Today’s operating room, environment requires OR staff to be able to plan for, set up, assist with, and manage increasingly complex high technology procedures. Differing levels of training and variations in recent experience are additional challenges to providing a proficient, confident OR team every time for every case. This software solution gives operating room staff (even those with minimal computer experience) the tools to easily create a real time point-of-care electronic guide for every aspect of team responsibilities for any surgical case. Step-by-step instructions show end users how to incorporate pictures, video and text to guide the set up of the operating room for each surgical procedure. Key elements of the operation can also be demonstrated in sequential fashion. Additionally, the resource is fully indexed to provide fast, easy access to the library that is created by the surgical teams.
The project was designed to create a user-friendly application for developing electronic versions of education and training resources for the OR. Since the average cost of training a new hire is generally at least 1.2 times more than their salary, and using “travelers” until a permanent employee can be hired is even more expensive, it became necessary to find a more cost-effective method for training and education. Our solution was to develop an easy to use computer-based content management system to facilitate information distribution.
The system’s menu begins with a three-dimensional model of the human form. Nurses, technicians and surgeons are able to click on an anatomic region and select the desired surgical procedure. The menu then facilitates navigation through a variety of sections including, patient positioning, draping, Mayo stands, back table layout, physician preferences, equipment setup and troubleshooting instructions. The information can be created and displayed as full-color high-resolution images, video, text instructions, or a combination of any of those techniques. It helps new operating room nurses and surgical technicians to quickly achieve basic competence and familiarity, and also allows experienced staff members to quickly review procedures for difficult or low-volume cases. Surgeons may easily translate their knowledge, experience and preferences into a sharable, durable format.
Procedure details that can be incorporated for training include pick sheets, preference cards, instrument assembly and equipment setup. The application is completely customized and allows each OR to develop its own unique case preparation procedures. The intuitive user interface permits the staff to quickly review setup procedures prior to each case. Developed in-house for approximately $50,000 and 500 man hours, the application has helped nurses and surgical technicians develop confidence in their preparation and knowledge base. Surgeons agree that the system has improved the performance of the surgical team.
Since adopting the system in the summer of 2006, St. Vincent’s has reduced its traveling staff to 0 from 41 out of 80 positions. Although many factors have contributed, improved staff and surgeon satisfaction related to use of the software is felt to have had a major impact. Using permanent staff instead of travelers has resulted in a net gain of about $1.5 million annually in labor costs.
As noted earlier, the system has not only simplified education and training, but has also served as a ready resource for nurses and technicians to review key details of the operation prior to the start of the procedure. Turnover time has been reduced to an average of less than 30 minutes for complex inpatient procedures including cardiac surgery, total joint replacement, spine surgery and major abdominal procedures.
With the utility of the application having been clearly demonstrated in an operating room environment, we now realize that the tool has a more universal potential and are planning to expand the system to the ER, ICU and Recovery floors. We estimate it may take up to 320 labor hours in each department for the electronic reformatting of training and education resources. Our organization plans to apply for funding from the American Recovery and Reinvestment Act of 2009 to continue the development of the application.
Patients under anesthesia in the operating room are one of the most vulnerable patient populations in healthcare. Not only can they not speak up for themselves, but family members are not present to advocate on their behalf. Our point-of-care electronic guide has improved patient care and safety by helping members of the surgical team to be well-prepared for their roles. We plan to extend the same help to our ICU and ED teams, who care for a similarly complex and vulnerable group of patients.
John Middleton
Physician liaison for medical informatics
St. Vincent Healthcare
Billings, Mont.
