Operationalizing a fleet of multiple da Vinci surgical systems is possible; here's how

The stigma that surgical robots are overrated or too expensive should be reconsidered because of the many benefits they can offer a health system.

Francesco Cascio, director of robotics at New Hyde Park, N.Y.-based Northwell Health, discussed how the system developed and manages a large fleet of da Vinci surgical systems during a Feb. 23 webinar, hosted by Becker's Hospital Review and sponsored by Intuitive.

1. Surgical robots are outcome machines. "You probably heard there is no quality outcomes benefit, or it is too expensive [to acquire one]," Mr. Cascio said. Northwell Health faced the same issues until system leaders met in 2016 and aligned the system's clinical and operational arms to form a robotics committee. "The messaging at the time was very clear," Mr. Cascio said. "They would continue to invest in the program if we were able to first demonstrate superior quality outcomes, excellent patient care and standardization of care delivery." Since that meeting, Northwell grew its robotic program's volume by 86 percent, and grew its fleet from 12 da Vinci systems to 26 total da Vinci systems.

2. Growing a da Vinci fleet. To achieve both of those accomplishments, Northwell first had to determine what success would look like. Northwell assembled internal leadership committees and entered into a collaboration with Intuitive to lead efforts around measuring and improving these metrics. "We wanted the care that you received regardless of what robotic facility you go to be the same," Mr. Cascio said. The most important pillar of success and the most critical was credentialing. When the program began, 171 surgeons had the ability to perform robotic surgery, and more than 40 had not performed a robotic case in more than two years. Northwell had to ensure that the people who had access to robotic technology were the ones who could effectively perform robotic procedures. With Intuitive's help, Northwell cut down the lag between when a surgeon received his or her credential and when they began performing procedures.

3. Ensuring quality. Northwell put its surgeons into tiers and revised which surgeons had access to what procedures to ensure the robotic program would be successful. Site of care is a strong consideration, for instance, surgeons in community hospitals aren’t the ones performing the highest-risk cases. It was data like this that was essential to the program's quality component. With robots spread across the entire system, and billing departments varying on a facility-by-facility basis, Mr. Cascio had to create a dashboard that centralized all that data and made it easily digestible. The dashboard presents your standard quality measures, but Northwell overlaid that with additional information that explores complications on a case-by-case basis. The system also added an ability to compare outcomes by specialty and identify any potential outliers.

4. Standardization leads to success. "What we really wanted was to invest in our surgeons and ensure that they are given and afforded all the opportunities to really be an all-in robotic surgeon," Mr. Cascio said. Northwell vocally publicizes its victories throughout the system, and has created a new leadership-focused committee that incorporates perioperative leads from each of its facilities to learn and then teach best practices from around the Northwell system. All of these efforts play into standardization. For example, one other area Northwell targeted was variation in instrument choreography. Mr. Cascio analyzed lean instrument trays at one facility, found it was able to cut the number of instruments from 146 to 77 and then rolled that out systemwide to improve efficiency. "Always continue to innovate, and always ask the question, 'What can we continue to do better?'" Mr. Cascio said.

To watch the webinar, click here. Learn more at our Robotics Content Hub.

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