Achieving the Optimization of the Da Vinci Program

Operating room (OR) turnover time (TOT) is the time it takes to prepare an OR for the next surgery after the previous one has been completed. Reducing OR TOT can improve the efficiency of the OR, reduce costs and improve surgeons’ and patients’ satisfaction. To evaluate the effectiveness of an Operating Room (OR) Turnover Time (TOT) reduction initiative using the Lean Six Sigma methodology (DMAIC) in the bariatric and thoracic service lines. Performance improvement strategies consisted on simplifying steps (surgical tray optimization) and concurrent steps (parallel task execution). We compared two non-consecutive months (pre-implementation and post-implementation). A paired t-test was used to assess whether the difference in the measurements was statistically significant. The study found that TOT was reduced by 15.6% from an average of 35.6 minutes with a standard deviation of 8.1 to an average of 30.09 minutes with a standard deviation of 9.7 (p < 0.05). Specifically, in the bar...

2013

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Pediatric Endosurgery & Innovative Techniques, 2003

Objective: To share our recent experience in developing and implementing a program for computer-assisted, robot-enhanced surgery. Background: Minimally invasive surgery has revolutionized our approach to the surgical patient during the last decade. While robotic surgery does promise the ability to operate at a distance, thus providing surgical skills in remote and hazardous areas, we have found several features that could enhance our abilities as surgeons in the same room with our patient. These include tremor filtration, motion scaling, movement indexing, provision of a wrist at the end of the intracorporeal instrument, movements of the instrument that are intuitive in that they follow the surgeon's hand, and a steadier image controlled by the surgeon. It is our view that robotic surgery is the next logical step in performing more complex procedures on smaller patients in a minimally invasive manner. Methods and Procedures: We defined a core group of individuals who shared our vision: pediatric surgeons, our institutional research director, a biomedical engineer and physicist, and our hospital chief executive officer. We then identified the individuals and corporations who are working with surgical robotics. After extensive comparisons and site visits we chose a single corporate partner. Our partnership was not just a plan to purchase instrumentation but also an agreement to continue research and development of equipment and surgical techniques. We developed short-term and long-term educational, research, and business plans. We shared information on surgical robotics and our business and research plans with our hospital administration and our hospital board of trustees to garner support. The staff of the hospital development office was also involved in generating financial support. We developed and implemented a robotic surgery training program and started to perform robotic surgery procedures in humans and to develop new procedures and technology in the laboratory. Results: Institutional and private donor support has allowed us to implement a robotic minimally invasive surgical suite in our operating room and in our research building. Within one year of embarking on our program we performed our first robot-assisted minimally in-415 1 The Maxine and Stuart Frankel Foundation Computer-Assisted, Robot-Enhanced Surgery (CARES) Program, Children's Hospital of Michigan,

IEEE Robotics & Automation Magazine

Robotic-assisted surgery is now well-established in clinical practice and has become the gold standard clinical treatment option for several clinical indications. The field of robotic-assisted surgery is expected to grow substantially in the next decade with a range of new robotic devices emerging to address unmet clinical needs across different specialties. A vibrant surgical robotics research community is pivotal for conceptualizing such new systems as well as for developing and training the engineers and scientists to translate them into practice. The da Vinci Research Kit (dVRK), an academic and industry collaborative effort to re-purpose decommissioned da Vinci surgical systems (Intuitive Surgical Inc, CA, USA) as a research platform for surgical robotics research, has been a key initiative for addressing a barrier to entry for new research groups in surgical robotics. In this paper, we present an extensive review of the publications that have been facilitated by the dVRK over the past decade. We classify research efforts into different categories and outline some of the major challenges and needs for the robotics community to maintain this initiative and build upon it.

Urologia Internationalis, 2014

range 13-21] vs. 15 [interquartile range 8-16] nodes; p = 0.02), biopsy (p = 0.04) and specimen Gleason scores (p = 0.03), and length of hospital stay (median 8 [interquartile range 7-14] vs. 9 [interquartile range 8-18] days; p < 0.01). Conclusions: Da Vinci ® device sharing with transfer of surgical know-how can reduce the costs of RARP without compromising surgical outcomes, even at the beginning of the learning curve.

Journal of Industrial Engineering and Management, 2023

Purpose: Implementing process management methodology through Lean Management and Design Thinking provides a new way to manage surgical blocks, maximize efficiency and adapt to the high variability of demand. This article presents our experience of implementing a set of improvement actions within the surgical process in the context of Lean Healthcare Processes. The project involved a total of 900 healthcare professionals over a 3-year period (2017-2019) and has impacted over 38,000 surgical patients each year at the Vall d'Hebron University Hospital in Barcelona, Spain. The purpose of this article is to present a set of improvement projects within the surgical process and show the indicators that monitor its evolution. These projects have been implemented successfully in a hospital with high surgical complexity and indicate how health care professionals and process engineers can work together as a team to improve healthcare resources. Design/methodology/approach: To evaluate the effectiveness of the actions presented, we propose a series of standardized indicators showing how our findings increase the efficiency of the surgical process. We also indicate Lean projects that can reduce patient waiting times and increase capacity. Below is a management model for the surgical process that considers industrial production criteria such as resource planning, optimizing the use of operating rooms and professionals' time and generating the best surgery combinations. Findings: Projects that have increased efficiency in the surgical block the most have been standardized and converted into a model of action. This is designed to adapt to any level of complexity within the hospital process. The set of improvement projects has been divided into 6 stages: Programming, Material logistics process, pre-surgical stage, intra-surgical stage, post-surgical stage and transversal projects; each affecting a different area of the general hospital (not only the surgical unit). Furthermore, a visual flow chart was designed using the results of the project. Findings from the study have led to a 15% increase in surgical capacity without the need for new resources. The average hospital stay also dropped from 7.2 days to 4.1 days. The flow vision in the care process improves the experience of both patients and health care professionals, who see their participation as part of the whole health care process. Research limitations/implications: the projects were mainly developed at the Vall d'Hebron University Hospital. Although several of these projects have been carried out in other hospitals in Spain by the same team of process engineers, results may be biased when the team provides support within its own process department, compared to when it supports the local team in another hospital temporarily.

Implementation science : IS, 2014

Background: Robotic surgery offers many potential benefits for patients. While an increasing number of healthcare providers are purchasing surgical robots, there are reports that the technology is failing to be introduced into routine practice. Additionally, in robotic surgery, the surgeon is physically separated from the patient and the rest of the team, with the potential to negatively impact teamwork in the operating theatre. The aim of this study is to ascertain: how and under what circumstances robotic surgery is effectively introduced into routine practice; and how and under what circumstances robotic surgery impacts teamwork, communication and decision making, and subsequent patient outcomes. Methods and design: We will undertake a process evaluation alongside a randomised controlled trial comparing laparoscopic and robotic surgery for the curative treatment of rectal cancer. Realist evaluation provides an overall framework for the study. The study will be in three phases. In Phase I, grey literature will be reviewed to identify stakeholders' theories concerning how robotic surgery becomes embedded into surgical practice and its impacts. These theories will be refined and added to through interviews conducted across English hospitals that are using robotic surgery for rectal cancer resection with staff at different levels of the organisation, along with a review of documentation associated with the introduction of robotic surgery. In Phase II, a multi-site case study will be conducted across four English hospitals to test and refine the candidate theories. Data will be collected using multiple methods: the structured observation tool OTAS (Observational Teamwork Assessment for Surgery); video recordings of operations; ethnographic observation; and interviews. In Phase III, interviews will be conducted at the four case sites with staff representing a range of surgical disciplines, to assess the extent to which the results of Phase II are generalisable and to refine the resulting theories to reflect the experience of a broader range of surgical disciplines. The study will provide (i) guidance to healthcare organisations on factors likely to facilitate successful implementation and integration of robotic surgery, and (ii) guidance on how to ensure effective communication and teamwork when undertaking robotic surgery.

2008

The new millennium was a turning point for the scrutiny of quality and safety in healthcare. An increasing number of studies, investigations, reports and audits worldwide acknowledge that there is a significant risk of unintentional harm to surgical patients. The reasons for this are complex, but, in broad terms, surgical systems are to some degree failing to establish equilibrium in balancing service demands with systems development. In order to resolve this, healthcare must adopt a systems approach to performance.

Anesthesiology Clinics, 2010

Quality of care and service in health care can benefit from the use of algorithm-driven care (standard work) that integrates literature assessment and analysis of local outcome and process data to eliminate unnecessary variation that causes error and waste. 1-6 Effective management of an ambulatory surgery center requires that leadership emphasize constant improvement in the processes of care to achieve maximum patient safety and satisfaction, delivered with highest efficiency. Such work is only effective if staff and physicians understand the value of such improvement to patient and family experiences, and if they believe there is a gap between current operations and the ideal. Therefore, leadership needs a method to obtain, evaluate, and share process and outcome measurements in an open, objective, and clear manner. Measurement and explication of outcomes of operational workflow are of value in directing process improvement efforts in a variety of industries, including health care. 7-10 The seemingly ubiquitous increase in operational improvement models (Six Disclosure: Both authors are members of SAMBA, and DGM is a member of the Board of Directors for SAMBA and the AQI. Excel is a registered trademark of the Microsoft Corporation. Toyota Production System (TPS) is a registered trademark of the Toyota Motor Manufacturing Corporation. The Six Sigma Management System is a registered trademark of Motorola Inc.

Current Problems in Surgery, 2019

The basis for many of the performance improvement tools of today started 100 years ago with the work of Walter Shewhart at Western Electric's Hawthorne plant in Illinois. Previously quality was controlled by having multiple inspectors look at a finished product for defects, then return it for repair or discard. Shewart recognized that measuring and understanding the steps in the process, would signal when variation was occurring. It was Shewhart's development of the statistical process control (SPC) chart that provided a visual representation of variation. An SPC chart builds on a simple run chart by adding a measure of variation that differentiates between what we now refer to as common-cause variation (random variation) and special cause-variation (non-random variation). These concepts are coming into medicine, with the understanding that frequently used simple run charts, although easy to create, do not allow an identification of a true variation. Process control took an additional step forward with the contributions of W. Edwards Deming and Joseph Juran. Deming popularized the PDSA (Plan Do Study Act) cycle and Juran worked in post war Japan, identifying concepts such as the Pareto Principle (80% of the problems come from 20% of causes.) The rapid expansion in capability and quality from Japan's manufacturing complex subsequently ensued. During the gas crisis of the 1980's US auto manufacturers recognized the need to compete with foreign imports and sought to learn techniques such as the Toyota Production Method, LEAN and Six Sigma. It also forced US companies to recognize the vital importance of the front-line worker in identifying areas of risk as well as providing possible solutions. This has been challenging in Medicine. The top down management style of many hospitals has made adoption of these concepts challenging. Further, surgeons were trained in hierarchical environments and taught that any error was a personal failure requiring blame. This inhibited honest discussion of the system /human interaction. Fortunately, this is beginning to change. Measuring and Analyzing Data Deming, Shewart and Juran all recognized that if you don't measure something, you can't fix it. They did not have the types of incredible computing power currently at our fingertips. It is quite easy to upload