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Science fiction or fact? Lights come on by command
Digital ORs boost efficiency, communications
Ask a science fiction fan about the operating room of the future and you might hear about surgeons transporting from OR to OR, images and lab reports that magically appear, or lights and equipment that operate according to the surgeon's thoughts. While the technology for these actions is not yet available, digital technology now in use not only gets close to the science fiction picture but also offers a platform for even more advances in the future.
While some academic health facilities lead in theory but lag behind in practice, Massachusetts General Hospital in Boston has had to push forward into the operating room of the future to address the steadily increasing volume in its traditional hospital-based operating department that handled inpatient and outpatient procedures in the same area, says Warren S. Sandberg, MD, PhD, co-program leader of the OR of the Future project at the hospital. As the hospital-based surgery program grows, cases that were treated as 23-hour procedures have been moved to outpatient surgery, he says. There has been a steady growth in surgical volume, which increases the need to be more efficient, he explains. "We find ourselves in the interesting position of emulating the best practices of nonacademic-based ambulatory surgery facilities in order to handle our volume," he adds.
One way to improve efficiency in the operating room is to place all information needed during surgery in one place, says Sandberg. "We have a 42-inch flat panel screen on the wall at the foot of the bed that displays the surgical video and a series of tabbed windows that contain information such as patient identifiers, progress log, vital signs, and identification of personnel in the room," he says. All of the information displayed on the screen is gathered from various electronic data collection systems including the electronic nursing perioperative record, physiological monitors, and the hospital's computer system. Moving between different windows requires no effort, because the tabs advance automatically as data are entered into the clinical systems from which it is harvested, he explains. Massachusetts General is working with a vendor (LiveData; Cambridge, MA), but hospital staff have built most of the equipment they are testing.
The philosophy behind a system that gathers and displays information in one location is that it improves patient care and safety through improved communication, says Sandberg. Because patient information is displayed as the room is set up, one nurse who was preparing a standard setup for a procedure noticed that the patient who was coming into the room was allergic to latex. "The nurse told me that having that information displayed enabled her to save time because she knew to set up the room with no latex, so she did not have to redo the setup," he says. Having allergies to medication and products displayed for everyone to see enables all staff members to avoid exposing the patient to items to which they are allergic prior to or during the surgery, he adds.
In the future, there will also be smart alarms, suggests Sandberg. There could be alarms that remind physicians about the proper timing of prophylactic antibiotics, he says. Simple alarms such as notifying the staff that the patient has exceeded 60 minutes in a tourniquet are possible in the future, he says. Addressing physiologic alarms related to dangerously low blood pressure are more difficult because each patient's "normal" is different, he explains.
Centralize all functions
While he can't transport himself from one room to another, Skip Whitman, MD, an orthopedic surgeon at Hugh Chatham Medical Center in Elkin, NC, can speak to surgeons in other operating rooms or even to physicians in the emergency department from every operating room through the communication system in his digital operating room (Smith & Nephew; Andover, MA). "This technology offers us an efficiency that we must have in outpatient surgery today," he says.
Although voice activation systems are still in their infancy, they are definitely helpful in the operating room, says Whitman. "I can operate the bed, the lights, instruments, and dictate notes using our voice activated system," he says. Whitman dictates his notes as the case is finishing, and he usually has completed them as the patient heads to recovery. "No more unfinished charts," he points out.
A central nursing station in each of the ORs at Hugh Chatham, enables the circulator to control lights, equipment, video displays, and even pull up X-rays or lab reports as needed without having to walk from place to place, Whitman says. "We also allow the patient's family to watch the surgery through a window, and I'll talk with them with a wireless microphone I wear during the procedure," he says. "I believe that more outpatient surgery programs will allow family members to watch [in the future] because people are more sophisticated and they want to be able to tell the surgical patient what happened during surgery and what the physician talked about during surgery."
Letting the family watch
Allowing the family member to watch and listen during surgery is just an extra step in patient/family education, he says. This knowledge does help when nurses are giving discharge instructions and explaining what the patient can expect as they recover at home, he adds. During surgery the family member can see exactly what happens and can hear Whitman explain where the incisions are placed and what is done during the procedure.
"Even though all of this is explained prior to the surgery, the patient often doesn't remember, and the family member can explain why they feel pressure or tightness in an area because the family member saw the surgery," he says. "The family member can tell the patient that the small incision is where the scope was placed."
Plan for future with system
Established outpatient programs that want to switch to digital operating rooms must look carefully at space requirements for the central information station, room for wires and cables, and electricity needs.
These were not issues faced by the staff of Bayside Surgery Center in North Falmouth, MA, an outpatient surgery program that opened in mid-2006. "We choose the digital operating room system we wanted to use prior to building so we were able to design the rooms to accommodate the system," says Garry Brake, MD, a general surgeon at the center (Smith & Nephew; Andover, MA). "All three operating rooms are designed exactly the same, so there is no wasted time adjusting to a different setup," he says.
Because his program is small, there are many features that are not used at this time, but they did build the system to accommodate future expansion, says Brake. "It is better to invest in the potential for expansion than to have to start all over with a new system in the future," he says. However, even when planning for the future, keep it simple, he suggests. "Don't be swayed by presentations of different capabilities that you don't need," he says.
For example, Brake's facility has only three operating rooms and one procedure room, so the leaders thought there was no need for a communication system between the ORs, he explains. "Be clear about what you need today and what you realistically will need in the future," Brake says.
For more information about digital operating rooms, contact:
A few of the companies that provide digital technology for the operating room are: