Effective Communication in the Operating Room: Electronic Whiteboards
Stephanie Ayala
NUR 516
June 20, 2021
Effective Communication in the Operating Room: Electronic Whiteboards
Introduction
The operating room is a highly stressful environment that has many moving parts. The operating room team consists of the Surgeon, Registered Nurse, Scrub Tech, CRNA, and Anesthesiologist. The OR team also works with the Charge RN and other staff outside of the operating room (pre-op RN, recovery RN, ICU RN, radiology, lab, blood bank, ancillary staff) to coordinate a successful surgery.
The operating room is a highly stressful environment that has many moving parts. The operating room team consists of the Surgeon, Registered Nurse, Scrub Tech, CRNA, and Anesthesiologist. The OR team also works with the Charge RN and other staff outside of the operating room (pre-op RN, recovery RN, ICU RN, radiology, lab, blood bank, ancillary staff) to coordinate a successful surgery.
(OR Team, n.d.)
(OR Team 2, n.d.)
Each team has their role and they must be able to coordinate their role to coincide with the rest of the team for a smooth and efficient outcome. You can think of it like a symphonic orchestra. Each member has their instrument and their music sheets, but they all have a specific role that must coincide in perfect timing with the rest of the orchestra in order to achieve that perfect sound.
(UBC Bands, n.d.)
Identification of Problem
Lack of communication happens during transition times (including the whole care team and even for patient's families) (Rambourg et al., 2019). During transition times in the OR, Surgeons and Anesthesia are very mobile and the surgical suite is interconnected with pre-op, OR, PACU and ICU (Rambourg et al., 2019). Surgical suite awareness and communication problems are the main source of delays-most of all on the turnover task (Rambourg et al., 2019). Turnover is defined as patient "wheels out" of the OR to new patient's "wheels in" to the OR. This includes breaking down the room set up, turnover team comes in to wipe down everything and mop the floor, and OR team re-enters room to set up for a new procedure. Turnover time between surgeries is defined as one of the most critical performance indicators (Rambourg et al., 2019). The accumulation of delays in the surgical suite is critical because it can lead to case cancellations, the staff is stressed, and it results in the loss of revenue for the hospital (Rambourg et al., 2019). Having access to the right information at the right moment to the right person and without delay or overload and letting him/her enter the interaction continuum to improve quality of care is the next frontier (Rambourg et al., 2019).
Communication
The main source of communication in the operating room is the OR board. The OR board will show all scheduled cases and emergency add-on cases for the day. Each case will show the assigned room, patient information, surgical procedure, time of procedure, anesthesia type, OR team, and status of each case. Other sources of communication include a printed OR schedule carried by clinical staff, telephone, mobile phone, and Vocera/Spectralinks carried by clinical staff.
(OR Schedule, n.d.)
(Rambourg et al., 2019)
(OR Layout, n.d.)
Electronic Whiteboard
Operating room revenues represent about 50% of large hospitals' income, and these communication issues present an opportunity for improved management of the surgical flow (Rambourg et al., 2019). Electronic whiteboards display pertinent patient information and workflow, and they help to streamline the patient admissions process as well as the quality of handover between staff (Li et al., 2019). In a study done by Li et al., (2019), 12 qualitative questions were completed by surgical registrars. One before the electronic whiteboard implementation in 2013, and one after the implementation in 2016. There was an improvement in staff satisfaction with electronic whiteboards (9% in 2013 and 78% in 2016) and with the admissions and handover processes (Li et al., 2019). SmartOR is an electronic whiteboard that uses sensors to track OR status via mobile and fixed, shared computer interfaces (Rambourg et al., 2019). The interfaces provide information through different locations and devices and allows for its manipulation to foster appropriate collaboration on unforeseen events and decisions (Rambourg et al., 2019). The information is displayed throughout the OR in a simple tablet display thereby removing the need to enter the room (which reduces airborne infection) or walk to OR board to note any changes. Other features of SmartOR was the design of a mobile phone app that brings information to the staff outside of the surgical suite. An alternative set up included placing RFID tags on each member of the staff for tracking purposes, but acceptance of this technology by personnel was low. I don't blame the staff for not wanting to be tracked so closely! SmartOR can also be set up in the OR manager's office to prevent interruptions to their daily duties. The use of an electronic whiteboard saves time and it improves communication to all members of the OR team.
Here are some examples of an electronic whiteboard:
Operating room revenues represent about 50% of large hospitals' income, and these communication issues present an opportunity for improved management of the surgical flow (Rambourg et al., 2019). Electronic whiteboards display pertinent patient information and workflow, and they help to streamline the patient admissions process as well as the quality of handover between staff (Li et al., 2019). In a study done by Li et al., (2019), 12 qualitative questions were completed by surgical registrars. One before the electronic whiteboard implementation in 2013, and one after the implementation in 2016. There was an improvement in staff satisfaction with electronic whiteboards (9% in 2013 and 78% in 2016) and with the admissions and handover processes (Li et al., 2019). SmartOR is an electronic whiteboard that uses sensors to track OR status via mobile and fixed, shared computer interfaces (Rambourg et al., 2019). The interfaces provide information through different locations and devices and allows for its manipulation to foster appropriate collaboration on unforeseen events and decisions (Rambourg et al., 2019). The information is displayed throughout the OR in a simple tablet display thereby removing the need to enter the room (which reduces airborne infection) or walk to OR board to note any changes. Other features of SmartOR was the design of a mobile phone app that brings information to the staff outside of the surgical suite. An alternative set up included placing RFID tags on each member of the staff for tracking purposes, but acceptance of this technology by personnel was low. I don't blame the staff for not wanting to be tracked so closely! SmartOR can also be set up in the OR manager's office to prevent interruptions to their daily duties. The use of an electronic whiteboard saves time and it improves communication to all members of the OR team.
Here are some examples of an electronic whiteboard:
(Electronic OR Board, n.d.)
(Electronic OR Board 2, n.d.)
(Rambourg et al., 2019)
Desirable Outcomes
With an electronic whiteboard ORs will experience:
1. Shorter turnover times between cases
2. Reduced staff overtime
4. Improved patient satisfaction and outcomes (Rambourg et al., 2019)
Orlando VA
I work in a surgical department that uses an electronic whiteboard called LiveData. It is very beneficial to have this technology in my workplace. I no longer have to run out of my room and check to see if there were any changes to the schedule like I used to do at my previous hospital. While the electronic whiteboard is beneficial, and it does in fact save time, there are improvements that I would implement to be more efficient and save time. I would add an option to document the same OR team as the prior case. Usually the OR team remains constant throughout the entire shift. Charting the same people each time is a time-waster. I would also have the system calculate the actual delay time instead of the RN having to find the times from the previous case and do the math to then input that in the chart. This information is important as it is a critical performance indicator. Delay reporting should be accurate and reported in real-time so that leadership can accurately gauge the case flows and plan accordingly. Calculation of delay times should be automatic as the times are already entered in the chart. I would have the OR rooms change color to alert available staff that additional staff help is being requested. One of the biggest time-wasters is waiting for other members of the team to complete their part before we can roll back to the operating room. An example would be missing essential items (consents, labs, skin marking for laterality, medications, implants, equipment, staff, etc). If all members of the team were able to document what they are still waiting for, then the system can deliver this information in real-time, and it would save an incredible amount of time. If all members of the team communicated via the application, we could plan our down/wait-time accordingly and increase efficiency. An efficient and well informed operating room team is able to provide quality and safe patient care.
Summary and Conclusion
Effective communication is the key to positive patient health outcomes. The use of an electronic whiteboard is beneficial for informing the OR team of updates to the surgery schedule at a moment's notice. Since delays in the surgical suite ultimately affect patient outcomes, it is critical that ORs address how to improve their communication amongst one another. One viable option is the use of an electronic whiteboard. With so many moving parts in an OR, a telephone call is sometimes not an efficient option. Real-time updates on the electronic whiteboards that are located throughout the OR are an effective means of communication that promotes quality patient care.
References
Electronic OR board [Infographic]. (n.d.). Retrieved June 19, 2021, from https://www.researchgate.net/publication/286986833/figure/fig1/AS:319643358122012@1453220323356/Figure2-OR-Status-display-board-during-all-feedback-phase-of-study-OR-operating-room.png
Electronic OR board 2 [Infographic]. (n.d.). Retrieved June 19, 2021, from https://www.bing.com/images/search?view=detailV2&ccid=6rFjrK2V&id=6E8FE2CEAA08CAF2C82B0DA39308EBC4D52F649B&thid=OIP.6rFjrK2VFX7IpuEp-w3JogHaF8&mediaurl=https%3a%2f%2fwww.ascom.com%2fcontent%2fdam%2fascom%2fws%2fready-for-use%2fglobal%2fimages%2fOperating+room.png%2f_jcr_content%2frenditions%2fcq5dam.web.1280.1280.png&cdnurl=https%3a%2f%2fth.bing.com%2fth%2fid%2fReab163acad95157ec8a6e129fb0dc9a2%3frik%3dm2Qv1cTrCJOjDQ%26pid%3dImgRaw&exph=531&expw=662&q=operating+room+board&simid=608048682101264898&ck=EF906B7F6F1A1FB3CCC324D388D7961B&selectedIndex=87&FORM=IRPRST&ajaxhist=0&ajaxserp=0
Li, Y. H., Fitgerald, E., & Roberts, R. (2019). Electronic whiteboards improve the acute surgical patient admission process. The New Zealand Medical Journal, 132(1490), 22. https://doi.org/https://www.nzma.org.nz/journal-articles/electronic-whiteboards-improve-the-acute-surgical-patient-admission-process
OR board [Infographic]. (n.d.). Retrieved June 19, 2021, from http://ww1.prweb.com/prfiles/2012/05/21/11034851/HXSRmediaPR.jpg
OR schedule [Infographic]. (n.d.). Retrieved June 19, 2021, from http://ww1.prweb.com/prfiles/2012/05/21/11034851/HXSRmediaPR.jpg
OR team [Infographic]. (n.d.). Retrieved June 19, 2021, from https://i.pinimg.com/originals/cf/04/82/cf04824aa640accc6058748a5b402e6a.gif
OR team 2 [Infographic]. (n.d.). Retrieved June 19, 2021, from https://www.altro.com/getmedia/f85fb68a-2a55-42d2-a110-27326067734b/Centre-Hospitalier-de-l%E2%80%99Universite-de-Montreal-Altro-Whiterock-White-01-preview.aspx?width=600
Rambourg, J., Gaspard-Boulinc, H., Conversy, S., & Garbey, M. (2019). A continuum of interfaces to engage surgical staff in efficient collaboration. Journal of Medical Systems, 43(7). https://doi.org/10.1007/s10916-019-1318-1
UBC Bands [Infographic]. (n.d.). Retrieved June 19, 2021, from http://100.ubc.ca/wp-content/uploads/2015/07/UBC_Bands.jpg
What a great idea! Those whiteboards can be so helpful but can also be a hinderance. They could definitely help in the operating room environment!
ReplyDeleteHello Stephanie,
ReplyDeleteThis is a really nice post. Very informative, you have really gone out and represented the information in a detailed manner. It is indeed true that the use of whiteboards will go a long way to improving patient outcome. It is quite interesting that this is something that you have already used and have seen its usefulness. The illustrations with diagrams puts everything into perspective. Efficiency in the operating rooms will go a long way to saving time and in the long run saving lives.