Increase in Robot Assisted Operating Room Efficiency: A Quality Improvement Study
Diboro L. Kanabolo, MD1, Paul Merguerian, MD2, Daniel Low, MD1, Jennifer Ahn, MD2, Nicolas Fernandez, MD, PhD2.
1University of Washington, Seattle, WA, USA, 2Seattle Children's Hospital, Seattle, WA, USA.
Introduction:Nationally, the economic impact of COVID 19 resulted in billions of dollars in lost revenue. Consequently, adaptation to this challenge has placed a premium value on operating room efficiency. Previous literature from our group on standardized perioperative protocols has shown positive variation, with average time improvement by standardizing and intervening intraoperative tasks. Our aim is to reduce operative time, provide value by reducing total robotic console time in robot assisted pyeloplasty (RP) cases. We hypothesize that process improvement and supply management during RP leads to a significant reduction in operative time.
Methods:Baseline data was collected and assessed using process control charts for RP to capture operative time and tasks performed during different sections throughout the surgery. Interventions included: standardized OR staff task list, a priori supply inventory procurement for each anticipated major step in the case. These steps included: patient positioning, docking, retroperitoneal and ureteral dissection, hitch stitch, pyelotomy, stent placement, and anastomosis. Variables of interest included intra and postoperative complication rates, procedure laterality, consoles used, console time per surgeon, instrument active time, instrument inactive time, instrument count and exchanges, trainee console time, and trainee involvement. Outcome of interest was RP duration. Baseline data for RP cases performed between November 2020 and February 2022 by a single surgeon (NF) were automatically extracted from charts and analyzed using AdaptX (Seattle, WA). Cases performed after intervention started on March 1 2022 and continued until March 2023. Student’s t-test was used for continuous variables, assuming unequal variance.
Results: We identified 37 patients undergoing RP during the study period. 15 cases were performed prior to intervention and 22 post intervention. Dual consoles were used in 40% and ~69% of cases pre- vs post- intervention, respectively. No difference in patient age distribution between groups was seen (p=0.1498). Trainee operative time did not differ statistically pre- and post-intervention (61.3 vs 48.6%, p=0.0871). Total console time prior to intervention was 152 vs 109 mins after intervention (p=0.0002). Dual instrument inactivity was reduced from 13.1% to 7.1% (p<0.0001).
Conclusions: Decreasing surgical lapses and standardizing intraoperative tasks can consistently facilitate more efficient case completion and increase OR capacity. By reducing robot operative time, more cases may be added, improving patient throughput.
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