New Lenox, Ill.-based Silver Cross Hospital is an independent, 300-bed hospital with a Level II trauma center.
In 2012, the organization launched its robotic-assisted surgery program.
In 2016, it established the highly successful Midwest Institute for Robotic Surgery.
During a September webinar hosted by Becker's Hospital Review and sponsored by Intuitive, two Silver Cross leaders discussed how the hospital has continuously enhanced its robotic surgery service line through standardization of care:
- Ruth Colby, president and CEO
- Marybeth Antone, associate vice president, operations
Four learnings:
1.) The Midwest Institute for Robotic Surgery’s outcomes guided by safety, quality and patient satisfaction metrics translate into financial benefits. To participate in the MIRS program, physicians must meet three of the following criteria: top patient satisfaction scores, low surgical infection rates, low readmission rates by specialty and low conversion to open procedures. "We set these metrics by specialty with assistance from Intuitive and our performance to date has been excellent," Ms. Colby said. "Our surgeons' conversion rate to open across specialties is 0.6 percent, readmissions are just 2 percent and surgical site infection rates are 0.3 percent."
Excellent outcomes translate into financial benefits. For example, Silver Cross' length of stay for robotic colorectal procedures is significantly shorter than for open procedures. In response, commercial payers have increased reimbursement rates. This contributes to the organization's financial well-being in a world of value-based care.
2.) Standardization is the key to operational efficiency in robotic surgery. Silver Cross Hospital has deployed four identical Intuitive Xi robots in four standardized robotic operating rooms. "We've learned from Intuitive's Genesis program how beneficial it is to have standardized equipment and processes," Ms. Antone said. "Working with Lean principles ensures that operating rooms are standardized, which leads to increased efficiencies."
Silver Cross uses peel pack instrumentation and its case setups are simple and consistent. The organization also implemented a robust preference card process to identify which instruments to eliminate from inventory due to limited use. "We created this standardization through our robotics committee and reinvest any savings back into the program," Ms. Antone noted.
3.) Data, physician engagement and training are critical to standardization. After analyzing its inventory, Silver Cross Hospital developed the appropriate periodic automatic replenishment levels for instruments and accessories. "We saved money, but it wasn't easy," Ms. Antone said. "We looked at utilization of instruments and variation by case type. Physician engagement was essential. They had a seat at the table and their voice was heard."
Intuitive's market access and customer analytics team also helped Silver Cross improve its robotic surgery program. "You should reach out to the MACA team to dive into your data," Ms. Colby said. "They helped us with analytics and targeting open and minimally invasive opportunities."
To promote continuous improvement, Silver Cross' ongoing training initiatives include webinars, the Intuitive 360 event and other coordinator courses available through da Vinci. More than 40 individuals are trained to provide robotic support to surgeons and the goal is to continuously expand this talent pool.
4.) The da Vinci Extended Use program reduces costs per case. Intuitive recently redesigned some of its fourth-generation reusable da Vinci instruments, enhancing the materials, manufacturing processes and testing protocols. The Extended Use program increases the number of times that customers can use core da Vinci X and Xi instruments. "This is an opportunity for us to reduce costs per case for procedures like cholecystectomies, benign hysterectomies, unilateral inguinal hernias and ventral hernia TAPPs," Ms. Colby said.
"Our recipe for success has been aligning with the doctors; focusing on safety, quality and the patient experience and cultivating a strong relationship with Intuitive," Ms. Colby said. "We've leveraged the full scope of the da Vinci ecosystem, from surgeon training to efficiency consulting and data analytics."
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