ORs innovate, upgrade despite pandemic

July 26, 2021
Surgical tools, technology and care push through COVID-19 and beyond

As the COVID-19 pandemic starts to subside in its second year and elective and backlogged surgical procedures begin to resume, surgeons need the right tools, technology and space on their floors and in their hands ramp up and return to service.

Consequently, when surgeons and clinical teams don’t have the critical resources they need then they may experience staff and patient injuries and infections, increased costs or other harmful out-comes.

Making investments in operating room (ORs) and other surgical environments ultimately may im-prove surgical workflows, procedures and conditions and enhance patient care, safety and outcomes.

Current state of surgical care

The COVID-19 public health emergency, now in its second year, certainly has disrupted the flow and volume of care in many hospitals and healthcare facilities.

How are OR and surgical teams handling cases and ensuring efficiency, effectiveness and safety in proce-dures?                                                                           

They are playing catch-up with fewer staff and less support in care, observes Anthony Fernando, President & CEO, Asensus.

“After the reduction in elective procedures during the COVID-19 pandemic, hospitals have a backlog of procedures now,” Fernando noted. “Remember, ‘elective’ doesn’t mean unnecessary; patients still need care for serious conditions. Hospitals and surgeons are going to be stretched more thin than they already were. Because of this, it may be difficult for providers to go back to the way it was. We are seeing a cautious and prioritized approach to working down the back-log of cases.                    

“There are many pressures on hospitals, surgeons and OR teams:

·  The first pressure is to reduce surgical variability. Technology needs to help reduce this variability. In terms of variability, surgical procedures are limited by human ability – surgery is an art that is influenced by experience and training. Skill variability and discrepancies across surgeons and facilities can lead to a wider gap in sur-gical outcomes.

·  Second, is the rising pressure around cost. Value-based healthcare means delivering the best clinical outcomes relative to the optimal cost of care.

·  Finally, hospital CEOs certainly lose sleep over the impending surgeon shortage. This is no small matter – the Association of American Medical Colleges forecasts that there will be a deficit of over 33,000 surgeons and specialists by 2030¹.”

Equipment that is non-modern or not properly maintained poses possible danger risks to staff and patients, explains Howard Higgins, Senior Marketing Manager, Dräger.

“If you picture the current status of many ORs across the country, they are still relying on mobile equipment carts and wall mounted electrical and gas outlets for providing services,” Higgins pointed out. “This now antiquated approach can be fraught with problems, such as inconsistent medical equipment and supply placement among facility ORs negatively impacting work efficiency; staff fatigue from having to reach to connect sockets; staff trip hazards from floor run lines/hoses; and significant challenges with keeping surfaces disinfected to help pre-vent hospital-acquired infections.”

Electrical instruments, in particular, come with their own sets of benefits and challenges, addresses Kevin Anderson, Clinical Coordinator, Clinical Affairs, Healthmark Industries.

“It is commonplace to use electrical instruments and devices in the operating room today,” Anderson stated. “These electrical devices have made less invasive procedures possible all while limiting the amount of blood lost, which leads to better outcomes for the patients. But there is a potential threat with these electrical instruments that has become increasingly evident as time goes on.”

“When there is a defect or breakage in the insulation layers of the instrument, this allows the electricity to escape the instrument from areas where it is not intended to. When this stray electrical activity occurs during surgery, the potential for adjacent organs and tissues can and have been burnt. Some burns have been so severe that they lead to surgical-site infections, prolonged hospital stays or even additional surgery. Sterile processing techs can help combat this problem by checking these insulated instruments for damage each time they are processed.”

OR practice, workspace adapt 

Even during such a cata-strophic crisis like COVID-19, OR surgeons, surgical staff and facilities press on with innovation in care.

What new devices, technology, techniques and settings are teams using in order to achieve good surgical out-comes and prevent complications for patients?

Peter Veloz, CEO, UVDI, for example, observed, “In a time of great change, a constant is a continued focus on operational efficiency through innovation practices. A pioneering example of this is a new study from the University of Siena recently presented at SHEA 2021 confirming UV decontamination of operating rooms between surgeries in only six minutes. In addition, facilities are looking more than ever to standardize products and manufacturers across Infection Prevention practices, and especially now for both surface disinfection using UV devices and air disinfection with UV-C technology installed in HVAC systems.”

OR workspaces, as another example, are moving forward with changes and improvements, adds Veloz.

“More broadly, we are on the cusp of a wave of new construction and retrofitting to ‘future proof’ the operating room – with a primary focus in creating modular operating room spaces to accommodate different procedures and patients, as well as for new technologies, robotics and equipment,” he explained. “For UV room disinfection, devices that are easy to maneuver in tight or unique spaces – with a minimal footprint and is lightweight – can drive operational efficiency.”

With regard to care and workflow improvements, Dräger’s Higgins points to “hybrid operating rooms that enable the ability to conduct complex minimally invasive or open cavity surgical procedures guided with advanced imaging feedback to achieve precision and eliminate the critical time delay by having to image the patient in another department.”

Fernando further highlights a shift toward guided and robotic surgery support.

“Through a new era in surgery called Performance-Guided Surgery, surgeons can achieve more control through digitization and tackle some of the biggest issues facing surgical outcomes,” he observed. “Surgical robots not only improve the ergonomics of surgery, they can also reduce surgeons’ cognitive load. What this means for our healthcare system is better outcomes and reduced surgical variability.”

Additionally, telepresence is aiding surgical teamwork, education and procedures, notes Keith Griffis, Executive Director of Marketing for Surgical Endoscopy and Systems Integration, Olympus America Inc.

“One of the greatest needs is to limit the number of people in the OR while still being able to communicate and collaborate in real time with people outside of the procedural space,” he explained. “Telepresence solutions are being used to further life-saving medical device innovation. Telepresence technology allows physicians to broadcast procedures to other clinicians, as well as to medical students, fellows and other trainees anywhere in the world for the purpose of proctoring, consultation and clinical education.”

Technology, devices develop

Technology also continues to forge ahead to shape outcomes in surgical suites and care, says Higgins.

“There is constantly evolving medical technology being introduced to the OR to address new advanced therapies and medical technologies, while also minimizing the impact and damage to tissue allowing for much quicker recovery and hospital discharge,” he stated. “In the recent period there is more focus than ever on flexible ceiling supply unit designs (booms) for the OR and the positive impact they can have on overall workflow. This pertains particularly to the areas of staff efficiency, ergonomics, patient and staff safety, and infection prevention.”

Further, Higgins points to decreased size and increased visualization with surgical instruments.

“Laparoscopic surgical instruments, for example, keep shrinking in size and require fewer entry points via trocars (in some cases it’s now down to one entry point),” he explained. “The use of flexible endo-scopes allows lower impact visual diagnosis and surgical procedures utilizing the body’s natural openings without requiring traditional open surgery.”

Fernando additionally highlights precision of surgery and devices.

“Over the last three decades, surgery has evolved and patients have benefited from this evolution,” he shared. “Open surgery was the ‘go to’ modality for most general and gynecologic procedures. Laparoscopy allowed surgeons to perform the same procedures, but with much smaller incisions; this allowed less pain, less scarring, and quicker recovery. Then laparoscopy was digitized; this allowed for the integration of augmented intelligence, the practical use of 3mm instruments, and force-sensing at the incision site. As a result, patients are leaving their procedures with a better overall experience. [For example], a recent study published in the Journal of the Society of Laparo-endoscopic Surgeons showed that among a cohort of patients who received Senhance surgery, patient satisfaction with their procedure was 98%. Among this same group, patient satisfaction with scarring was 100%.”

As Fernando sees it, “Next-level technology completely changes the idea of what’s possible. As technology enhances and changes the world we live in, the OR can move beyond inefficiency, unpredictability and outdated technology. By digitizing surgery and building machine learning algorithms and AI, surgeries become smarter and more instinctive and result in better patient outcomes.”

1.  Source: Association of American Medical Colleges. The Complexities of Physician Supply and Demand: Projections from 2016 to 2030. March 2018.