As robotic surgery becomes more widely adopted for general surgery, healthcare systems recognize that they can't limit these procedures to traditional, weekday business hours.
During a June webinar hosted by Becker's Hospital Review and sponsored by Intuitive, four leaders from Barnes-Jewish Hospital in St. Louis shared how their organization has increased patient access to minimally invasive robotic surgery:
- Jackie Martin, MD, vice president of perioperative services
- Michael Awad, MD, PhD, director of robotics and associate professor of surgery
- Andrew Pierce, director of supply chain
- James Thomas, BSN, RN, manager of perioperative performance improvement administration and information systems
Four key takeaways:
1.) Operational barriers often inhibit broader access to robotic surgery. Most health systems offer open and laparoscopic surgeries at all hours. Yet, most robotic surgeries are scheduled between 7:30 a.m. and 5 p.m., Monday through Friday. "Historically, we didn't allow surgeons to perform robotic surgery on Saturday mornings," Dr. Martin said. "How many capital investments do you limit access to 23 percent of the available time? Not many, if any."
Since the launch of its robotic surgery integrated program in 2017, Barnes-Jewish Hospital has increased from 568 to 1500 cases per year by creating structure and accountability. Access to robotic surgery has grown during primetime hours, as well as outside of that time window. To achieve this, the team addressed operational barriers like access to competent staff, as well as good support from central sterile processing and materials management.
2.) To align goals around robotics, BJC Healthcare and Barnes-Jewish Hospital have created new roles and teams. BJC Healthcare formed a robotics governance committee that includes all network hospitals with robotic systems. This group meets quarterly to discuss synergies, share best practices and discuss common challenges. Barnes-Jewish Hospital, which is part of BJC Healthcare, has also formed a robotic steering committee, a robotic operations committee and new roles like the director of robotic surgery and robotics coordinator. "The robotic steering committee meets monthly to discuss clinical topics, education and training, and joint research initiatives. Intuitive participates in these meetings," Dr. Awad said.
3.) Detailed analytics identify improvement areas for Barnes-Jewish Hospital's robotic surgery program. To support program growth and improve patient outcomes, the Barnes-Jewish Hospital team developed additional quality metrics and better visuals. "We've seen dramatic results in a short period of time," Mr. Thomas said. "All of our robotic cases now have a 30-minute median turnaround time and we're focusing on case scheduling accuracy."
4.) Price transparency tools create a culture of cost awareness around robotic surgeries. Barnes-Jewish Hospital uses quarterly surgeon scorecards to show the interoperative record of items used and their acquisition cost. "The unblinded report generates dialogue between surgeons about cost reduction tactics and product choices," Mr. Pierce said. "Robotic surgeons in particular are focused on monitoring and improving cost per case trends." Other tools include supply receipts for every OR case and comparisons of Intuitive robot records of intraoperative items used and data in the EMR. Intuitive's new line of instruments with longer lives has reduced the cost per case at Barnes-Jewish Hospital by 27 percent. This is expected to generate $240,000 in cost savings for robotic procedures.
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