SAVANNAH, Ga.—The keys to building and sustaining a top-level robotics program come down to some simple basics of staying organized and maintaining engagement of the healthcare team, a presenter said at the 2023 OR Business Management Conference.
One of the first essentials is appointing a dedicated robotic coordinator, said Sherry Rogers, the program director of robotics at Emory Saint Joseph’s Hospital, part of Emory Healthcare in Atlanta. The hospital has six robots and performs over 1,600 cases per year.
“The robotic service line can be a very expensive service line if you’re not watching everything and making sure that people are being very responsible with the equipment,” Ms. Rogers said. Her hospital hired a scrub tech for the coordinator role. He provides surgical support, trouble shooting in the operating rooms. He is also involved in inventory management, organizing the back table and updating surgeon preference cards, and training and education.
When it comes to training, she advised, make it fun and engaging for team members so they want to be part of the program. There will always be challenging naysayers; for them, share your outcomes, and let them see cancer or cardiac patients post-surgery to get them enthused, she said. Set up clinical pathways where robotic surgery team members—and their assigned mentors—can assess their knowledge of the robots. The pathways contain everything from basic steps covering how to plug in and turn on the devices to detailed steps defining roles for each team member such as scrub techs, nurses and first assists.
“It’s very important to have clear expectations for your staff of what they need to know and how to do it in robotic surgery,” she said. With challenges hiring enough first assists, Emory recently established protocols and embarked on training to allow scrub techs to assist in that role for certain types of procedures.
It’s also essential for team members to stay up to date on manufacturer continuing education and trainings, Ms. Rogers said: “We make sure everybody signs up for a My Intuitive account, we set up deadlines for them and assign their learning.” This avoids staff accidentally selecting courses related to software you don’t have at your institution. Make good use of your customer service representative and involve them in in-service trainings for all team members.
“Remember that success takes practice,” she said. “If you have multiple robots and lots of people learning, try to train them by roles” putting nurses with nurses, and scrub techs with scrub techs.
Also consider if you need any additional trainings specific to your institution. Ms. Rogers’ hospital instituted a robot driving school course to allow new nurses and others hands-on time to learn to dock the robots. “It gives them some good one-on-one time [with experienced nurses] and gives them a really good comfort level.” The group also has set up periodic competitions using robotic simulators to practice skills like knot tying and needle driving, which has created fun and buy-in, she said.
Hospitals without simulators can adopt another technique the hospital tried: having team members practice painting a pumpkin using the robotic instruments. “It was a great team-building event. Things like that help train staff and then they want to get on the learning portal and learn more,” she said. “They want to be involved with the program.”
To further build engagement, Ms. Rogers’ hospital has involved staff in teaching, bringing the robot to local high school science education events; invited the C-suite to see the different robots in action; and created an interactive newsletter to highlight recent cases, tips and tricks, in-service reminders, new hires and volumes and other statistics. They also congratulate team members on different milestones or other events. The newsletter is sent to all robotic surgeons, staff and the C-suite.
Additionally, they have held contests to name the robots, with small prizes awarded to the winners, and put up a bulletin board to post the newsletter, statistics, resources and other information. When the team did it’s 10,000th case, Ms. Rogers displayed information about the case and photos of all team members involved.
“Don’t forget about recognizing your team members,” she advised. “It’s such a free and easy thing to do that will rise your ship above you so beautifully.”
Tip and Tricks for Smoother Operations
To help improve turnover times and keep the workflow smooth, place colorful laminated signs in the robot rooms reminding people of basic steps such as wiping the robot down with disinfecting towelettes after each case and putting instruments back in the tray, Ms. Rogers advised. She also hung cards on each robot with the unit’s serial number, and names and phone numbers for the manufacturer, robotic coordinator, BioMed department and herself.
Post signs with specific cleaning reminders and keep supplies like wipes handy, labeled “for robot use only,” she advised. Place labels to ensure cords are inserted correctly and sent for reprocessing as necessary, and keep robots plugged in so the battery maintains full charge. Keep the operating bed plugged into a dedicated outlet, and only use the bed cord to avoid damaging the remote.
To minimize turnover time, involve all staff and surgeons, and give them specific roles, Ms. Rogers said. Using a trigger can help. When the lights turn back on following a robotic case in Ms. Rogers’ hospital, the team knows how to set the transition process in motion. Scrub techs get the instrument trays organized with what to keep versus sterilize. Nurses have a checklist and start calling the preop and post-acute care units letting them know they’re almost ready, and asking environmental services to be nearby so that when transport wheels the patient out, they’re already gathering trash. Surgeons are expected to be in the room in a timely fashion. Turnaround times have been as little as 12 to 15 minutes, she said. Ms. Rogers highlights fast times in the newsletter and bulletin board.
After each case, the nurse completes a daily wrap sheet to document any issues with starting the case on time, any issues with the robot or instruments, and to check off what instruments and equipment was used for billing purposes. Monthly audits through the robotic system’s customer portal can be used to confirm the wrap sheet reports.
Ms. Rogers reported receiving honoraria and speaking fees from Intuitive Surgical. This talk was done independently.
This article is from the September 2023 print issue.