How one Atlanta hospital restructured surgery service priorities amid COVID-19: 5 key takeaways


The COVID-19 pandemic shut down elective and nonurgent procedures across the country, as hospitals raced to increase capacity for coronavirus patients and stay-at-home orders were implemented. As a result, hospitals had to make strategic pivots to their surgical services. One hospital in Georgia found that a strong robotics service line, in particular, was a boon in uncertain times.

During a June 17 webinar hosted by Becker's Hospital Review and sponsored by Intuitive Surgical, leaders from Emory Saint Joseph's Hospital in Atlanta (Kevin Andrews, COO and Sherry Rogers, Program Director of Robotics) discussed the effects of the coronavirus pandemic on surgical volume and how their robotics service line helped see them through initial difficulties related to the pandemic.

Like most other healthcare organizations, Emory Saint Joseph's Hospital's surgical operations changed once the COVID-19 pandemic began. By mid-March, the Atlanta-based Emory Healthcare, the hospital's parent, suspended elective procedures and surgical case volumes dropped. Emory Saint Joseph's Hospital then retooled its priorities to meet the challenge of the moment, Mr. Andrews said. Here are five key takeaways from the discussion:

1. The hospital, and the larger Emory system, created a number of working groups to guide clinical decision-making and protocols relating to surgery services. Representatives from Emory Saint Joseph's Hospital were a part of the health system's working groups, and the hospital had its own facility-specific incident command center and surgery management and adjudication teams, Mr. Andrews said.

The hospital relied on a tiered huddle structure, which is critical to ensure top-to-bottom, clear and succinct communication. Members of the medical staff, operations staff and executive leadership were all involved in the hospital's communications structure. The hospital had about 720 huddles within a seven-day period, Mr. Andrews said, and during the huddles, the teams would bookend their days with preparations for the next day.

In addition, the hospital designated a COVID-19-specific OR, which could be used for any surgery, including robotic surgery. They created policies and procedures specific to this OR and ran simulations with the staff to hardwire them. They also set up video monitors and white boards outside the OR to reduce the amount of traffic in and out of the room, improve communication and provide information about surgeries for patients with COVID-19.

2. The hospital also readied its robotics surgery program so the robots could be used, when appropriate, during the pandemic. First, communications were sent out to surgeons that the robotics program was there to support them, Ms. Rogers said. Robotic systems were deployed on a first come, first served basis.

The robotics service line team reviewed infection control practices and clinical guidelines from the Society of American Gastrointestinal and Endoscopic Surgeons and other organizations to ensure robotic systems were being used appropriately. In addition, the hospital relied on CDC, Environmental Protection Agency and Intuitive guidelines to make sure the robotic systems were being cleaned properly through the day.

One thing the hospital was lacking was the ability for smoke evacuation in the OR. The hospital updated its OR smoke evacuation capability before going forward with robotic surgery, Ms. Rogers said.

3. The hospital created surgery parameters and a detailed evaluation process to identify which surgeries could move forward during the period when nonurgent procedures were not allowed. These parameters included factors such as availability of beds and risk of prolonged hospitalization or intensive care unit stay. These parameters aligned with robotic-assisted minimally invasive surgery, which allow for shorter lengths of stay and are associated with fewer complications, according to Mr. Andrews.

"We've had a longstanding trust in some of the benefits of robotic-assisted minimally invasive surgery here at Saint Joseph's," he said. "But it provided a totally different dynamic when that was applied to an environment where you have an ED full of COVID [patients] or persons under investigation, and critical care census is maxed out or close to maxed out … In an environment like that the benefit of a shorter length of stay just hit home a lot harder."

4. Another key challenge was convincing patients it was safe to come to the hospital for surgeries. Emory Healthcare deployed marketing campaigns via TV, radio, print publications and billboards, with the consistent messaging that "Emory is a safe place to come to, no matter what the need," Mr. Andrews said. The health system emphasized the extra precautions they were taking, and surgeons would even call and speak with patients directly, reinforcing the messaging about patient safety and also communicating the unique benefits of robotic surgery.

"In an environment where there were no visitors allowed, being able to get back home with their loved ones was a real advantage that the [patients] saw," he said.

5. The hospital doubled down on strengthening the foundation of its robotics program. Some key aspects of a strong foundation include executive partnership with the program and robotic steering committees, said Ms. Rogers. At Emory, there are three robotic steering committees: a staff-level committee that includes staff members who perform robotic surgeries across all specialties; a surgeon and executive-level committee that supports the staff-level committee and are responsible for individual hospitals' robotic programs; and a system-level committee that supports the five Emory hospitals that perform robotic surgeries.

The hospital standardized its fleet of robotic systems to fourth generation technology across five hospitals and more than 100 da Vinci surgical system-trained surgeons. Executives played a key role in driving the standardization process, Ms. Rogers said. In addition, the hospital placed great emphasis on data and training. Dashboards can be used to track trends and compare surgeons to their peers performing similar procedures.

A formalized training program was also established and created competencies by role for nurses, scrub techs and first assistants, as well as specialized competencies for complex surgeries such as surgical oncology, Ms. Rogers said. It is also important to make the training fun. During the initial stages of the COVID-19 pandemic, the hospital wanted to make sure staff kept up with their robotics skillset, and so they organized weekly quizzes with Intuitive's help.

Laying the foundation for a strong robotics program ultimately helps improve outcomes as well as physician satisfaction, which can lead to reduced costs and an enhanced patient experience — thus helping the hospital align with the quadruple aim.

"I can't stress enough, for those of you that have either existing [robotics] programs or new programs just getting off the ground, building a strong foundation is a key component," said Ms. Rogers. "We have spent greater than six years building relationships … Each layer that we have put in place [in the structure of the program] has complemented the other. And it's a true partnership with Intuitive and our hospital."

Learn more about Intuitive here and view the webinar here.



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