Essay on Revolutionizing Perioperative Nursing: Integrating Smart Hospital Technologies for Enhanced Patient Care

With the advancement of technology and the rapid innovation pace of science, the smart hospital is one example of future informatization. Incorporating information technology in the clinical process, management system, and infrastructure, the smart hospital aims to improve operation efficiency, and patient safety, lower cost, and facilitate information sharing and standardization. Perioperative nursing has been at the forefront of technological change in health care. Each year, new technology is introduced to operation theatre to improve surgical outcomes, such as advanced imaging, 3D printing, and navigation, to name a few. The perioperative nurse needs to play an active role in embracing technology with nursing care to provide quality healthcare services for patients.

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The perioperative service encompasses care to a patient before, during, and after surgery. Currently, the perioperative service enhancement program in OT provides surgical information to an in-hospital patient regarding the OT environment, steps of general/ spinal anesthesia, and pre-op preparation. The program is a pioneer in extending OT's service and helping the patient relieve stress before operation by education. With the aid of advanced technology, we can enhance our perioperative service to a more comprehensive level. In the following action plan, three different technologies will be explained and illustrate their function in enhancing perioperative service in OT.

Virtual Reality (VR) experience of OT

The hospital environment contains quite a harsh environment that may make a patient uncomfortable with the hospital's visit from their views of the surroundings to doctors and other patients' sights (Haque, 2017, p.6). To protect the patient from the shock of being admitted to a hospital for the first time just before the surgery, researchers have found it useful to take the patient through a pre-operation tour. We are currently providing this service to some patients who meet the selection criteria. However, this service is not feasible for most patients because of the high demand for OT services and manpower shortage of qualified personnel to lead the tour.

The advantage of VR technology is to recreate a realistic perioperative journey by using artificial intelligence and a 360-degree image showing the OT's surroundings and the procedures patients are about to go through. This tour is efficient in relieving the patient's stress by showing them a realistic OT experience in a safe, comfortable environment. The VR experience also helps to explain concepts or instructions that are difficult to interpret. The VR experience is rated satisfactory by patients in many studies for stress relief and is used for treatment in some countries (Chirico et al., 2020; Ioannou et al., 2020). It can also be tailor-made for a specific operation, which could provide more personalized and relevant information to the patient regarding pre-op preparation and post-operative care (Simon et al., 2019, p.117).

One of the action plan's end goals is to promote the benefits and facilitate the installation of the virtual reality system. The setup time for the VR experience from zero to the testing period takes about two months, including the video and soundtrack recording production. The cost of using VR service is estimated to be $100K, including a 10-12 headset and a video production cost. Some service providers also support remote playing, editing, and uploading a video to the headsets. Furthermore, it can also allow for the upload of new videos to all the headsets at a single time whenever there is an update (Premium Virtual Reality Headset – ClassVR, 2020).

Although there might be doubts and hesitations when encountering new technology, this technology not only brings benefits to the patient but also relieves the workload of OT staff when the program's execution is complete. This technology can also extend to the training of new staff and pain relief in PACU in the long run.

Smart whiteboard in an operating theatre

During the experience of the COVID-19 outbreak, we experienced many more cases that required the use of isolation theatre. The communication between inside and outside of the isolation theatre relies on a phone, which is inconvenient since only two-way communication between two parties. Once the line is held up, we cannot reach the personnel inside. Also, when multiple requests and information need to be exchanged between two sides, delays and errors are likely to happen. In a generation of exploding communication technology, there are some better ways to enhance communication during OT.

We used a whiteboard for communication for ages; in the past decade, the digital version of the whiteboard has become more common because of advanced features like real-time display of patient information, visual enhancement, etc. The application of smart whiteboards in hospital wards indicates that such technology has the potential to reduce the workload for nurses, speed up patient management, and enable more proactive coordination of care (Gjære and Lillebo, 2014). A smart whiteboard enhances easy and quick patient identification in an operating theatre from the experience of a hospital in Korea. In contrast, relevant patient data, including lab reports, x-ray or CT reports, are automatically displayed for checking before an operation, not only saving time for searching, it also facilitates the paperless trend in hospitals (Lim, Koh, and Poon, 2017).

Some may question the difference between digital whiteboards and the existing display monitors, showing patient information. Nowadays, the smart whiteboard is so much more than a display monitor; the interactive functions allow the surgeon or anesthetist to communicate with personnel in the theatre remotely. For example, in case of emergency, anesthetists could request the preparation of fluids, lines, and intubation equipment while reviewing a case in AED or ward; a surgeon could input information for positioning or request a specific instrument through a mobile app link to the smart whiteboard. All the information can be shown on the smart whiteboard instantly without passing the message through a different tier of communication, decreasing inaccuracies during emergencies. This technology improves multidiscipline communication and coordination (Wong et al., 2009). Furthermore, it can also be used as signage outside the theatre to alert others for infection control and radiation safety purposes. For isolation, the interactive function allows the nurse inside the theatre to communicate clearly with multiple parties outside simultaneously, which improves efficiency and minimizes the risk of contamination.

Radio Frequency Identification (RFID) in stock management and equipment tracking

Radiofrequency identification is the use of a wireless non-contact radio system to transfer data from a tag attached to an object, for automatic identification and tracking. This technology has been widely used in asset tracking, inventory management, and personnel tracking in various industries. There are different types of RFID tags that have features that are suitable for different applications in OT. To rank the tags from low to high cost would be passive RFID, intelligent RFID, and active RFID (Marcellino, 2020).

A passive RFID tag is suitable for inventory management and can track the item when the tag leaves a checkpoint, e.g., a storeroom. The cost for passive RFID tags is low because it does not require a power source and does not send data actively, so it is suitable for use on consumable items, like O&T implants, vascular grafts, adhesive glue or patch, etc. It doesn't require much infrastructure support and is easy to set up.

The cost of an Intelligent RFID tag is moderate, but it is more energy-saving than active RFID since it only sends out data when the tag leaves the last location. Therefore, it is suitable to use for equipment tracking. Since there are over 30 theatres in 3 different levels in the new acute hospital, it might be time-consuming to locate various equipment every shift. Using this technology, we can locate the equipment's whereabouts through Bluetooth devices, enhancing our work efficiency.

Active RFID tag tells the whereabouts of the item in real time. Although it requires an infrared system's infrastructure input, it is the appropriate time to consider it as the new acute hospital is in the production stage. It is suitable for personnel tracking or patient tracking, such as providing tags to a patient during premed or post-operatively transfer. Knowing patients' whereabouts in real-time enables theatre nurses to prepare theatre and coordinate with surgeons, anesthetists, or ward nurses more effectively. At the same time, patient privacy issues can be overcome if we input an alias for a patient, e.g., a TH1 patient.

QR code on the equipment

Attaching a QR code on equipment like a cell saver and linked information or video showing the setup steps will facilitate the accuracy and work efficiency of OT nurses at all levels. This also saves time and manpower input for training and promotes an active learning culture in our practice (Simon et al., 2019, p.109). Furthermore, the setup cost and requirement is low and easy, and the benefit is observable.

Changes to Occur

For the actualization of the action plan that involves implementing the virtual reality kit and the smart whiteboards outside of the isolation theatres, there needs to be training for the personnel that will be the machinery's frequent users. Technology is quite efficient when used effectively but may harm if wrongly used (Simon et al., 2019, p.112). The perioperative nurses' introduction to how the technology works is quite important in ensuring that implementation is undertaken smoothly. That may involve spending funds in purchasing the kits and payment of a plan to ensure that the nurses are oriented on how they operate and how to offer quality healthcare while using the new advancements.

Evaluation of the action plan

The effectiveness of the smart technology implementation in OT could be monitored by continuous evaluation throughout different program stages. The evaluation of effectiveness can be reviewed through various methods, like gathering feedback from OT nurses and patients. These evaluation methods can be done quarterly after launching each program.

Conclusion

To sum up, many technologies are available to improve the service of perioperative nursing. OT nurses had a key position in facilitating service improvement through technology, research, and continuous training. However, the application of smart technology in hospitals should not only focus on replacing human input with machines and AI but rather reallocating manpower resources to provide better caring services. Continuous assessment is necessary for the actualization of the plan.

References

Chirico, A., Maiorano, P., Indovina, P., Milanese, C., Giordano, G., Alivernini, F., Iodice, G., Gallo, L., De Pietro, G., Lucidi, F., Botti, G., De Laurentiis, M. and Giordano, A., 2020. Virtual reality and music therapy as distraction interventions to alleviate anxiety and improve mood states in breast cancer patients during chemotherapy. Journal of Cellular Physiology, 235(6), pp.5353-5362.

Classvr.com. 2020. Premium Virtual Reality Headset – Classvr. [online] Available at: <https://www.classvr.com/school-virtual-reality/teaching-vr-headset/> [Accessed 17 September 2020].

Evans, E.A., 2016. Improving Patient Safety and Nursing Care Utilizing.https://core.ac.uk/download/pdf/190330865.pdf

Gjære, E., and Lillebo, B., 2014. Designing privacy-friendly digital whiteboards for mediation of clinical progress. BMC Medical Informatics and Decision Making, 14(1).