Smart Surgery

5 Key Components of the Integrated OR in 2018

16 Aug 2018

The modern OR is a technological wonder. Surgeons have never had so much real-time information at their disposal: data about current procedures, patient conditions and histories, even risk calculators. That’s the good news.

The bad news is that all too often, the most important and time-sensitive information is scattered across disconnected devices and displays, preventing quick access at the exact time when it's needed the most. It's like trying to fly a 737 through a rough storm at night, while its instruments and displays are distributed randomly around the cockpit – you can do it, but it takes a lot more work, relies heavily on intuition, and is much more risky.

Studies published in the New England Journal of Medicine and a research brief from the Rand Corporation show that surgeons already carry the highest risk of malpractice lawsuits within the hospital. As these organizations take on more financial risk through the transition to value-based payments, it becomes even more imperative for hospitals to remove any distractions or impediments to surgeons delivering quality outcomes.

The modern OR has shown tremendous progress over the last 10 years, specifically through advancements in ergonomics, surgical efficiency, and OR turnover time. But in order to ensure that the OR is offering surgeons a similarly improved workflow and the data visibility enjoyed by pilots in the aviation profession, there are five, key considerations to reflect on:

1. Deliver the best image quality, from scope to screen

Surgeons require two things of their video feeds in order to improve outcomes: the sharpest images possible, and true, zero latency. The industry standard has been to run cables from a variety of sources, such as scopes and room cameras, to a standard definition video switch, which then passes the signal to monitors around the OR.

Today’s most advanced integrated ORs improve on that concept by taking advantage of fiber optic cable running to a network switch that benefits from video over IP (VoIP) to deliver HD, 4K, and other high-quality outputs.  The approach greatly increases the level of detail surgeons can see, and provides a clear path toward deploying future technologies and standards with minimal interruption.

2. Consolidated video is better video

The first generation of integrated ORs was a big improvement over previous approaches. But it still required surgeons to monitor multiple screens to obtain the full perspective in situ. Today’s integrated ORs mimic the unified cockpit view, delivering OR video feeds as well as vital signs, PACS imaging and EHR data from outside the suite. This multi-view consolidates every relevant piece of intelligence in-process, saving time while helping the surgical team deliver better care.

3. Make it vendor-neutral 

Integrated ORs should be able to accept video feeds regardless of the device's manufacturer. And it’s now possible to integrate with other sources, such as EHRs and PACS. The top integrated ORs accommodate such integrations, with the intent of decreasing risk and improving care via data consolidation and sharing - regardless of the label on the device.

4. Automate, automate, automate!

Fully integrating the OR with outside systems such as EHRs and PACS helps with more than the surgical procedures themselves. It also can reduce many of the administrative burdens surgical and management teams face.

For example, building a list of surgeries that will occur in OR 1, and pulling in the information for each patient for those surgeries, was a very labor-intensive and time-consuming task in the past. Now integrated OR suite technologies can create those lists and gather than information automatically, freeing clinicians for more critical, higher-level work. Additionally, it ensures the surgical team understands all the risks inherent with a particular patient before the patient enters the OR, such as latex or medication allergies, and simplifies creation of the case card so surgeons are confident they have everything they need to be comfortable with the procedure.

Automating the information-gathering process also makes it easier to operate from checklists and build in timeouts.

5. Create opportunities to educate and improve

Traditionally, OR integrations offered the ability to record video, curate it, and use it in a variety of ways to improve training and performance. Surgeons can review their own procedures, surgical interns can watch videos as part of their training, and speakers can use them to illustrate points in seminars and symposiums.

The advantage of the next generation of integrated ORs is that they can provide more than video. Like the “black box” used in aviation, they record everything - video, conversations, data, images, etc - in order to deliver a moment-by-moment look at what happens in a surgical case. Observers can watch the hand movements of the surgeon, as well as what is happening inside the patient, to understand surgical technique or discover areas of improvement. Having vital sign data available shows how patients react to different events throughout the procedure. Even the room camera can be valuable in discovering whether there are more efficient and ergonomic ways for the full surgical team to work together. This “black box” approach helps reduce the time to learn, while creating a cycle of continuous improvement.

Today’s integrated OR make it easier to obtain and use all the available data (in all its formats) to help hospitals increase success rates, while at the same time helping to drive down risk and costs. They make the difference between flying blind (or partially blind) and delivering the best care possible with every surgery.

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Written by Caresyntax

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