In surgery, the state of the art rarely stands still. While technological advances have long been the primary driver of change, recent years have seen the impact of the economy on how surgical care is delivered. Here are 3 ways that healthcare reform and its effects will change the way your OR works.
1 It'll be busier, but EMRs breed efficiency
The aim of 2010's Affordable Care Act is to insure the uninsured. This is likely to create a larger patient population, which could in turn lead to higher case volumes in surgical facilities nationwide.
"There will be a great demand for preventive services," says Debra Ann Maleski, MBA, a senior associate at the ECRI Institute, a non-profit healthcare research organization in Plymouth Meeting, Pa. "This will result in additional imaging and surgical procedures needed and ordered," particularly among Medicare patients and others who don't face high deductible barriers.
Clearly, the surgical workplace will need to adapt to meet this demand. "Estimates I've seen run as high as a 10 to 15% increase in volume," notes Terry Miller, BSEE, executive vice president of Gene Burton & Associates, a Franklin, Tenn.-based equipment planning firm. "No industry can accept an increase of that magnitude without implementing new efficiencies. The alternative would be chaos.
"Today, our key element of efficiency is increasingly technology," says Mr. Miller. "Tools that let us accomplish more, faster, using the same resources and staff. In health care, tools must be employed to streamline the diagnostic process, reduce redundancy, automate testing and reporting, decrease procedure time and speed recovery."
Chief among these tools are electronic medical records systems, on which OR teams will rely heavily. "Greater interfacing of information will lead to greater efficiency," says Ms. Maleski. "Quickly obtaining and comparing data can lead to faster and potentially better care."
Healthcare information technology has been the leading capital expense industry-wide for several years running, and Mr. Miller acknowledges that more than a few facilities have struggled with its implementation. "Yet if properly applied, the promise of EMRs is efficiency: immediate access to current, accurate patient records, reduced testing, quicker diagnosis and treatment execution, and more thorough follow-up."
All of which can reduce time and expense. "Healthcare is largely an information-based industry," he says. "Information, in many ways, is the raw material of good medicine."
2 It'll be versatile: Meet the hybrid OR
"Making surgery less invasive continues to be the main trend across all clinical service lines and patient populations," says Ms. Maleski. "Although published evidence does not always support the touted benefits over more invasive or less high-tech approaches (as in the case of robotic surgery), a large percentage of patients will continue to expect and demand minimally invasive surgery."
The streamlined procedures and speedy recoveries promised by minimally invasive approaches benefit from ORs that are fully integrated with real-time imaging technology, and this technology may in fact boost the widespread adoption of the "hybrid OR," says Mr. Miller. A concept emerging from hospitals' interventional procedure rooms, hybrid ORs could optimize surgical suites to accommodate more types of cases.
Hospital angiography and cardiac catheterization labs are outfitted with imaging technology that let physicians view and navigate delicate pathways. But these procedure rooms aren't usually considered part of the surgery department because they've been designed for radiology cases.
"So you prep the patient, bring him into the room, anesthetize him, make the incision, do the procedure, close and take him to recovery. Doesn't that sound like surgery?" argues Mr. Miller. "Today, more and more surgeons want that kind of real-time imaging to support their minimally invasive cases."
Alternatively, in the event that a diagnostic imaging procedure in a cath lab reveals a cause for immediate action and a mid-case conversion to surgery, the equipment and ventilation of a surgical OR would prove convenient. "The future of surgery is the ability to have that kind of imaging lab and surgical setting blend," says Mr. Miller.
High-quality real-time imaging could ramp up the use of remote robotic surgery, he says, pointing out that an OR with no people in it except the patient could be a boon to infection prevention efforts. It could also open the door to telesurgery. "Once you're outside of the room, you could be anywhere," he says. "That, to me, is the promise of OR integration."
3 It'll be profitable (if it's practical)
A growing patient population and efficient technology aren't all that's necessary to survive in the volatile healthcare economy. Shrinking reimbursements from government and commercial insurers underline the importance of capturing charges, maintaining quality and eliminating waste.
"Cost containment is key," says Ms. Maleski. "It will have a direct impact on the clinical environment. Surgeons' OR times and OR turnover times will be monitored, with an emphasis on improving both. There will be a push for supply standardization to reduce product costs and increase staff and surgeon efficiency."
Don't underestimate the consumer appeal of surgery's more marketable aspects, such as the long list of what patients can have done and still be discharged home the same day. "ASCs are continually adding more complex procedures," says Lynne Ingle, RN, MHA, CNOR, a medical equipment planner for Gene Burton & Associates. "This is related to the adoption of more advanced technology in minimally invasive surgery — for example, the anterior approach for total hip arthroplasty — and new means of managing post-op pain. I see ASCs adding the ability to do more intensive post-op care, like a 23-hour unit from the old days."