hasn’t even been rolled out yet in the surgical environment.

“I would not recommend centers do this planning on their own,” says Mr. Mignault. “It takes about $120 a minute to run an OR. If you’re saving five to 10 minutes a case from an OR upgrade, you’re looking at millions of dollars a year if you have several ORs. When you’re upgrading, you should step out of the box and really assess where you want to be in five to seven years — and make sure you do it right.”

Surgical centers should consider how many ORs they’ll need available for use while an integration project is being completed. Upgrading two or more rooms at one time will allow for quicker implementation, but a center might not be able to afford to operate with only a few traditional ORs available during that time period.

“The most important thing to plan for is flexibility,” says Ms. Silver. “You want to be able to accommodate the newest technology and support the more complex cases, even if the ORs are not currently used for that purpose. You may not have a robot currently available in your surgical center, but you need to plan ahead to support one as you build and expand. The more inputs, monitors and booms available will allow for the seamless flexibility and capacity to ensure optimal utilization.”

An integrated OR project is ideal for administrators who are looking for ways to enhance operations at their facilities and provide the best tools to their surgeons.

“If you want the newer crop of surgeons, you need to upgrade,” says Mr. Soudagar. “And you need to choose the right partner to help you on your OR integration journey.” OSM