Isabella Zorra

Week 1 in OR

Observation of Superficial Parotidectomy

• There are 2 anesthesiologists, 2 scrub nurses, 2 rotating nurses, 2 M3/M4 students, 1 visiting student and 4 CIP students in the OR in addition to Surgeon and Resident
• Space limitations around the patient, viewing is difficult for those other than surgeon and scrub nurse.
• Height differences in surgeons, scrub nurses, fellows etc makes it very difficult for all parties to have comfortable ergonomics.
• Tools: bovi/cauterizing tool has many moving parts that need to be connected and the timing of connecting prior to scrubbing does not always work smoothly, can cause nurse to break sterility
  • The bovi has suction system that is marginally effective.
  • I was standing behind the patient about 2 feet away and even with the suction was breathing in the fumes
  • Need to manage visibility with safety (the fumes are carcinogenic?)
• Tools: suction tool is also separate and needs to be plugged in, similar issues to above
• There was a lot of work being done to hold the skin open during the procedure, with at least one, if not 2 assistants working the whole time to hold flaps of skin open to allow the surgeon to use other tools. This may be an area for improvement.
• Gauze needed to stop bleeding; some surgeons seem to use a lot more gauze than others.
  • Gauze collection system in place, nurses manually count out verbally and keep track on clipboard of gauze before the surgery, then twice during surgery.
  • Used gauze is thrown into a makeshift basket that may or may not be sterile.
  • Eventually a rack is used brought out with clear holder that looks like an over the door plastic shoe holder.
  • The circulating nurse then counts and places used gauze in clear “shoe holder” to confirm no gauze is mistakenly left in the patient and notes this along with unused gauze on clipboard.
• The most challenging aspect of the surgery was to locate the nerves and make sure parotid removal did not affect facial nerves.
  • Wonder if there is a way to project nerve placement like a hologram onto the patient.
• Bringing in the patient bed, to lift the bed up, I had to crank the pedal manually and it actually was quite cumbersome and slow, with all eyes on me as I am trying to heave my full body weight onto the pedal to lift a bed that weighs about as much as I do.
• Obvious issues but the cords in the ground are trip hazards, which is further complicated by the sheer number of tools, equipment and sharp objects in the vicinity
  • It is amazing there are not more OR accidents with the number of cords on the floor and equipment.
  • Actually, do not know the number of OR accidents, will look this up and see if there may be a strong need for improvement here.

Week 1 discussion with Team

• Surgery team would like to see improvement in Turnover time between surgeries to increase OR efficiencies.
  • Cleaning
  • Setting Up
  • Wait for Dr Orders
  • Bring patient in
  • Our OR uses SANDPO System
    • Surgeon ready
    • Anesthesia ready
    • Nursing Ready
    • Documentation Complete
    • Patient Ready
    • OR ready

Storyboard of Counting Gauze Process in the Operating Room.

Needs Statements

Population: OR Staff

Opportunity: Simplify surgical counting

Outcome: Increase count accuracy, patient safety, decrease OR turnaround time

Needs Statement 1: OR staff need a method to simplify surgical counting to increase count accuracy, patient safety and decrease OR turnaround time.

Needs Statement 2: OR staff would benefit from a more accurate surgical counting method to increase patient safety.

Needs Statement 3: OR staff would benefit from a faster surgical counting process to decrease OR turnaround time.

Needs Statements

Needs Statement: OR Scrub Nurses/Techs would benefit from a more accurate surgical counting method to increase patient safety.

Population: OR Staff

Is OR staff too broad, maybe it should be OR nurse and/or techs

Opportunity: Simplify surgical counting

Simplify? Improve? Shorten time? What is the goal here?

Outcome: Increase count accuracy, patient safety, decrease OR turnaround time

Many possible outcomes but not sure we should focus on all

Surgery gauze management device
Patent: WO2005053557A1

A surgery gauze management device includes: a radio transmission/reception device (18) for counting a number of surgery gauzes (1) having RFID by transmitting an electric wave to a gauze heap (11) in a gauze vessel (10) arranged in a predetermined range and receiving a unique signal from the RFID; a gauze counting section (19) for counting the number of gauzes according to the number of the unique signal of the received RFID; a weight measurement section (9) for obtaining the total weight of the gauze heap and the gauze vessel; a calculation section for deciding gauze-absorbed blood amount in the gauze returned by subtracting the unused weight of returned gauzes (obtained by multiplying a standard weight of one unused gauze by the gauze count) and the gauze vessel weight from the aforementioned total weight measured; and a display section for displaying the number of gauzes, total weight measured, and their calculation result.

• The patent above describes a gauze counting method that meets a lot of needs, including determining amount of blood absorbed to determine total blood loss, as well as locating gauze itself and counting gauze based on weight.
• All of these needs exists and would benefit users, but the complexity of this 5 in 1 device would require a lot of training to teach users how to gather all the data the device provides.

Needs Statement: Facial surgery patients need pain management solutions that limit the use of opioid in post-surgical care.

Population: Facial surgery patients

Opportunity: Provide pain management

Outcome: Reduced opioid usage

Total Addressable Market Share

Calculating TAM

TAM = # of units/year * cost of product

Number of units/year = 1,392,162 patients based on below data

• Cost of product = estimated cost per use

Total Physician Fee : $38,890

Average cost of product: $4,321

• • TAM = # of units/year * cost of product# of units/year
    • # of units/year = number of patients/year
    • 1,392,162 patients
  • Cost of product = estimated cost per use
    • $150

  TAM = 1,392,162 x $150 = $208,824,300

  • $200M

More details on the types of facial procedures completed in the US in 2020.

More details on the types of facial procedures completed in the US in 2020.

List of cost for facial surgeries in the US in 2020.