ERUS 2018: Improving Theater team efficiency with the “Robotic Dance.”

Marseille, France (UroToday.com) Dr. Tyritiz gave an excellent talk on how to improve the efficiency of the robotic surgical procedures. He began by presenting some data that was originally presented in the ERUS 2012 meeting. This was a comparison of robotic surgical procedures done in a UK center and a high-volume US center for two years between 2009 and 2011. During this period, the UK center performed 382 robotic cases, while the US center performed a total of 1881. The US staff had consistent team members in over 80% of the time. During a 9-hour working day, the UK center managed to maximally have two robotic cases per day, while the US center had 4 cases per day. The most incredible data and probably the most significant difference between the centers was the turnover time between cases, being on average 84 (55-126) and a staggering 19 (12-55)! Min in the UK and US centers, respectively.

The ultimate goal should be to have a team of experts, who together comprise one unit, adept and experienced in working as a team. The concept of “Lean thinking” was introduced by Dr. Tyritiz, which includes several important factors. These include reduction of variability and incorporation of a consistent systemic approach to reduce mistakes, convenient, user-friendly theater layout with a work island for each team member. Furthermore, it includes avoiding unnecessary steps and duplication, with work done in parallel.

The consistency of the team is a crucial element. Dr. Tyritzis gave a typical hospital example, which if you have a team of 3 different robotic surgeons, four different assistants, six different scrub nurses, four different circulators, and five different anesthetists, in total you have 1440! Different combinations of personnel working together. This emphasizes the need to try and have the teams as consistent as possible.

Another change that should be implemented is the creating of a single tool tray for all robotic procedures, instead of having a specific tray for each procedure. In the long run, this will save time, improve outcomes, and reduce costs. It is also important to have the team be as efficient as possible and avoid performing unnecessary steps and duplicate different stages. The theater room layout should be user-friendly and consistent. It should be setup in a way that enables the personnel to do fewer steps and be more efficient. Work should be done in parallel, to save time and maintain consistency, and each staff member should know his steps and tasks for every procedure.

Tasks need to be converted from a stop/start (serial) to a continuous working (parallel). Examples of these tasks include: setting up and clearing the back table, draping and undraping the robot, draping the patient, and putting dressings on the patient.

Dr. Tyritzis summarized his great talk by pointing out the main factors that need to be optimized. These included: identification of all individuals tasked with turnaround, optimize the theater layout, strive for >80% of the time having one consistent team working, divide the workflow between the team members, standardize the approach and the work trays, work in parallel, build team pride, and educate and train all the trainees in a structured manner. This will eventually enable team members to utilize “Lean thinking,” build credibility, reduce costs, improve consistencies, and enhance patient safety and quality outcomes.

Presented by: Stavros Tyritzis, Justin Collins, ORSI academy

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, Twitter:@GoldbergHanan at the EAU Robotic Urology Section (ERUS) Meeting - September 5 - 7, 2018 - Marseille, France