How Remote Video Auditing Can Improve OR Operations

Di Capua John GIncreasing operating room efficiencies is an uphill task, as there is an almost constant flow of activity in this area. Coordination among teams of surgeons, nurses and support staff is essential for an optimal surgical environment as well as efficient turnover times.

There are a number of practices and processes that can improve efficiencies and utilization by increasing engagement in the OR. However, these only work if every staff member is 100 percent compliant. But how can a healthcare organization ensure this compliance without resorting to rigorous accountability and  punitive measures?

According to John Di Capua, MD, CEO of North American Partners in Anesthesia and senior vice president of anesthesiology services for the North Shore-Long Island Jewish Health System in Manhasset, N.Y., the answer lies in remote video auditing technology.

"For the first time, we are collecting unbiased information about activities in the OR," says Dr. Di Capua. "With RVA capturing data on 100 percent of these activities, the statistical power of the data that is gathered is unquestionable — allowing us to implement strategies that deliver better care through enhancements to overall performance, operating efficiencies and patient safety."

Origins of RVA for the OR

In 2007, NAPA introduced the concept of surgical safety checklists in a North Shore-Long Island Jewish hospital and then subsequently deployed the tool in all NAPA hospitals. "But we were still seeing mistakes in the OR," says Dr. Di Capua. "In this pressurized environment, it's easy for the team to miss a step in the checklist process. So we started thinking not only about how to deploy the checklist, but also how to make sure that every team member was engaged with it. RVA technology presented itself as an option to accomplish this.”

Dr. Di Capua saw that RVA was being used at North Shore University Hospital in Manhasset, N.Y., to ensure hand washing compliance in the intensive care unit. Cameras were placed near hand washing stations. The feed was monitored and data was collected. Real-time OR status information and OR performance feedback was posted to wall-mounted, digital scoreboards. With the scores streaming directly onto the boards  — and without mentioning any individual names — compliance quickly zoomed from less than 10 percent to nearly 100 percent.

This success led NAPA to partner with Arrowsight, a company focused on providing operational improvement solutions, in order to develop proprietary RVA technology for the OR, called NAPA Peak Performance². "We adapted remote video auditing for the OR to improve compliance with checklists, increase OR efficiency and productivity and ultimately, enhance the quality of care that was being delivered," says Dr. Di Capua.

Pilot Program

The program to introduce RVA technology in the OR was deployed in early 2013 at Forest Hills (N.Y.) Hospital. According to Dr. Di Capua, the program involved setting up LED boards wherever the departmental leaders wanted them — at the nurses' stations, in the anesthesia department as well as in the waiting rooms. These boards displayed the status of the surgery and made that information available to everyone, including patients' families.

An auditor was also assigned to monitor the system and communicate with the surgeons and support team. For example, as soon as the auditor saw that a procedure in the OR was complete, he would alert all the team members who were affected by turnover times. The information displayed on the boards was also made available via a smartphone application. Surgeons could download the app and thus be informed as soon as a procedure in the OR was complete, in addition to knowing when the room was ready for the next procedure.

The system was introduced to the senior management first and then to the staff. "Educating and training senior management prior to the staff was important as it equipped them with the proper tools and knowledge to guide their staff on this new initiative," says Dr. Di Capua. NAPA and Arrowsight collaborated to customize the system according to the insights they gleaned from management and staff feedback.

The Changes RVA Brought About in the OR

According to Dr. Di Capua, RVA has led to drastic changes in the OR at Forest Hills Hospital. Previously, they took staff at their word on task completion. "For example, if I asked whether the surgical safety checklist had been completed, every staff member would say 'yes.' Once we implemented RVA, we actually found that the compliance rate was 24 percent," he says.

Data objectivity and constant monitoring are two key aspects of the system that make it effective. Previously, compliance was measured by a third-party coming into the OR to ensure that all the steps were being followed. "But when someone is in the room, everyone is extra careful," says Dr. Di Capua.  "You need to see what happens when nobody is in the room to get an accurate representation of actions."

RVA also led to greater satisfaction among physicians, patients, staff and even healthcare facility administration. "We started tracking OR metrics, such as turnover time, and made that information known to the medical and administrative staff. The results showed that we saved 50 minutes per OR per day," says Dr. Di Capua. This allowed surgeons and staff members to leave work on time. It also increased patient satisfaction due to fewer delays. Healthcare facility leaders were happy because they could offer more blocks of time to more surgeons and thereby increase caseload and revenue, says Dr. Di Capua. In addition, the monitoring system confirms whether ORs have been cleaned thoroughly and properly, both in between cases and overnight, thereby reducing the risk of infections.

Once implemented, the RVA system and the changes it brought about have been easy to maintain. "What typically happens when the champion of a new project leaves is that the team goes back to behaving the way they did before the project was implemented," says Dr. Di Capua. "But with RVA, the results keep on coming. Once the system is in place and the auditors have been assigned, the program can run without burdening facility resources. The program results in improved compliance, which can be maintained, leading to more efficient and effective OR processes."

Click here for more information on NAPA’s Peak Performance² program.

More Articles on Anesthesia:

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University of Michigan Health Startup Receives FDA Clearance for Patient Monitoring Software

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