224 - Improving Staff Readiness for Robotic Surgery Codes Through Hi-Fidelity Simulations

Description: Advances in surgical technology bring unique challenges in navigating medical emergencies in the operating room. This was evident in the rapid expansion of robotic technology, which has been shown to be safe and highly beneficial to patients. This type of minimally invasive surgery is associated with better patient outcomes and shorter length of stay. As more complex technology driven procedures are done, this increased the challenges for the OR team to manage potential intra-operative emergencies. Complications such as major and uncontrolled bleeding may require an emergent conversion to laparotomy. In situations like this, time is of the essence. Staff has to manage both patient and technology to facilitate an expedient effective resolution.

VHC Health Robotic Assisted Surgery Program has steadily grown every year. The rate of emergent events are low, but risks are high. We conducted a survey of our operating room staff's knowledge of assigned roles and responsibilities during such events. We found as the team expanded rapidly, the gaps in knowledge and skill in managing a robotic surgery crisis requiring an emergent conversion to open laparotomy increased. This knowledge gap included emergent undocking procedure for the robot and changing operating setup to open cases. Both surgeons and staff recognize this and has since sought solutions to close the gap. It was clear that a need to develop an algorithm directing members of the team in their roles during these events, as well as having the necessary surgical instruments, equipment and supplies readily available.

An interdisciplinary team consisting of OR staff, surgeons and anesthesia team was formed. After extensive literature research, an emergency algorithm and emergency conversion cart were developed. A hi-fidelity simulation based mock code training was established for the OR team. After training, the OR staff were able to successfully apply the newly developed emergency response protocol during intra-operative emergencies. The post survey results showed increased staff readiness to respond to emergent conversion cases in robotic surgery.