This presentation is about setting up Gynecological endoscopy services: the components, the challenges and finally achieving and sustaining excellence.
5. Surgeons:
the modern day priests
“We are the modern day priests – we prepare, we
change to our holy garments, we bring patients to
another world, and we change them.”
Dr. Simpson, Your Doctors Orders.
6. So…
Surgeons: Modern day Priests
Operating rooms: Modern day temples
Patients : Our Gods
Surgery: Prayer
7. Setting up of surgical services is thus akin to
making a temple, with careful consideration, faith,
hard work and tireless effort. Hoping that amidst
the multitude of units, it still finds its place,
providing healing and solace to people and
providing a haven of safety to their troubled bodies
and souls.
8. Gynec Endoscopic
procedures
Level 1: Diagnostic laparoscopy, tubal ligations
Level 2: Salpingectomy, adhesiolysis, cautery of
minor endometriosis, myolysis, ovarian drilling
Level 3: oophorectomy, salpingostomy, surgery
for pedunculated fibroids, moderate
endometriosis
Level 4: Hysterectomy, Myomectomy, ovarian
cystectomy(>8 cm), severe endometriosis
20. Modular Operating Rooms
mod·u·lar (adj)
.1. Of, relating to, or based on a module or modulus.
2. Designed with standardized units or dimensions, as
for easy assembly and repair or flexible arrangement
and use: modular furniture; modular homes.
28. One way!
One way changing room
One way flow of supplies into the OR and one way
flow of soiled good outside the OR
Shared corridor for patients and staff
Sterile supplies delivered in OR from CSSD :separate
corridor
Two designs: Double loaded corridor with
substerile rooms and perimeter corridor with
clean core
32. Recovery area
Accessible from theatre and outside
1.5 spaces per OR
Space per trolley/bed 9 sq. meters
O2, suction, power, lighting
Communication lines
Scrub, nursing station
34. Equipment
Camera
Telescope
Monitor
Light source
Insufflator
Irrigation/suction system
Electrosurgical generator
Recording and archiving
35. Camera
Single chip: all three primary colors sensed by a
single chip
Three chip: three sensors for red, green and blue
SD camera: A 4:3 aspect ratio, 640 by 480 horizontal
and vertical lines.
HD camera: The HD format provides a 16:9 aspect ratio,
1280 by 720 horizontal and vertical lines. The 1080 HD
standard also offers a 16:9 aspect ratio, but 1920 by
1080 horizontal and vertical lines-seven times the SD
resolution at 480 lines.
36. Telescope
6 to 18 rod lens system telescopes are available
0 to 120 degree telescopes are available
1.5 mm to 15 mm of telescopes are available
41. What is ideal ?1
What is feasible ?2
What is viable?3
42.
43. Justifying the costs
Sharing with other subspecialities
Developing a high throughput unit
Shared facility between different gynec
endoscopic surgeons
46. Anesthetist: Father
Surgeon: son
Nurse: holy ghost!
“He acts as Comforter, one who intercedes, or supports or acts as an
advocate, particularly in times of trial. He acts to convince
unredeemed persons both of the sinfulness of their actions and
thoughts, and of their moral standing as sinners before God”
47. Theatre: Camera person, assistant: two, scrub
nurse, floor nurse
Recovery staff
Support staff
49. “The best cars with the smartest drivers cant reach
anywhere if there isn’t a road”
50. Clinical pathway: Multidisciplinary management tool
based on evidence-based practice for a specific
group of patients with a predictable clinical course,
in which the different tasks (interventions) by the
professionals involved in the patient care are
defined, optimized and sequenced either by hour
(ED), day (acute care) or visit (homecare).
Outcomes are tied to specific interventions.
51. Integrated clinical
pathway
An ICP aims to have...
the right people
doing the right things
in the right order
at the right time
in the right place
with the right outcome
all with attention to the patient experience
52. Pathways
Patient admission and preoperative workup
Discharge pathway
Dealing with readmissions
Thromboprophylaxis
Infection control
54. Challenges
Infrastructure: maintenance and repair
Manpower: training, attrition, motivation
Pathways: non conformities, non compliance
“ The real challenge is to keep growing, keep moving, slowly at
times, but always forward”
59. Key performance
indicators
In-patient workload
Out-patient workload
Cancellation rates on day of surgery
Day of surgery add-on rates
Start time accuracy – first case of the day
Start time accuracy – subsequent cases
Estimated case duration
Turnover time in-patient
60. Turnover time out-patient
Total case time in-patient
Total case time out-patient
Room utilization: 7:30 a.m.-3:15 p.m.
Surgeon satisfaction
Employee satisfaction
Cost per case (labor)
Cost per case (materials)
Cost per case (total)
Gross revenue per case
61. “Excellence is never an accident. It is always
the result of high intention, sincere effort, and
intelligent execution; it represents the wise
choice of many alternatives - choice, not
chance, determines your destiny.”