Establishing a Robotic Surgery Program

Abstract

With the potential for faster recovery, less pain, and less risk of infection, facilities are working to leverage robotic technology and the consumer demand for robotic surgery is on the rise. However, establishing a robotic surgery program takes more than the capital investment of purchasing a robotic system, according to Erin Ulrichsen, MS, RN, CNOR, CNA, robotics program manager for the Visconti Center for Robotics at St. Joseph's Hospital in Atlanta. She is also Professional Issues/Practice Chair for AORN's MIS/Lasers/Robotics Specialty Assembly. Ulrichsen said the key to creating a successful robotics program involves a combined focus on patient safety, staffing, education, public outreach and a sound business model that will keep the robotic system from becoming an unused piece of equipment collecting dust. Five years ago she was the perioperative nurse manager at this facility. When an innovative cardiac surgeon came to the facility wanting to establish a robotic surgery program, Ulrichsen stepped in to coordinate. “My role evolved into the program manager position as we saw what was needed to make the program successful, but I didn't really believe in the role myself. I figured robotic surgery would be one part of my management position, until I was hit with all that needed to be coordinated to keep the program running,” she explained. As of March 2010, St. Joseph's Hospital has done more than 1,500 robotic surgeries and has four active robotic systems, with one system used for training. Ulrichsen speaks to perioperative nurses, CEOs, surgeons and other health care professionals across the country about the key concepts she and her team have found to successfully grow their robotic program. While a typical day for Ulrichsen is about 80% focused on clinical patient care, the other 20% is consumed with outreach activities, whether it is talking to the hospital's marketing department to determine how robotic surgery is represented on their Web site, updating the hospital CEO on the program or calling a constant list of interested patients who want to know more about robotic surgery at her facility. She also speaks with perioperative robotic program coordinators at other facilities to discuss best practices, troubleshoot challenges, and share knowledge. Perioperative registered nurses are often the health care professionals selected to take on the role of robotic surgery coordinator. Many of these nurses across the country network to share resources, trouble shoot problems, and to discuss best practices. Carrie Mackay, BSN, RN, CNOR, taps into this network whenever she can as she continues to develop the robotic surgery program she coordinates at Providence Portland Medical Center in Portland, OR. While she has worked with the two robotic systems at her facility for more than a year, she is just stepping into the formal role of robotics coordinator. Mackay believes perioperative nurses are uniquely qualified to serve as robotic program coordinators because, she says, “having a perioperative nursing focus to keep the patient safe is primary.” She also stresses the importance of team communication and says it is important to be able to communicate with surgeons of different specialties and to be available for new surgeons learning robotic surgery, as well as to communicate continuous training for the entire surgical team. She is working closely with all members of her team to review and update policies and procedures for robotic surgery that can improve patient safety. For instance, each robotic patient has two IVs started to help prevent difficulty gaining access during surgery, once the robot is placed. Her facility has established a specific “Time Out” for robotic surgeries, which includes a first Time Out prior to induction to confirm correct patient, site, procedure, allergies, and implants. Then the team does a second Time Out after the patient is positioned and before the surgery begins, when the RN Circulator says th