A Sound Investment
Clear and unambiguous communication between team members is an essential component of any surgical environment. It’s particularly important – and indeed particularly challenging – in catheterisation (cath) labs and electrophysiology (EP) labs where physicians and clinical staff in interventional cardiovascular and other minimally-invasive therapeutics are typically spread across multiple rooms and physically separated by lead-lined doors.
In these environments, the laser-like precision of the surgical procedure needs to be guided by similarly precise instruction from technicians and radiologic technologists located outside of the operating room (OR). It requires collaboration and concentration. Moreover, it requires crystal clear communication.
The inherent complexities of EP and cath lab settings alone present significant communication challenges. However, these are exacerbated by the natural cacophony of a typical working environment; the chatter of workmates, the hum of the air conditioning and the relentless drone of essential technology. These combine to create a high-stress clinical environment where multidisciplinary teams’ need for tranquillity is commonly confounded by practical necessities they cannot change.
There’s widespread recognition amongst EP physicians and their clinical colleagues that communication challenges during live procedures are increasing stress-levels, impacting workflow and – in cases where patients choose to remain conscious during surgery – damaging the patient experience.
It’s not just a recognised problem, it’s an escalating one. The global use of electrophysiology and robotic surgery is growing rapidly. As secondary care facilities seek to capitalise on the clinical, operational and patient benefits of new surgical innovations, analysts predict that investment in electrophysiology and robotic surgery will grow by 10 and 20% respectively in the next 5-10 years.
The increased uptake – which continues an existing trend towards minimally-invasive technologies, where appropriate – places renewed pressure on facilities to ensure that OR communications are optimal. Failure to do this risks squandering the undoubted benefits of surgical innovation; the patient implications of an avoidable clinical error due to miscommunication could, in the worst extremes, be catastrophic. Fortunately, communications technology has evolved to present a simple, affordable solution.
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Traditionally, facilities have adopted primitive measures to facilitate communications between the OR and the monitoring suite. This has ranged from using strategically-placed microphones in each room and amplifying conversations through analogue speakers, to communicating via bulky ‘helicopter pilot-style’ headsets.
Both approaches are problematic.
Basic microphones not only have variable pick-up ranges they are also a hostage to interference. The likelihood of mishearing an instruction, or repetitive, panicked communication that can unsettle conscious patients, naturally increases with basic microphones. Similarly, the use of bulky headsets also has drawbacks; aside from the implications of their inferior sound quality, large headsets can be cumbersome and inhibit surgeons’ movements.
In recent years, the development and adoption of wireless headset technology has transformed communications in EP/cath lab environments. The technology, which operates on high quality digital frequencies and is encrypted to avoid interference from other devices or emissions in the OR, enables multidisciplinary teams to collaborate and communicate – hands-free – in the interventional OR or hybrid suite, at monitoring stations, through adjacent control rooms and ancillary areas.
2015 research published in The Journal of Minimally Invasive Gynaecology showed that the use of wireless headset devices in robotic surgeries was associated with improved quality of communications between team members as well as a reduction in the noise level in the OR. A lead clinician in the study suggested that the technology helped contribute to better patient outcomes by creating a calmer environment for clinicians and staff.
Certainly, the more tranquil environment enabled by better team communications can only enhance the patient experience in patients who choose to remain conscious through their procedure. By eliminating frantic or confused communication between the multidisciplinary team, avoidable patient anxiety is naturally reduced. Similarly, stress-levels across the clinical team are significantly improved.
There is little doubt that clear and discrete audio communication between physicians and clinical staff in EP/cath lab settings results in safer, more effective workflows and treatment. As the global use of EP and robotic surgery increases, wireless headset technology will be an essential companion to ensure optimal, efficacious and cost-effective communications.
Five minutes with Stanley Healthcare's Troy Dayon
Stanley Healthcare provides technology solutions for caregivers, whether they are in a hospital, a care home, or at home. Here the company's President Troy Dayon explains the challenges carers face and what role technology plays in care for the elderly.
The healthcare workforce is shrinking while the population is aging. How can this be addressed?
Not only is the healthcare workforce shrinking, but the industry is facing the issue of overload and burnout among healthcare professionals.
One major approach to address this is to help each caregiver to accomplish more – not by pushing them harder but by focusing their attention on the things that matter most, harnessing technology such as AI and machine learning.
This technology provides caregivers with information on what care is needed, and which patients or residents to focus on first based on risk or acuity. The insights that it provides can help caregivers to be more efficient and address issues that would usually require more of their time, such as critical asset location, which takes time away from giving the care where it’s needed most.
What do healthcare providers need to do to address clinician burnout?
It is key for healthcare providers to understand the setting and the specific environment in which clinicians have been working. Many hospitals across the globe reconfigured entire wards to treat COVID-19 patients, and for more than a year, clinicians have been working in crisis mode.
They need the opportunity to return to regular, sustainable routines, supported by technologies that help make them more efficient, but also more fulfilled because they maximise time with patients, applying their hard-earned education and experience to work at the top of their license.
In aged care, the experience of managing a highly contagious and deadly virus has reinforced the need for a proactive approach to managing the health of residents. Caregivers need predictive tools like the Foresite solution to help them understand which residents are at greatest risk, so they can focus their efforts where they can have the most impact.
How can technology support older people?
AI-based technology such as Foresite harnesses a range of passive monitoring technologies to develop a baseline profile of a resident in aged care that highlights changes in health or behaviour. This information can help caregivers see where and when they need to spend their time, identifying heightened risk for falls and early indication of heart issues and even infections.
In fact, the technology has been shown to accurately predict events like falls, which allows intervention prior to an event occurring, rather than just automating routine processes.
Beyond this, connecting caregivers remotely to seniors to provide efficient care outside of traditional care settings is crucial. During the pandemic, there was a marked increase in the use of telehealth and remote monitoring of vitals, medication management and daily health.
These technologies fill a major gap in healthcare delivery: care for patients once they’ve been discharged from hospital, or for seniors who need some level of care but don’t need to be in an aged care home. By caring for people effectively in their own homes, we can help reduce the burden on hospitals from readmissions and leverage the expertise of aged care organisations beyond the confines of the four walls of the facility.
A lot of care is in fact delivered by unpaid carers. How can they be better supported with tech?
The remote monitoring technology that professional caregivers have access to can, in turn, also provide information and support to unpaid caregivers. For example, helping ensure a loved one is taking their medication, or knowing when they might be experiencing a change in health that can put them at risk.
Human observation is inherently limited, no matter how often you see a loved one, and you can’t always rely on what a senior says about themselves. It’s very common that they downplay problems, because no one wants to be a burden or relinquish their independence.
Remote solutions that connect family to an older relative help increase safety and wellbeing for the senior and reduce the burden on caregivers. They also make possible care decisions based on facts. At some point, a senior may need to transition to an aged care setting, which is often a difficult family conversation. This is an area where we can offer support to unpaid caregivers – reassurance during what is typically a very stressful period for the people providing that care.
In Japan several large hospitals are deploying robot nurses. Is this a potential solution?
I think the best path for robotics in healthcare is to focus on the root problem. It’s about dealing with a limited number of caregivers for a population that’s rapidly aging. Robotic technologies offer solutions that support the human healthcare providers with the information they need to make better and faster decisions about care. It’s about convergence and use of technology rather than a specific solution such as a robotic nurse.
This technology could be in the form of AI and machine learning or a robotic agent for routine administrative tasks. Removing low-value activities that distract caregivers from giving care is a key focus when it comes to robotics in healthcare. This automation can free up time for caregivers to spend more time with patients while optimising workflows.
Robots in this sense don’t replace humans. They are leveraged for what they do well – repetitive routines done with speed and precision – while humans are given the time and space to deliver what ultimately we all want: human-centered care.