Robot surgery one of several projects cutting down on hospital stays
Vitalite Health Network lists its robotic surgery programs as one of the initiatives showing success in cutting down length of hospital stays
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Robot surgery and teams of kinesiologists are some the projects showing success in reducing the length of stay in Vitalité Network Hospitals.
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In a quarterly report released last week, Vitalité said improving patient flow is one of its top priorities, in addition to rolling out its primary care model.
The health authority is implementing a “large-scale initiative over an 18-month period that will touch every stage of the patient’s care, from consultation to admission, through to discharge.
The goal of the project is to reduce the length of stay in hospital, cut down on wait times for surgery, testing, and emergency services, and reduce occupancy rates which is putting pressure on the health-care system.
Some of the initiatives include the creation of discharge planning teams, data collection to support the management of hospital activities, as well as the establishment of assessment criteria at each stage of a patient’s care to make it easier to identify alternatives to hospital admission, as well as the risks and preparation for a patient to go home.
Communication tools will be developed to involve families and keep them better informed about the care process, the anticipated discharge date and the steps that need to be taken.
Robot surgery program
Vitalité’s robotic surgery program is one of the examples of the workflow project. The health authority said the program is showing early success. Between Feb. 1, 2023, and March 1, 2024, 365 patients were operated on using the surgical robot installed at the Dr. Georges-L.-Dumont University Hospital Centre, and there were no complications in the first year of the program.
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“The robot enables less invasive surgery, which reduces the risk of complications, promotes faster recovery and therefore shortens hospital stays,” said Vitalité in the report. “This program has an impact on patient flow because it frees up beds more quickly for the next patients.”
The acquisition of a surgical robot was made possible through a $6.5 million fundraising campaign by the CHU Dumont Foundation.
Currently used for urology and gynecologic oncology surgery, the robot will soon be used for other specialties too. The health authority said when more surgeons are trained to use the “state-of-the-art equipment,” thoracic surgery and then general surgery will be possible.
Katherine Woodard, a Moncton patient who underwent a robot surgery procedure, said in the report her experience was positive.
“It’s still surgery, so there’s a certain amount of fear involved, but the robot made things easier than I could have imagined and I didn’t really have to take any pain medication,” said Woodard.
So far, six surgeons are trained for the robotic surgery program. The average length of stay has been reduced for patients. Currently, the length of stay compared to having open surgery has decreased 2.2 days for a nephrectomy (kidney removal), 1.5 days for a cystectomy, and 0.5 days for a prostatectomy and hysterectomy, the report stated.
The Saint John Regional Hospital also has the Intuitive’s da Vinci surgical robotic equipment, the same kind of technology as Vitalite. The system has four robotic arms, controlled by a surgeon, and provides a high-definition, 3D view of the operating field, Horizon Health Network had said.
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Dr. Jocelyne Hébert, regional medical director for the Dumont, said the Davinci robot equipment is ergonomic for surgeons to help them from becoming fatigued. It also aids in reducing bleeding and allows for patients to heal faster.
“It’s more precise, it’s more focused,” she said.
The device also allows surgeons to have precision when they are working deep in the abdominal cavity, which opens up the opportunity for surgery for some patients who would have previously been told chemotherapy and radiation were their only options.
Woodard said in a video played during a Vitalite board meeting on Tuesday she went in for a hysterectomy on Jan. 10. The only ill effects from surgery were pain in her shoulder and hand. She said she was prescribed heavy pain medication, but was able to recover using Tylenol.
“Compared to some people it was probably a pretty decent experience,” she said, noting she returned to work Feb. 10.
Hébert said the next stage will be to use the robot for thoracic surgery and eventually lung surgery colon and rectal surgery, and liver surgery in addition to general surgery.
Currently, medical professionals want to work at the Dumont to be able to be involved in the robot surgery program. The equipment can be a recruitment and retention tool for Vitalite.
She noted the Davinci is being used to its “maximum capacity” and there is a need for another robot to increase their capacity for services.
Vitalite president and CEO Dr. France Desrosiers said in an interview on Tuesday she learned of the need for the equipment at the board meeting. A formal request for a new robot has not been made yet.
“Certainly we will look at the need in order to prepare,” she said.
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Patient mobilization
Another example of a project that is reducing the length of hospital stays and reducing the burden on nursing staff is the patient mobilization program.
A team of kinesiologists is on hand to help inpatients with their exercise needs. The goal of the project is to maintain muscle mass and improve mobility, as well as to reduce the risk of complications. Follow-up continues after hospital discharge to help maintain independence and prevent readmission, the report stated.
Vitalité said to date, around half of patients continue to exercise according to the plan after returning home.
The mobilization program is now set up in a large number of units in Vitalité’s four zones, and 22 of the 26 kinesiologist positions created have been filled.
“The results are clearly positive,” said in the report. “We have seen a one-day reduction in the average length of stay for patients who have taken part in the initiative. We have also noted an improvement in mobility and autonomy in the activities of daily living.”
Another piece of technology to help in recovery is a new app that provides advice and follow up before and after surgery.
Starting this spring, patients undergoing hip or knee surgery, colorectal surgery or gynecologic surgery will have access the app, available to patients undergoing surgery in the surgical suite of the Dumont, Chaleur Regional Hospital or Edmundston Regional Hospital, as well as patients in the Restigouche Zone.
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Last month, Horizon announced its hip and knee patients would have access to the SeamlessMD to help them educate themselves in preparation and recovery from surgery. The app was first used by cardiac patients at the New Brunswick Heart Centre and Horizon had previously said 95 per cent of patients who used the app felt more confident in their recovery.
Measuring waiting times
Vitalite is also looking to streamline its hospital admission process. As part of an improvement process at the Dumont, the working environment has been redesigned, and some “process-related inefficiencies” were eliminated.
The adjustments reduced the average registration time from 18 minutes in February 2023 to 13 minutes in January 2024, said the health authority in the report.
Kiosks have been installed at the Chaleur Regional Hospital, the Lamèque Hospital and Community Health Centre and the Dumont. The machines provide reliable indicators of wait times and instantaneous measurement of waiting room occupancy.
Vitalite said the kiosks will eventually be installed in all of its admitting departments. There is also a questionnaire that allows a patient to give feedback on their experience.
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