Iowa Health System Sees Benefits from Data-Driven Surgery

University of Iowa Hospitals and Clinics is using technology in the OR to study how surgical procedures are done, with a goal of improving efficiency, reducing workflows, and improving clinical outcomes

Hospitals are turning to technology to get a good look at how their operating rooms, well … operate. And the results are not only improving OR efficiency but boosting clinical outcomes as well.

"These things turn out to be very important in patient outcomes," says John Cromwell, MD, FACS, associate chief medical officer and the director of surgical quality and safety at University of Iowa Hospitals and Clinics. "The amount of data we're getting will help us see things that we never would have seen before."

UIH launched its "data-driven surgery" program in July 2021 in a partnership with Caresyntax, one of several digital health companies developing technology platforms to improve operational and clinical efficiency in different parts of the hospital. The hardware and software program taps into connected devices and platforms throughout the OR while capturing audio and video recordings of the procedure.

John Cromwell, MD, FACS, associate chief medical officer and director of surgical quality and safety at University of Iowa Hospitals and Clinics. Photo courtesy University of Iowa Hospitals and Clinics.

Using that data, Cromwell says, administrators can gain a better understanding of how surgical procedures are done, as well as how the different members of the surgical team work individually and as a team.

"It's surprising how many variations we can find in processes," Cromwell says. For example, review teams can look at surgery outcomes based on the time of day, the day of the week, workflow patterns, even fluctuations in the weather.

While the platform acts as a kind of audit, Cromwell says it's not used to evaluate anyone's skills or performance.

"There are always concerns when you start collecting this type of data," he says, adding that it's not used for HR purposes or "gotcha moments." The data, he says, that's collected is federally protected and stored behind a strong firewall.

What it is used for, Cromwell says, is to examine how surgical procedures are conducted, with an eye toward, for example, how devices and supplies are used and where surgical team members are placed.  Administrators can then look for more efficient workflow adjustments that might save time or reduce wasteful processes or the use of supplies.

By leveraging EHR data, Cromwell, says, review teams can also take into account clinical outcomes.

"You can do some really interesting things [with the data] that are not always obvious," he says, such as identifying when and where infections might occur, due to fluctuations in temperature, changes in a patient's vital signs, or processes that open up opportunities for an infection.

Cromwell says the health system has used this technology to make some short-term improvements in OR procedures, mainly affecting efficiency and room turnover rates. Shaving 5-10 minutes off of a procedure "can be an enormous amount of time saved," he says, when played out over 50 or more OR rooms.

As administrators learn how to train the technology on specific aspects of a surgical procedure, he says, they'll be able to identify processes that can affect clinical outcomes (such as infections) and make improvements.

"This is a new way of doing things," he says. "There's really no other way of doing this. We can't really put people in the OR to watch over everything and tell [the surgical team] to do this or that. It's the technology that is really enabling us to get a better look and see where things can be improved."

He says surgeons are interested in the data as well and are often curious as to how they can improve their skills.

Cromwell sees other areas of the hospital where this technology could help, such as the emergency department. He sees the technology playing a part in credentialling and training programs, especially as healthcare organizations move into value-based care and gain a better understanding of how clinical services affect the revenue cycle.

"It's limitless in what we can do with the technology," he says. "And it'll become a standard of practice in the future as [we] figure out what we can learn from it."