NARUS 2018: Tips and Tricks to Run the Robotic OR Like a Machine
At NYU, they typically have two circulating nurses and it is important to define each nurse’s role to improve efficiency. In general, the primary circulating nurse should be assisting anesthesia, assisting with positioning, hooking up equipment, completing computer/paperwork, staying in the room at all times, and interviewing the next patient. The assisting circulator’s roles may include opening supplies, assisting with instrument counts, running for the room (ie. to pathology), hooking up equipment, and restocking equipment.
Ms. Sorin also emphasized that preparation improves workflow and efficiency. Specifically, the evening before the case, the OR evening shift can pick the first scheduled case using the surgeon preference card, making notes on the preference card of any needed supplies/instruments not available. Additionally, the evening crew can setup the OR rooms for the next day’s first start, including the positioning supplies. The day of surgery, at 6AM the patient arrives for a 7:30AM case, freeing up the day shift to expedite with the anesthesia team getting the patient in the room for an on-time first case start.
There are specific roles for each member of the team, however it is important to understand how to do everyone else’s job to a certain extent, according to Ms. Sorin. This is particularly important for the circulating nurses, bedside assistants, and surgical technologist. The one exception to this is the anesthesiologist and surgeon, however it is important for the nurses, PA’s and surgical techs to learn their steps in order to provide additional support.
Ms. Sorin also highlighted the importance of communication, notably closed-loop communication and “read backs” to ensure specific tasks are not only understood but communicated that they are completed effectively. Read-backs are the immediate repeating back of a request or a command, which is done to verify the person has been heard in addition to requesting clarification, demonstrating understanding and confirming the action has been taken. This works very well in other fields, in particular military communication, as well as air traffic control operators.
It is also important for the team to know the room layout for each case. Specifically, turning the OR table rather than repositioning the patient cart between cases, making sure the bedside assistant can easily see the monitor and hear the surgeon, and keeping sterile areas in one location. It is essential to have consistency and to “do it the same way every time.” This includes the room layout, positioning, prepping and draping, cord management, port placement, docking, instrument choices, sutures and hemostatic agents, and specimen extraction methods. This allows the team to anticipate the next step and be ready, which ultimately increases efficiency.
Ms. Sorin concluded with emphasizing the importance of communicating when the case gets tense. It is human nature to want to shut down, to be quiet and not make waves, but this is the time for the allied health team to talk to the surgeon, so they feel connected to the team and the patient.
Presented By: Suzannah Sorin, New York University, New York, NY
Written By: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre, @zklaassen_md ,at the 2018 North American Robotic Urology Symposium, February 16-17, 2018 - Las Vegas, NV