More and more hospitals in Germany are modernizing their operating rooms. These so-called “Hybrid ORs” enhance the workplace of a surgeon with imaging techniques such as angiography and computer tomography and sometimes even provide a robotic assistance system. This “high-tech” equipment, however, can quickly become a bad investment if the personnel are not able to use it due to a lack of training, stresses an expert in the run-up to the MEDICA EDUCATION CONFERENCE 2016 taking place between November 14 and 17 in Düsseldorf.
Today, many operations are performed in “minimally invasive” procedures. A surgeon removes the gall bladder is using small openings in the abdominal wall. Controlled by a surgeon working in an adjoining room, a robot assist in prostate surgery. Heart surgeons repair valves via a catheter in the inguinal artery. Vascular surgeons implant complex vessel prostheses using catheter procedures also via the inguinal artery. These interventions require high-quality equipment including “high-end” devices that in the past could only be afforded by large university hospitals.
Now, mid-sized and small hospitals also have high-tech operation rooms. Professor Dr. med. Clemens Bulitta, who manages the Institute for Medical Technology at the Eastern Bavarian Amberg-Weiden University, estimates that more than 200 hospitals in Germany have a hybrid operating room. In smaller hospitals, there is usually enough money for just one unit. Vascular surgeon, neurosurgeon, traumatologist, oral and maxillofacial surgeon, urologist and general surgeon: they all must share the room. Everyone brings in his/her own demands and devices. “The interdisciplinary use increases the complexity in the project”, says Professor Bulitta. Even planning becomes a challenge.
For this reason, hospitals should invest enough time and effort so that in the end the hybrid OR meets the requirements of all users. Professor Bulitta explains: “We recommend a single ‘master plan’ that is oriented based on the hospital's workflow and considers all groups such as medical technology, technical building equipment and building.” Building information modeling, which runs through all steps on the computer, improves planning but is not yet standard. In practice, visualization of the 2D plans in 3D helps best at present. All relevant interest groups should be fully involved into the planning process.
For small hospitals, a hybrid OR is associated with enormous investment costs that can only pay off with optimal utilization. According to Professor Bulitta´s experience, this can only be achieved when the personnel is appropriately trained. “Many hospitals think only of investment and operating costs but forget the qualification costs for the personnel”, says the expert. It is not only the high-tech devices that are challenging to operate. Professor Bulitta explains: “Personnel must know the basics of modern imaging and post-processing, the options for radiation protection, patient positioning and how to organize ordering and storage of interventional materials.” To this list must be added knowledge of material and device sciences as well as the required basic knowledge of the medical aspects of the procedures. “Due to the challenges in interdisciplinary cooperation, specific communication training also makes sense”, adds the expert.
If personnel are not adequately trained, many scheduled operations may not be able to be performed later. “In the worst case, the hybrid OR is filled with unused high-tech toys”, warns Professor Bulitta. As a result, it is not only the patient who suffers when deprived of optimal treatment. The hybrid OR could become an expensive investment disaster for the hospital as well. According to Prof. Bulitta, this situation can only be avoided when the high-tech OR is planned from the beginning as an overall system with the personnel working within. The expert addresses this notion of optimal planning in the symposium “Hospital engineering: Workflow-driven hospital and clinical engineering” on the fourth conference day of the MEDICA EDUCATION CONFERENCE 2016.
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