NK8EOa

 

Innovation NK8EO

 

Using the required empirical outcomes (EO) presentation format, provide one example of an improved outcome in a care setting associated with clinical nurse(s) involvement in the adoption of technology. 

 

 

Example a: DaVinci Robotics

Problem

Catholic Health Initiatives (CHI) St. Vincent Hot Springs (SVHS) is always looking for ways to decrease its average length of stay (ALOS). Decreasing patients’ LOS enables SVHS to accommodate more patients who require admission. As inpatient volumes are routinely high, having patients spend less time in the hospital enables SVHS to admit and treat more patients. Decreasing patients’ LOS also decreases the risk of hospital acquired infections, which can make them even sicker. Less invasive surgical techniques decrease the risk of complications, which can decrease patients’ LOS and lead to better outcomes.

 

Pre-Intervention

1st Quarter 2021 (January-March)

 

January 2021
CommonSpirit Health (CSH), the parent company of CHI SVHS, gifted CHI SVHS a DaVinci Robotics (Robot) for the Operating Room (OR). Douglas Ross, MD, FACEP, President SVHS, shared this great news with Tonya Baier, BSN, RN, CNML, Clinical Director Nursing, and Tim Lambeth, BSN, RN, Operating Room Nurse Manager. Leaders were excited for this opportunity, as the DaVinci Robot is less invasive than other surgical techniques that were being used at CHI SVHS. Robotic assisted surgeries minimize the risk of postoperative surgical complications, leading to better outcomes.

 

February 2021
Baier and Lambeth met to discuss next steps for plans to use the DaVinci Robot at CHI SVHS. In collaboration with Vincent Medina, MD and John Webb, MD, they decided to start using the DaVinci Robot for hernia and gallbladder surgical procedures as these are more common and easier procedures for the team to develop their knowledge and skills. After becoming proficient with these easier procedures, the team would begin using it for more complex procedures.

 

Baier and Lambeth discussed candidates for the Robotics Coordinator role. They approached Circulating and Clinical Nurse Amy Harper, BSN, RN, OR, to determine her interest in assuming the role. Harper has approximately 20 years of experience as an OR RN, has a great work ethic, and is detail oriented. Baier and Lambeth believed Harper could handle the workload of being a circulating and clinical nurse in the OR with this new program.

 

March 2021

  • Baier and Lambeth reviewed the DaVinci Robotics Coordinator role with Harper, who accepted the position.
  • Kim Sessions and Nathan Offutt, Intuitive Representatives, introduced the DaVinci Robotics program to Baier, Lambeth, and Harper.
  • Harper and Lambeth completed spatial planning for the DaVinci Robot, including which OR to place the robot in and where in the room to place it.

 

Harper, Lambeth, and Baier reviewed CHI SVHS inpatient units ALOS for hernia and gallbladder surgical patients, which was 0.61 days for 1st Quarter 2021 (January-March). The team planned to continue to monitor the impact on surgical patients ALOS following the adoption of the DaVinci Robotics technology.

 

Goal Statement

Decrease the CHI SVHS inpatient units average length of stay for hernia and gallbladder surgical patients.

 

Participants

 

 

DaVinci Robotics Work Group

 

Name/Credentials

Discipline

Title/Role

Department

Amy Harper, BSN, RN

Nursing

Circulating and Clinical Nurse/Robotics Coordinator

Operating Room

Tim Lambeth, BSN, RN

Nursing

Operating Room, Nurse
Manager

Operating Room

Tonya Baier, BSN, RN

Nursing

Clinical Director Nursing

Nursing Administration

Kim Sissions

 

 

Intuitive Representative

Nathan Offutt

 

 

Intuitive
Representative

 

Description of the Intervention
2nd Quarter 2021 (April-June)

 

April 2021

  • Sessions and Offutt educated Harper using online modules on the robot.
  • Harper educated clinical RNs and scrub techs using the online modules. The objectives included:
    • Why the robot would be used
    • Introduction to all the robot’s working parts
    • How to operate and use the new technology in surgery

 

May 2021

  • Facilities oversaw the completion of wiring in the OR to support the DaVinci equipment.
  • Information Technology updated internet access in the OR to support the DaVinci equipment.
  • Harper continued to educate clinical RNs and scrub techs using the online modules.
  • A robot simulator was made available for all surgeons and staff members, including all OR clinical nurses, for hands-on training.
  • The robot was delivered and installed.

 

June 2021

  • Harper and Offutt educated clinical RNs and scrub techs through in-person training.
  • Staff members received hands-on training and gained practical experience with the robot.

 

The interventions were fully implemented by the end of 2nd Quarter 2021.

 

The OR began using the DaVinci Robot for hernia and gallbladder surgical patients on July 1, 2021. OR clinical nurses’ involvement in the adoption of the technology of the DaVinci Robot was associated with the improved outcome of a decrease in ALOS for hernia and gallbladder surgical patients at CHI SVHS.

 

References

Feliciano, D., Hawn, M., Heneghan, K., & Strand, N. (2012). Ventral hernia repair. ACS. https://www.facs.org/for-patients/the-day-of-your-surgery/ventral-hernia-repair/

 

SAGES. (2022). Ventral hernia repair surgery patient information - society of american gastrointestinal and endoscopic surgeons. https://www.sages.org/publications/patient-information/patient-information-for-lap aroscopic-ventral-hernia-repair-from-sages/

 

Outcome

(Evidence NK8EOa-1, Average Length of Stay in Days Graph)