ACCA: Making the case for a hybrid OR, how one hospital did it

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Teams of surgeons and interventionalists work in tandem in the hybrid OR at the Heart Hospital Baylor Plano in Texas.
Image source: Heart Hospital Baylor Plano
CHICAGO—Fusing together surgical and catheter-based procedures in one setting—a hybrid lab—can cut procedure time, allow for less invasive procedures and produce faster recovery times for patients all while creating a new, innovative business venture for hospitals, according to a presentation yesterday at the annual leadership conference of the American College of Cardiovascular Administrators (ACCA).

In a mission to evolve its pediatric and adult congenital heart program and combine disparate departments including cardiac and vascular, the Heart and Vascular Center at St. Joseph’s Hospital in Orange, Calif., with help of a $38 million imaging initiative, chose Siemens’ Artis zeego multi-axis system to command its hybrid OR.

The idea to integrate a hybrid OR into the facility was fueled by the ongoing need for transcatheter valve implantation, said Renee L. Mazeroll, RN, executive director of cardiac, pulmonary and vascular services at the St. Joseph Hospital and current president of ACCA.

The hospital performs almost 6,500 procedures per year and has an expansive portfolio. And four years and $5.5 million later, their hybrid OR, which incorporates 3D digital image reconstruction equipment, computer simulation, echocardiography and high-resolution displays, is up and running.

And while the process was tedious, the venture now allows surgeons and physician’s to join together to provide less invasive, better care to patients by allowing surgeons to replace heart valves, repair aortic aneurysms and open blocked arteries with smaller incisions.

While the planning process was delayed and meeting minimum cath lab standards in the hybrid lab difficult, today, the St. Joseph Hospital hybrid OR is 960 sq/feet (including control room) and has enabled four new positions to be added to the facilities hybrid team.

The hybrid lab team consists of nurses, cardiovascular technicians, radiology technicians, an interventional radiology technician, among others, and Mazeroll said that training was an integral part of success.

“We didn’t know what we didn’t know,” said Mazeroll. “We wanted to focus on training because the worst thing you can do is do something too fast or halfway.” To ensure that staff was trained in the best possible way, the hospital focused on an intensive six-week training period where staff worked three weeks prior to opening the suite and three weeks after, eight-hour days Monday through Friday.

Included in that training was “OR training 101,” even though staff had a long history of dealing with these interventional procedures, said Mazeroll. Additionally, she said that experts from Siemens were on-site working with staff for two weeks to help them understand the new robotic equipment.

And while Mazeroll said that training is continuously ongoing, she offered that the most important thing you can do is be sure to “invest in training upfront because it will buy you a lot of time in the end.”

While the hybrid suite may be a costly investment upfront, Mazeroll said overall imaging is better, contrast is decreased by 50 to 80 percent and less radiation is used because you are not doing as many imaging procedures.

Between the first quarter of April 5, 2010, and June 30, 2010, St. Joseph’s performed 85 cases in the hybrid lab and saw a contribution margin that equated to $235,000.

While Mazeroll said that the hybrid lab can be considered a business venture, she concluded the hybrid lab can help streamline surgical and catheter-based procedures, incorporate newer imaging technologies and add to patient care by allowing for disparate departments to be intertwined, decreasing patient length of stay by the use of much more minimally invasive procedures. In fact, procedural time has decreased to almost 45 minutes per-procedure.