Smart ORs facilitate operation, sterilization for best outcomes

July 22, 2022

The future is now.

The operating room in 2022 is a complex and innovative theater of technology, combining HD, robotic arms, video and sound, control centers to produce results more efficient than ever.

The integration of equipment and automated tools has resulted in a digitally-enhanced OR that melds the smarts of doctors and nurses with the intelligence of modern technologies.

The benefits of a smart OR are endless, and the smart keep getting smarter. Simply said, a smart OR equates to better services, and enables optimization across the board.

Defining smart OR

Diversey defines a smart OR from an environmental hygiene perspective, said Larinda Becker, Executive Director of Marketing, Infection Prevention, Diversey. “It is an OR with simplified and standardized products and processes to clean and disinfect, and having a successful operation that has efficient turnover with effectiveness both between cases and end of day WITHOUT compromising quality. A Smart OR has a comprehensive approach to cleaning and disinfection that is effective, fast and simple. Staff can quickly engage, align and implement for consistent, positive results.”

“Doing” smart OR means execution of best products and practices with best practices, consistently achieving positive results, she said. Customers are practicing smart OR by, “defining the products and procedures, and implementing practices with the appropriate tools to provide repeatable and successful environmental hygiene (reduced risk).”

Delivery of a comprehensive toolkit for cleaning and disinfection between cases that is simple, engaging and standardized for staff to understand and implement with ease, Becker continued. “Enabling the best solutions to meet the needs for turnover with contact times, efficacy requirements and awesome user experience, with the right protocol to be both effective and efficient, and achieve the best results/quality.”

“Workflow tools and training tools utilizing AORN guidelines, defined clear roles and responsibilities, and a process designed to optimize the workflow and ensure the job is completed and nothing is missed or redundant,” are the kinds of products and devices that help design and improve workflow, she said. “Diversey has implemented an operating room turnover program. The program is to help improve employee engagement and satisfaction. Diversey’s TurboTurn program, which allows staff to quickly align products and tasks to ensure the lowest turnover time without compromising quality.”

What many expect to be the next major advance in Smart OR technology is already on its way, said Eugene Malinskiy, CEO and cofounder of Cleveland based med-tech startup Lazurite. “While there have been incremental advances in camera technology over the years, current systems remain tethered to the tower by a power cord and more importantly, by a light cord that generates significant heat. The desired benefits of a wireless camera system include ease of use, improved OR efficiency, reduced costs, and better patient outcomes.” A new, Food and Drug Administration (FDA)-cleared wireless arthroscopic surgical camera has been demo’d in surgical suites around the country and is on track for commercialization later in 2022, he said. Lazurite’s ArthroFreewireless arthroscopic surgical camera is powered by a high-efficiency, low-heat light source.
We believe practicing Smart OR is also practicing Right OR, said Cory Allison, CEO and Founder, KelCor, LLC. “It is crucial to re-examine how it’s always been done in the past. Using a roll of tape on multiple patients has been the standard of care for decades, but it’s time to change the old way. While change for change’s sake should be avoided, it is necessary to make a Right change that will improve the current standard of care and practice Smart OR. It is important to address known problems such as cross-contamination and HAI risks with time efficient and cost-effective solutions that ultimately provide better patient care.”

Maximizing time

“OR leaders and surgeons need to maximize every minute of available OR time,” said David Atashroo, MD,Managing Director, Perioperative, Qventus. “Manual scheduling processes and tools make this nearly impossible to achieve. To address these challenges, hospitals are using automation software that enables them to improve OR access and utilization. By applying AI and machine learning, the software automatically frees up OR time and then strategically fills the slots, increasing prime time and utilization of critical resources, such as robots. In the future, surgeons and OR teams will come to expect that all world-class surgical suites have highly efficient, automated access.”

“Previously, the Smart OR has been defined by innovations inside the OR at the point of care,” he continued. “Now, the Smart OR definition is expanding to include the use of AI and automation for the operational processes that surround the OR and improve efficiency, access, and utilization. Each day, half the battle is setting up the OR team for success before the first cut ever begins. But one of the biggest challenges is unpredictability around scheduling and staffing. Block time is often released at the last minute, forcing schedulers to scramble to fill the time with any available case. A significant amount of OR time goes unused, wasting critical resources. To reduce these inefficiencies, hospitals are now using AI-powered automation software that enables them to increase block release lead time and scheduling accuracy. These performance improvements reduce staff burn out, improve surgeon satisfaction, and enhance the care of the patient.”

“Everyone relies on automation to simplify their personal lives,” Atashroo said. “There’s no reason we shouldn’t have this technology available in our professional lives, including in surgical settings. For hospitals, automation softwares reduces the manual back-and-forth coordination for OR and surgeon schedulers. Surgeon schedulers can directly view and request OR time — without logging into the EHR. Data for the case request and procedure order form is then pushed directly into the EHR, enabling OR schedulers to focus on triaging and finalizing the requests. These efficiencies lighten workload, reduce call and fax volume, and minimize transcription errors.”

He emphasized the value of automation for OR leaders and teams. “By streamlining scheduling processes, they improve OR access, increasing utilization and growth. And by eliminating manual steps and using AI to guide decisions, they reduce workload, enhancing staff and surgeon satisfaction. “Unlike OR scheduling software that uses out-of-the-box models and fills open time with the next case on the list, automation software that applies AI and machine learning fills time based on hospital-specific goals, such as service line or robotics growth, and surgeon-specific criteria, such as case length distribution or booking patterns. In essence, the intelligence automatically creates the perfect match for every OR time slot that becomes available.”

Workflow improvement

A smart OR utilizes all tools available to help in process flow by increasing efficiency, specifically, during in-between case or after terminal cleaning, said Katja Auer, MA, MBA, CMIP, Clinical Director, American Ultraviolet. “In the case of fixed mount UV-C, UV-C fixtures are strategically placed throughout the OR to provide an even UV-C disinfection energy footprint for maximum adjunct disinfection. Some Surgeons utilize UV-C fixed mount packages during surgeries to help reduce microorganisms in the environment. This approach has been well studied and was first implemented by Duke University in the mid 1930’s. Surgeons at Duke were specifically interested in the reduction of SSIs at the time. Long-term studies are available highlighting the impact UV-C can have on SSI reduction.”

There is much interest in the automated fixed mount UV-C systems in operating rooms, Auer said. “Smart UV-C systems do not add any FTE’s, are user friendly, and with the push of a button provide adjunct cleaning to the operating suite. The UV-C fixed mount systems help take the stress out of the daily cleaning. Although UV-C is an adjunct cleaning technology and does not replace the manual cleaning process, it provides an additional layer of cleaning power by reducing microorganisms in the environment.”

Workflow is always improved when you do not have to invest in additional staff and you can rely on an automated system, she continued. “This is true for the UV-C fixed mount systems. Extremely easy to install, train staff on, and requires very little maintenance.”

The Smart Operating Room of tomorrow is here today, emphasized Peter Veloz, CEO, UVDI. “Advanced Internet of Things, or IoT, technology that we enjoy at home is now integrated into key products and technologies used in the Operating Suite. Technology with IoT, or Smart device communications, can automate and accelerate activities previously completed manually.  This is particularly valuable in an environment geared to speed and precision.  The UVDI-360 Room Sanitizer is now equipped with UV Smart Connect cloud communications — which automatically uploads usage data to operator websites in real-time, provides automated device updates and provides 24/7 device health monitoring.  The impact is enhanced efficiency – simply put, fewer steps completed faster using devices that integrate into - as opposed to disrupt – workflow.”
Rex Grindstaff, RNFA, Educator, CTO, medEclean Inc, suggests using workflow improvement products, such as the company’s Bio-containment Instrument Transport Bag to increase efficiency in sterile instrument reprocessing. “It addresses back injury protocol by reducing physical demands of repetitive lifting, squatting, and bending related to handling of contaminated surgical instruments and enhances infection prevention and sharps protocol.”

Digitalization

The advent of advanced surgical suites started with innovative hardware such as robotics systems and next generation C-arms and other imaging systems, said Rob Stineman, Director of Strategic Growth at Explorer Surgical (a GHX company). “These hardware platforms have evolved to incorporate software into their overall solution, providing important feedback on the procedure or the patient to the clinical team as they use the equipment. Software has allowed all of these disparate systems to become integrated with each other so that a single monitor in a control room, or even in the OR suite itself, can monitor them all at once. As surgical and interventional suites become even more advanced, the adoption of software will become more prevalent to reduce the administrative burden on teams so that clinicians can focus on what’s most important: treating the patient. Examples of such tools are RFID platforms to scan what instruments are used in a procedure, automated supply counting platforms, and other systems that seamlessly integrate with EHR platforms.”

Over the last couple of years, more advanced surgical suites are starting to embrace ‘procedural telemedicine’ offerings, such as digital case support, which allows specialists to provide remote support to surgical teams in the OR with real-time annotation and image-control, he said. “Digital case support helps drive standardization of best practices, reduce costly and risky variation, and increase procedural efficiency and effectiveness, all while enabling the clinicians in the room to continue focusing their energy on treating the patient. “COVID-19 dramatically accelerated the use of digital case support as it gave product experts (i.e., medical device representatives), proctors and trainees an avenue into the OR when pandemic-related travel and hospital visitor restrictions made it difficult to do so. Even though travel restrictions and access to hospitals aren’t as stringent today, medical device companies and providers continue to use digital case support given the many benefits it offers. This includes reduced travel costs, a more personalized training experience for physicians, reduced variability in device utilization and surgery workflows, standardizing training and helping clinicians stay current on the latest device and procedurale advances.”

Smart ORs contain next generation physical equipment that are integrated through software that communicates with each other and becomes connected around the case, Stineman emphasized. “All administrative tasks become automated so that the only preop, intraop, or postop work performed by the team is meant to accomplish one goal: achieve the best outcome for that patient. Not only is the entire room connected from within, but most Smart ORs can connect those in the room to experts or trainees from outside the room to facilitate even more education and collaboration.”

Smart OR technology, such as digital case support platforms, are helping clinicians improve collaboration and procedural workflows in pursuit of better patient outcomes, he continued. “With surgical best practices and guided workflows presented clearly for everyone in the OR, procedural teams are better prepared and can collaborate with those in the room and those joining remotely. This collaboration drives procedural efficiencies and repeatable processes to enhance patient outcomes. Additionally, the data that is captured during a procedure can provide insight to surgical teams about opportunities for improvement in future procedures, further contributing to improved patient outcomes. Ultimately, leveraging digital case support within the Smart OR environment will help drive adoption and utilization of other innovative technologies in the surgical suite that aim to bring life-saving therapies to more physicians to ultimately treat more patients and improve care overall.”

“First, do no harm” is a core value of all medical providers, said Brian Jackman, VP Marketing, National Accounts, Encision Inc.A smart OR needs to prioritize patient safety first and foremostThere are many proven patient safety technologies that can be implemented along with best practices from professional organizationsWhen these come together, they create an intelligent OR that delivers improved patient outcomes while also reducing OR expenses.