The traditional OR is plagued by problems that compromise patient care and safety. The clinical environment is overcrowded with technology, yet, at the same time, disconnected systems lead to inefficiencies and lengthy patient turnover time.
Julian Goldman, MD, director, CIMIT (Center for Integration of Medicine and Innovative Technology) at Massachusetts General Hospital, speaking recently at the HIMSS07 in New Orleans shared an alternate scenario—the OR of the future. The CIMIT project is a living laboratory to explore new technology platforms, achieve accurate data capture and analysis and promote multidisciplinary team work.
Health IT can be deployed to improve patient safety in acute care environments, said Goldman. The key is interoperability among the disparate modern and legacy systems that crowd the OR.
Re-engineering the OR
The OR of the future project began in 1999 as CIMIT gathered technologies and created a model. The suite was constructed in 2002, and over the last three years, CIMIT has measured results. Design and process considerations in the OR included:
- Improved workflows;
- Enhanced ergonomics;
- Integrated technologies;
- Patient safety;
- Increased throughput; and
- Staff satisfaction.
The OR of the future relies on a transformed process that begins in the induction room, where the patient is anesthetized. The patient is moved into the OR for surgery, and at the end of the procedure he is transported into an emergency room for early recovery. The emergence room delivers multiple benefits, said Goldman. The patient can be transported out of the OR early, while the close proximity to the OR enables easy management by the surgical team. The suite also incorporates a control room where surgeons can continue to work between cases.
The project employs a cross-trained perioperative nurse, a staffing addition that streamlines workflow. The nurse admits a patient and checks records in the induction room, visits the OR to check progress of the procedure and meets the patient in the emergence room. This model keeps the anesthesia team in the OR environment to accelerate patient throughput, said Goldman.
The OR of the future incorporates other enhancements to improve safety, comfort and efficiency. A system underneath the table connects all monitoring equipment to minimize cabling, and monitor placement is optimized for surgeons and clinical staff.
The OR of the future transcends technology, said Goldman. The arrangement re-directs traffic in the OR. For example, a display mounted on the secondary anesthesia boom is positioned close to the patient and can be used for literature searches and other functions.
At the same time, Goldman indicated that the OR of the future is not a specifically configured suite. The common theme among ORs of the future is a reliance on innovations in processes and technologies. For example, the CIMIT suite employs an indoor positioning system to track staff, patients and equipment.
“Preliminary data shows a marked increase in the capacity of room, while the marginal cost of additional cases is low,” reported Goldman. The project presents a model that maintains safety and increased efficiency. On the downside, current systems are limited, and advanced technology has not fulfilled its promise. “The absence of interoperability is a barrier to patient safety and integration,” explained Goldman.
“Problems will worsen as sites acquire and integrate new systems,” he said. Healthcare needs to follow in the steps of the consumer electronics arena, which has deployed and benefited from interoperability and “safety interlocks” in potentially hazardous products.
Interoperability can benefit the acute care environment in several ways, said Goldman. Benefits include:
- Enabling staff to focus on clinical problems and needs;
- Improving patient safety and workflow; and
- Reducing the cost of ownership of medical devices. Studies estimate cost savings at 40 percent of total cost of ownership.
In addition, comprehensive data integration will prevent errors and inefficiencies through smart alarms, decision support and real-time dashboards, said Goldman. He concluded by pinpointing a primary barrier to interoperability: devices from multiple vendors assembled by end-users or system integrators.