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Increase in robot assisted operating room efficiency: A quality improvement study
Diboro L Kanabolo1, Paul Merguerian2, Jennifer Ahn2
1Department of Urology, University of Washington Medical Center, Seattle, WA, USA.
Insights
Standardizing surgical tasks and improving supply management significantly reduced robotic console time for robot-assisted pyeloplasty (RP) in pediatric urology. This efficiency gain can increase operating room capacity for critical procedures.
Area of Science:
- Pediatric Urology
- Surgical Technology
- Healthcare Operations
Background:
- Robot-assisted pyeloplasty (RP) is a common, time-sensitive procedure in pediatric urology.
- Delays in RP can lead to irreversible renal function loss.
- Increasing operating room (OR) capacity is crucial for timely patient care.
Purpose of the Study:
- To reduce operative time in robot-assisted pyeloplasty (RP) by optimizing workflow.
- To provide value in patient care by decreasing total robotic console time.
- To test the hypothesis that process improvement and supply management reduce RP operative time.
Main Methods:
- Workflow analysis to identify and reduce OR inactivity during RP.
- Standardized OR staff task lists and pre-procedure supply procurement.
- Development of a clinical standard work (CSW) for RP, divided into 8 key steps.
- Analysis of pre- and post-intervention console time and instrument inactivity.
Main Results:
- Total console time decreased from 152 to 109 minutes (p=0.0002).
- Dual instrument inactivity reduced from 13.1% to 7.1% (p<0.0001).
- No significant difference in trainee operative time or patient age was observed.
Conclusions:
- Standardizing intraoperative tasks and reducing surgical workflow lapses enhances efficiency.
- Process improvements in RP can lead to more efficient case completion.
- Increased efficiency has the potential to expand OR capacity for pediatric urology procedures.
Introduction:
Pyeloplasties are time-sensitive, and the most common robot assisted intervention performed in pediatric urology. Early intervention is intended to avoid permanent loss of renal function with negative long-term effects if surgery is delayed when indicated. A need to increase capacity has become a premium value in patient care.
Objective:
Our aim was to reduce operative time, providing value by reducing total robotic console time in robot assisted pyeloplasty (RP) cases. We hypothesized that process improvement and supply management during RP leads to a significant reduction in operative time.
Methods:
Intraoperative surgical workflow was reviewed and routine tasks performed during the various sections were selected with the goal of reducing Operating room inactivity. We focused on robotic arm activity, and total operative time to assess our outcomes. Our intervention was to standardize an OR staff task list, a priori supply inventory procurement for each anticipated major step in the case, confirmed prior to each major step. Baseline RP duration data for a single Pediatric Urologist were identified and recorded before any interventions. A clinical standard work (CSW) was developed based on optimization of equipment/supplies for the RP procedure, compartmentalized into the 8 key steps for RP. These major steps included: patient positioning, docking, retroperitoneal and ureteral dissection, hitch stitch, pyelotomy, stent placement, and anastomosis. Balancing measures included percentage trainee console use, preparatory time, and OR block start/end time. Baseline data for RP cases performed between 11/2020 and 2/2022 were automatically extracted from charts and analyzed using AdaptX (Seattle, WA). Post-intervention was between 3/2022 to 3/2023. Mann-WhitneyU was used for continuous variables for non-parametric distribution.
Results:
37 patients underwent RP during the study period. 15 cases were performed prior to intervention and 22 post intervention Total console time prior to intervention was 152 vs 109 min after intervention (p = 0.0002). Dual instrument inactivity was reduced from 13.1 % to 7.1 % (p < 0.0001). Dual consoles were used in 40 % vs ∼69 % pre-vs post-intervention, respectively (p = 0.5000). No difference in patient age distribution between groups was seen (p = 0.1498). Trainee operative time did not differ statistically pre- and post-intervention (63.0 vs 48.6 %, p = 0.0871).
Conclusions:
Decreasing surgical lapses and standardizing intraoperative tasks can result in more efficient case completion, potentially increasing OR capacity.
