Proposed solution to Dual part robotic procedure question

[mhy12784]

Alright so I have an issue that I'm attempting to address

Robotic cases at my facility tend to have long turnover times, and this has become somewhat of an issue.

The robotic cases I am talking about tend to be a mix of robotic and laproscopic. As in the first 45 minutes (or longer) of the case are generally done laproscopic and the remainder is robotic.

Now one of the longest issues tends to be setting up draping the robotic etc etc. Our robotic cases have two circulators to help with setting up and docking/undocking the robot. A proposed solution would be to just setup the laproscopic portion of the case getting the case started a decent amount sooner.

Once the case starts the second circulating nurse would scrub in, open the robotic supplies drape the robot, calibrate and white balance the robot etc etc. If for some bizzare reason there's an issue with the robot and or robotic equipment then the case could easily be done laproscopically (this is absolutely a realistic possibility, but also relatively unlikely) of course there's a possibility that a normal robotic case would have to be done laproscopically or open as well.

And there should be more than sufficient time for the nurse to do their portion before they're needed to assist with the docking/undocking of the robot.

What are your thoughts on such a solution. Would it be a bad idea?

[Rose_Queen, BSN, MSN, RN]

On the majority of our combo cases, we assign 1 circulator, 2 scrubs, and an additional person to open supplies. The robotic and laparoscopic portions (or whatever the two parts may be) are set up at the same time. For our larger cases, we also build additional turnover time into the schedule. For example, our standard turnover is 20 minutes (10 for tear down and 10 for next case set up). Our larger cases, such as cardiac, larger robotics, neuro with intraop MRI linked imaging are scheduled with a 30 to 40 minute turnover. Faster isn't always better, and risking an issue with non working equipment for the sake of turnover time just doesn't seem like best practice. I wouldn't want to be the patient whose planned surgery had to be changed because of that without the upfront ok I could give if I were told "we have some issues with the robot. We can reschedule or we can proceed in another manner". And it's not just those of us in healthcare- we recently dealt with a backorder preventing us from being able to do minimally invasive valve surgery. One affected patient opted to have a traditional sternotomy and another opted to wait 2 months until we could get the necessary item in stock.

[ORRN21]

Wow, we have 1 tech and 1 circ. What cases do you do that are combined? We do a lot of robotic gyn, bariatric and thoracic but they are all robotic.