The hospital system's chief quality officers council created a multidisciplinary VTE performance improvement committee and appointed a hospital chief quality officer as a chairman. The committee worked with staff to carry out the program."We needed hospital staff buy-in to harmonize paper-based risk assessment tools and order sets at our hospitals," Velasco says. In addition, the health system's multidisciplinary committee agreed on a set risk assessment methodology to use through varied hospital disciplines.
Among the challenges that the hospital system had to overcome was replacing paper-based risk assessment tools and order sets.
"The primary key of our success is our strong belief in the use of the electronic health record to help advance quality and patient safety," Velasco says.
Success key No 3: Robotics
Hospitals are continuing to invest millions of dollars in robotic devices for various service lines, whether it's for general, pediatric, gynecology, urology, cardiothoracic, or other minimally invasive procedures.
In essence, hospital systems are counting on robotic systems now, despite the cost and possible lack of ROI, because of what it may bring in the future: improved efficiencies and an allure for patients.
Jacques-Pierre Fontaine, MD, a thoracic surgeon at the 206-bed H. Lee Moffitt Cancer Center in Tampa, FL, says he understands that the robotic procedure in some cases may be no different in terms of clinical outcomes compared with other minimally invasive procedures.
"It's not worse for the patient; it's the same," he adds, referring to outcomes with robotic and open surgeries. "It may be more expensive for the hospital now, but we're seeing a future in it and embracing it.
"We're embracing it because the future is going to be robotic technology. It will surpass what we have now for other minimally invasive techniques. If you surf, you don't want to be behind the wave and catch up to the wave; that doesn't work. It works if you are in front of the wave and then you ride the wave."
Such an attitude is helping to drive use of the robot systems used to perform minimally invasive heart, prostate, and other surgeries.
Use of the da Vinci device, for instance, has quadrupled in the past four years, being used in thousands of hospitals for various surgical procedures. Da Vinci is a multipurpose robot that can be used for lung cancer surgery, heart bypass and valve repair operations, hysterectomies, prostate removal, and other procedures.
The popularity is increasing despite reports of uncertainty that the estimated $2 million investment may not produce better results.
However, there have been studies showing that the da Vinci devices also result in fewer complications and improved recovery.
Despite the conflicting reports, officials of some hospital systems say they are confident in the robotic device and what it means for patients as well as hospital system ROI.
The 175-staffed-bed Methodist Willowbrook Hospital in Houston, an enthusiastic supporter of robotic surgery, has shown an increased patient load as a result of the technology. It is still compiling data, but preliminary evidence shows that patients are recovering quicker and there has been greater volume, says Patricia Worley, RN, BSN, director of surgical services for the Methodist Hospital System.
It has been important for the hospital system to use the robot for a wide variety of procedures, with its largest volume in its gynecological program and then general surgery, while building volume in bariatrics, Worley says, noting that the robotic surgery system has been used in 300 cases from August 2010 to November 2011. "Our robot is used very frequently," she adds. "We are very efficient with turnovers," adding that sometimes the robot is used for three to four cases a day.
While the hospital system is still evaluating data, preliminary information supports findings of a "decreased length of stay for inpatient cases of up to two days, which could offset the charges needed to support the da Vinci use," she says.
Despite the necessary capital investment needed for the robot, the hospital "community wanted it," she says. "It was a win-win situation. Our CEO was very supportive, and we branched out into the urology program. There have been so many interested surgeons getting trained in it across specialties. The docs have been interested, and it has taken off."