Intra Surgical Supply Chain Information: How Digital Technology and Content Can Improve Patient Care
(Fourth in a series of articles outlining how the Summate Digital Operative will improve different aspects of the O.R. supply chain)
Our previous article outlined the problems facing O.R. staff and surgeons with regard to supply chain information during surgery. In this article we address how Summate’s Valet software, with vendor supplied information content, can alleviate the information isolation that can occur in the operating room for HCP operating room staff. Einstein is equipped with Amazon voice recognition technology, which can be used to query the Summate Valet database for mission critical digital information during surgery, commanded directly from the surgical field.
Einstein’s functionality is highlighted in bold text.
Its almost 4 pm, which is late for the O.R. regular day, and before the surgery starts, the circulating nurse and the surgical technician are setting up the room for the “add-on” case, a bad tibial fracture. The surgical technician (ST) is new, and the circulating nurse is a “traveller”, and relatively new. The case involves an trauma implant set neither one of them has ever seen. They have no familiarity with most of the instruments in the set, or how the implants relate to the surgery. Yet, the ST will be responsible for managing the tray while the surgeon is focused on fixing the patient. Its going to be a stressful case because of this, and everyone knows it. The ST is especially nervous, as the surgeon for the case is not known for his patience. She fidgets as she waits for the patient to arrive at the room, glancing at the huge implant and instrument set sitting imposingly on the back table.
Turning to the Einstein cart, the ST turns and asks Einstein to "show the Synthes set up and video for the small fragment fracture tray”. The 3 minute video goes over all the important bullet points for setting up and handling the new tray, and the ST is much more comfortable as the surgeon enters the room. The case will proceed much more smoothly.
The attending surgeon and his second year resident are now in the room as the patient is put under anesthesia. Since this is a tough case, and the implant tray they are using is a new set, the surgeon would have liked the second year resident to review the technique guide on how the use the set. He’s had a frantic day, however, and forgot to mention it to the resident. The assisting second set of hands will learn on the fly during the procedure. As a matter of fact, the attending is a little vague himself on the new set layout as he has only used it once before, when the device rep was present. No rep was available today, so he’s on his own now. More stress.
The surgeon asks Einstein “show me the Synthes tibial fracture tray technique guide”, and has the resident review the PDF document as he works with anesthesia to position the patient.
The surgeon is having trouble reducing the fracture. He needs a specialty instrument from another implant set, and asks the circulating nurse to have “the other tray, the large frag tray” sent up from SPD (sterile processing, where the sets are kept.) The circulating nurse to gets on the wall phone and calls down to get it sent up to the room. The person on the other end of the phone in SPD looks up “large frag tray” and sends it up to the room. The problem is, its the Stryker large frag and not the Synthes large frag set. The case is delayed another 10 minutes while the right set is sent up. 15 minutes total of OR time is wasted.
Instead of calling down on the wall phone, the circulating nurse goes to the FIND INSTRUMENT function of of the Velox software running on Einstein, and the surgeon instructs her as to the name of the instrument he needs. She types it in, and the system finds the correct Synthes tray and its location. The nurse then clicks “order” and the request is sent to the STAT delivery screen in SPD. The proper tray is promptly sent directly to the room and arrives in 4 minutes.
While waiting for the tray, the surgeon realizes he needs a specific mesh from another tray, but he can’t remember which tray the mesh is in, and has no way of accessing the information. He asks the circulating nurse to get his cell phone and has her disconnect his light cable. Covered with blood and with his arms crossed, he has the nurse dial the device rep’s number, and has her hold the phone to his ear when the rep answers. The rep gives him the information.
Instead of calling the nurse over to unplug his light headset and leaving the surgical field, the surgeon turns to the Einstein cart and instructs “Einstein call Pete Simpson.” Using its VOIP capabilities, Einstein calls the rep on his cell phone from the Valet phone directory, and the surgeon speaks with Simpson and gets the information he needs while still at the surgical sight.
The operating room is quiet but for the tinny blare of the computer speakers on the nurse’s station, tuned to a random Pandora station the circulating nurse has selected. It’s “80s Pop”, but at least it beats the monotonous beep of the cardiac monitor. The surgeon is already aggravated because of the crappy music and now furthermore because the ST doesn’t know the instruments as he asks for them during the case. Now he needs bone cement to augment the tibial plateau. The circulating nurse has no idea what is currently stocked in the biologic supply cabinet 10 doors down in the “bone” room (where the cement is kept under lock and key), as the surgeon is asking for something she has never heard of before. She gets on the phone, but no one answers, so she leaves the O.R. and makes her way down to cabinet. The OR room is left unattended by any nursing staff while she is gone. When she gets to the “bone room” , she notices that there are 5 different sizes of product. She grabs the largest size, just to be safe.
Instead of instructing the nurse to get him the bone cement, the surgeon asks “Einstein find bone cement”. A complete list of all the bone cement in the biologics cabinet down the hall populates the screen. From the surgical field, the surgeon is able to identify the correct product and size from the list, and the nurse is able to get exactly what the surgeon needs delivered to the room.
(Einstein is also capable of playing the surgeon’s personal Spotify music lists on request during the case as well - providing no small measure of workplace satisfaction for the surgeon on long cases).
The surgeon is ready for the bone cement, but the nurse not only grabbed the wrong brand of cement (from which he is used to using) but 5 times more than he needs. The package has been opened, however, so they are going to use it. The problem now is that the ST has no idea how to prepare the cement, which if not done properly, will lead to a less than optimal surgical result. Under pressure, she asks the circulating nurse to read off the instructions for use. While the surgeon impatiently waits, she mixes the ingredients. 3 minutes of mixing is required, but the surgeon (used to the other product which needs only 1 minute of mixing) asks for the product “right now!!”. She hands it to him, and its implanted. 80 percent of it remains unused, and is later thrown out.
As the nurse is out of the room getting the bone cement, the ST instructs “Einstein show me the ACME bone cement mixing technique video”. The 2 minute video plays at the field, and everyone is on the same page as to the proper steps to prepare the product.
The room calls for turnover staff. The case is finished. The results of poor supply chain information? The ST is going to have a nervous breakdown the next time she gets assigned to a tibial fracture case, especially with this surgeon. The resident was not as thoroughly prepared for the case as he could have been. The circulating nurse inadvertently wasted $2,000 worth of product. About 15 minutes of OR time (at about 6000 dollars an hour) was wasted waiting for incorrect equipment. And most seriously, the bone cement was not properly prepared and may subsequently crack and fail. It probably won’t, but it was not an optimal use of the product.
Proper and timely information delivery from Einstein has ensured a more successful case. Time and money are saved, and the quality of patient care has been improved. Additionally, Einstein recorded through point of use scanning the correct implant usage from the case: the billing is correct, the patient record is correct, the restock order will occur instantly and will arrive early the next morning via overnight delivery. Digital management of orthopedic trays also solves big quality problems in sterile processing, where the trays are reassembled, restocked and autoclaved. Implants are restocked from the surgical record from the case, and the trays are reassembled by scanning the instruments back into proper sets and trays to ensure 100% accuracy.
The promise of the Summate Digital Operative has been fulfilled.
Historically enormous amounts of money and time have been (well) spent to improve patient information data, which has yielded tremendous gains in quality of patient outcomes. However another very important component of surgical quality - real time support information on the supplies, implants, and instruments and that surgeons use in the field - has been largely overlooked. A surgeon may use 5 or 6 different mission critical products - implants, power equipment, instruments, biologics - during a complex case. It’s not feasible nor does it make sense to have 5 or 6 vendor sales reps in the room to assist. OR Surgeons, nurses, and surgical technicians can effectively be on their own while in the surgical theatre. Those that work in the O.R. are keenly aware as to how this can affect the quality of patient care. Those outside the O.R. environment are not as aware - but it’s a real problem.
At the intersection of voice recognition and digital content and delivery, Summate’s Valet software and Einstein hardware option is a drop in solution for mitigating one of the largest issues of patient care quality in the O.R. - timely and accurate supply chain information. It simply makes sense that it will become a focus of the healthcare industry, and have vendor support for comprehensive content from the myriad of OR product OEMs and suppliers. Valet software will never replace a good and valued OEM sales consultant, but in fact augment their effectiveness, if used as a tool. The Summate solution could be invaluable for managing larger geographical territories with rural hospital accounts.
Ultimately, vendor developed and supplied digital product information, made available to surgeons and O.R. staff intra-operatively on the Valet/Einstein platform in real time, can have a positive impact on quality of patient care.
Summate Technologies, Inc.