For years, the potential of minimally invasive robotic-assisted surgery has been reflected in the headlines.
Thanks to continuous advancements, the technology has evolved from a sporadically used high-precision tool to a strategically conceived service line.
During a March webinar hosted by Becker's Hospital Review and sponsored by Intuitive, three leaders from Dignity Mercy General Hospital in Sacramento, Calif., discussed insights and best practices for building a robotics surgery service line. The panelists were:
- Allison Cotterill, vice president, chief nursing officer
- Brent Jackson, MD, vice president, chief medical officer
- Devan Johnson, vice president, chief operating officer
Five takeaways:
1.) A comprehensive robotics surgery service line is a must-have to stay competitive. Although robotics has been available across surgical specialties for years, the tendency in some cases has been to view it as a one-off tool rather than an essential pillar of organizational success. This approach can act as a deterrent to not only providing high-value care and performing more complex procedures, but also to recruiting surgeons who prize access to the latest available technology as an enabler to do their best work. "Independent physicians have options," Mr. Johnson said. "For certain specialties, you can't get them into the hospital without having robotics available to them."
2.) Having the right team is a critical component of implementing a well-thought-out robotics service line. For Dignity Mercy General Hospital, that meant establishing shared directorship of the program, which involved one employed and one independent surgeon, as well as appointing a dedicated robotics coordinator. Describing the qualities the hospital looked for in a robotics coordinator, Ms. Cotterill said: "We looked for someone who was clinically competent, had knowledge about the different robotics cases and equipment, was an excellent listener and had a strong ability to create in-depth relationships with physicians."
At Mercy General, the core robotics team then partnered with broader physician and nursing leadership and other staff to streamline safety and quality improvement practices. This partnership, along with a deeper understanding of the data, was key to facilitating difficult conversations, such as the decision to reallocate an underutilized robot in one specialty to other departments that had acute needs.
3.) Data is key to measuring success and guiding future development. To evaluate progress and inform future strategy, hospital leaders can consider the following metrics: duration of robotic-assisted cases compared to traditional laparoscopic or open cases; length of stay; infection and complication rates; opioid use; patient experience; patient engagement; nursing communication scores and physician and staff experience.
When Mercy General monitored the duration of robotic-assisted surgery and compared usage to the overall cost of deploying the robot, the assessment yielded an unexpected but welcome conclusion. "Over a short period of time we found that as surgeons got more experienced, the robotic cases had a lower overall cost per case and a lower time of surgery as well," Mr. Johnson said.
4.) Going forward, robotic surgery will expand beyond original indications and hospital walls. Current use cases of Intuitive's da Vinci robot are mainly in cardiology, urology, gynecology and general surgery, but new iterations are set to expand its use to colorectal surgery, gynecological oncology and surgical oncology. "As more indications for the robot become accepted or innovated, we're going to see more specialties adopt this," Dr. Jackson said. As the learning curve flattens and more surgeons acquire the skills to use this robot, it will eventually expand to outpatient surgery centers as well.
5.) To achieve robotics surgery line excellence, listen to physicians and act fast. Dr. Jackson highlighted the importance of understanding physicians' needs and responding to them quickly. He shared how he learned a personal lesson when, at the beginning of his tenure at Dignity Mercy General, surgeons were clamoring for the da Vinci robotics platform. Their wishes were not acknowledged fast enough. When their wishes were met, it provided the organization with a "quick win," Mr. Johnson said, and likely prevented some of them from becoming frustrated and walking away.
The overarching advice by Dignity Mercy General's leaders to organizations looking to implement a robotics service line is to form the right team, listen attentively to surgeons' ideas and frustrations, and stay up to date on the latest technologies. This combination of people skills and technical competencies will enable organizations to seize opportunities early on and address potential issues proactively.
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