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Adventist Health System Leverages Analytics to Improve Surgeons’ Robotic Surgery Skills and Performance

January 28, 2018
by Mark Hagland
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Stephen Knych, M.D. is leading an innovative initiative at Adventist Health System around improving surgical performance in the robotics area

As data analytics becomes more and more common in healthcare, it is being used for more and more complex and “advanced” purposes, and is reaching into all sorts of innovative niches in patient care organizations. That certainly is the case these days at the Altamonte Springs, Fla.-based Adventist Health System, where Stephen Knych, M.D., the 45-hospital-campus health system’s chief quality and patient safety officer, is leading a pioneering effort to leverage analytics to help improve the clinical skills and performance of surgeons engaged in robotic surgeries in that health system.

Dr. Knych presented about this initiative in a workshop focused on the “Business Case for Safety,” last May, at the annual NPSF Safety Congress, sponsored by the National Patient Safety Foundation, as well as participating in the IHI National Forum on Quality Improvement in Health Care, held in Orlando in December, and sponsored by the Cambridge, Mass.-based Institute for Healthcare Improvement.

Dr. Knych and his colleagues at Adventist have been partnering with the Seattle-based healthcare technology company C-SATS, in order to leverage analytics to improve surgeons’ clinical and operational performance.

Using C-SATS’ analytics at Adventist facilities, Dr.Knych and his colleagues have seen scientifically measured and statistically significant improvements in quality measures in robotic surgeries, specifically in reductions in cases that were converted to open surgery, and in blood loss. They have also seen significant reductions in procedural costs.

Among the advances documented by the collaborative performance initiative in this area so far:

> Conversions from robotic to open surgery dropped by more than half after a surgeon received 10 or more C-SATS assessments (5.3 percent to 1.6 percent)

>  Incidents of blood loss greater than 500ml during robotic surgeries dropped (2.4 percent to 0.7 percent) after a surgeon underwent 10 or more C-SATS assessments

>  Median surgery time reduced by 22-23 minutes in laparoscopic hernia repairs (ASA Class I-II and III-IV) after C-SATS assessments

Recently, Dr. Knych, along with Derek Streat, CEO of C-SATS, spoke with Healthcare Informatics Editor-in-Chief Mark Hagland, to discuss the progress being made in this initiative. Below are excerpts from that interview.

Tell me about the origins of this program?

Stephen Knych, M.D.: Our interest in the program began at Adventist when we had developed a robotic-assisted minimally invasive surgery guideline, and had had had that guideline approved internally, and our medical executive committees had approved it in all or in part. We had 15 hospitals at that time engaged in robotically assisted minimally invasive surgery. And because there’s no nationally recognized body, as in weight-loss surgery, these guidelines helped us structure how we managed the program. So we put that out, gave our facilities a year and a half to adopt it; and then we recognized a gap for surgeons, around continuing medical education credits, for robotic-assisted minimally invasive surgeries. Even the medical specialty societies hadn’t created programs around this.


Stephen Knych, M.D.

So we started looking for information. And Dr. Richard Satava knew about an innovative approach at the University of Washington, and introduced us to this technology. He is an independent surgeon, an expert in the field of simulation and training; he worked on a fundamentals of robotic surgery curriculum. He was on our robotic surgeon task force as a simulation and training expert; he was an external expert. He is based out of Washington state.

What pieces were missing, for practicing surgeons?

The robotic surgery guidelines are contained in a 25-or-so-page document; a consensus document that had been developed by our taskforce. What was asked for was a specific number of robotic surgery-specific CME [continuing medical education] credits for each privileging cycle that all doctors go through in hospitals. But they weren’t able to obtain that from their specialty societies, so we had to create this.

What types of gaps were there? Technical, clinical, process gaps?

All of the above. Education and training, privileging, etc. What was in the literature in 2015 when these were offered, and pertaining to establishing robotic surgery guidelines—clinical practice, education and training, and some of the nuances around privileging and credentialing.

What was the role of C-SATS in this?

Derek Streat: As Dr. Knych mentioned, C-SATS was spun out of the University of Washington in 2014, based on research by my co-founder, Dr. Thomas Lendvay. Dr. Lendvay is our co-founder and CMO, and still a practicing pediatric urologist at Seattle Children’s Hospital. Addressing this area of skill improvement, and doing it in a scalable and effective way. Even in his own practice, he was finding it was difficult to get feedback as a robotic surgeon. Either you’d get feedback from over your shoulder, and they’d be colleague at best, a competitor at worst; and most of all, people didn’t have the time. So he came up with the idea of using distributed reviewers, people with certain skills around surgery. And then he figured out how to take a complex task like a surgical case, and break it up into smaller pieces, to assign those pieces to people on a panel.

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