Are integrated ORs worth the cost and effort to install? I think so. Since we renovated 6 of our 8 ORs in 2013, we can call up patient information at the push of a button and control high-tech equipment on a single touch-screen device. Our efficiency, safety and satisfaction have all increased thanks to our high-tech rooms.
For us, integration was all about streamlining the perioperative workflow and increasing the interconnectivity of our equipment and software systems. It started when we realized our 25-year-old ORs needed a facelift. Within the last few years, they'd become crowded and outdated.
To fix that, we installed booms and purchased new capital equipment, including high-tech 2D and 3D endoscopic video systems and 58-inch monitors. We also made minor cosmetic changes, like a fresh paint job. Each room took 3 weeks to renovate and inspect.
The new equipment is great, but it's the interconnectivity of the systems that makes our ORs special. We are 100% integrated. All of the equipment and devices in the rooms from the lights to the laparoscopes are connected via a single software platform, letting a nurse or surgeon control everything with a single, small flat-screen device. Instead of the circulator getting up and turning on each piece of equipment, she can now just push a button.
The system also saves surgeon preferences. So, if a doctor is coming into the OR to do a knee arthroscopy, the circulator or the surgeon can log into the system, click on the doc's name and hit "knee arthroscopy." All of the equipment, including the shavers and burrs, will then turn to the settings he typically prefers. This really helps staff prep cases more efficiently.
One of the biggest benefits of integration is our improved patient and staff safety. Take, for example, the integrated suites' voice confirmation system. Let's say a surgeon tells the circulator to turn the electrocautery device up to 30%, but she mishears him and turns it to 40%. Before the temperature increases, the voice confirmation system will say, "The Bovie has been turned up to 40%," giving staff time to react and change it to the correct setting. In the integrated ORs, anytime we change the strength of intensity of something, you get that confirmation.
The interconnectivity also extends to our other departments and even to areas outside of the facility. The rooms' video conferencing lets surgeons telecast a procedure to a conference or a classroom, or phone-in another physician for a second opinion. This feature is also used within the hospital to cut down on wasted time going back-and-forth from the OR to other departments.
For example, in the past a surgeon would take a specimen in the OR, send it down to pathology, and if something wasn't right, pathology would have to come back to the OR, scrub in and speak to the surgeon. Now that we're integrated, pathology and the OR can instead videoconference with each other.
In addition to face-to-face speaking and broadcasting the endoscope's images, the video system also lets you tele-illustrate. That means in the example above, our pathology department could highlight or circle things on the screen to show surgeons exactly what they needed.
Finally, the room is also seamlessly integrated with the hospital's electronic medical records. This lets the surgeon access the patient's path report, X-rays, CCT scans and other pieces of information in the OR and display them on the big screens for the entire team to see.
The University of Pittsburgh Medical Center (UPMC) takes patient records seriously. It has to in order to keep its 20 hospitals and more than 500 doctors' offices and outpatient sites connected. The healthcare system's integrated patient records are why it has been named one of the "Most Wired" providers in the country for the past 17 years by Hospitals & Health Networks, the journal of the American Hospital Association.
The key to UPMC's success is its integrated electronic medical records, which let doctors and staff pull up a patient's history from nearly anywhere in its facilities, says Steven Whitehurst, MD, anesthesia and perioperative informatics lead of UPMC. "To me, being 'wired' means having the information available when you need it and where you need it," he says.
This ability to pull up X-rays, labs and other patient information is especially key in the OR, says Dr. Whitehurst, where surgeons and anesthetists need to make snap decisions during the case.
"In surgery, the point of care is in the OR," he says. "With the integration, we get the information fed to us as we're doing the procedures, so we can see them on the screen and make adjustments as necessary."
The equipment also communicates with the records system, says Dr. Whitehurst. UPMC's anesthesia machines digitally record information like a patient's oxygen saturation or blood pressure that providers used to document manually, and its endoscopic video systems can save and send photos to the EMR.
Not only does this integrated system make everything more efficient and let the massive health system treat more patients, says Dr. Whitehurst, it also ensures those patients are getting the best care possible.
"You're making things safer," he says. "Complications cost money. You can avoid bad outcomes if you have more information on hand. I know that we can catch more now based off of the EMR information we see in the OR."
While our high-tech rooms work effortlessly now, it took a lot of prep and planning to get there. After our lease with our previous vendor ended, we started looking into integration. Several manufacturers offer integrated suites, but we sought out those offering the most up-to-date features, like 3D video and voice activation.
Once it was narrowed to 2 contenders, we solicited input from the surgical teams. For several weeks, staff and surgeons trialed the equipment. In the end, everyone voted. They overwhelmingly chose one company (which we ultimately went with) because it had more technology to offer.
After we chose the vendor, next up was deciding which rooms to renovate and what technology to include. I considered the updates the rooms needed right away like new video systems and booms, for example as well as features I thought they might need for the future, like video conferencing, since the hospital's goal at the time was to become a teaching facility.
This type of thinking could help save you thousands if you're considering integration. By getting the technology we needed for both today and tomorrow, we saved ourselves from having to go through the backend of the system to upgrade it with the videoconferencing technology, which would have cost twice as much.
While the hospital originally planned to renovate and integrate only a few of the ORs, we ultimately decided to do 6 of our 8 rooms, only leaving out our 2 urology suites. We knew that otherwise it would be a scheduling nightmare for surgeons. Everyone wanted to use this technology, so we ended up forking over the money and it has been worth every penny so far.
Desirable place to work
While increased efficiency and safety are 2 big benefits to the new rooms, our surgeons' desire to use the integrated suites has also helped make the upgrade worth it.
At the time we started the process of integration, we had a lot of senior surgeons and wanted to bring some younger doctors in. Since implementation, we've definitely done just that. But, the surprising thing is that our older surgeons like the technology just as much. And it's not just our surgeons attracted to the hospital's high-tech ORs. Our staff loves them, too. I even have a waiting list of people wanting to join our team, and that's in a time when most are struggling to try and find OR nurses. I correlate that to the technology and equipment we have here. People don't have to work harder, since they're working smarter.