OR Today Magazine January 2023

MACHINE LEARNING IN THE OR

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THE PROBLEM

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the Integrity of Equipment

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Shaver Leak Tester

Designed for pressure testing arthroscopic shavers to help identify leaks caused by failing seals that degrade over time from repeated use and processing.

For more of Healthmark’s intelligent solutions for instrument care and infection control, visit hmark.com

MACHINE LEARNING IN

advancements in the 21st century have transformed practically every industry, including health care. Machine learning and artificial intelligence are becoming more common in the

I.C. Medical’s patented Crystal Vision® surgical smoke evacuator is the only surgical smoke evacuation device with both laparoscopic and open procedure modes.

• In laparoscopic mode, the Crystal Vision® monitors pneumoperitoneal pressure and activates the pump when a preset pressure is exceeded, helping reduce the potential of an air embolism.

• For open procedures, the Crystal Vision® pump has the highest suction power of any plume evacuator. This enables the highest flow at the nozzle leading to more e icient, e ective smoke evacuation.

• Crystal Vision®’s occlusion detection feature detects trapped tissue in both open and closed procedures, minimizing trauma to the tissue.

particles which range from 0.06-0.14 micron. SAFEGUARD BLUE ® Hydrophobic ULPA with Built-In Fluid Trap simultaneously ensures that evacuated surgical plumes,

Another important thing to know is that Key Surgical now has more weights and sizes of double-bonded, SMS sterilization wrap than ever before. With sizes starting at 18" x 18" and up to 54" x 54" and weights from 100 to 600, wrapping the various size trays in SPD (making sure to always leave the ‘tongue’ out) will be easier said and done.

Periop CONNECT

Two AORN Chapters Announce Events

A successful partnership between OR Today and the Georgia Council of periOperative Registered Nurses continues in 2023. The duo will once again team up to host the organization’s annual meeting on September 29-30.

The 2022 annual meeting was a huge success. The popularity of the meeting and positive feedback from attendees and exhibitors exceeded all expectations!

A sold-out exhibit hall featured 37 perioperative companies with almost 100 booth personnel on hand to answer questions and deliver insights regarding their products and solutions. In addition, 135 perioperative professionals from throughout the United States registered to attend. Some attendees traveled from California and Connecticut for the annual meeting after seeing the education and exhibits that would be at the event. Attendees also included several AORN board members and board member candidates. Sponsors Stryker, Aerobiotix and ConMed added to the value of the annual meeting with networking events, door prizes and an outstanding keynote addresses. Attendees could earn up to 5.5 CE credits approved by OR Today, a licensed Continuing Education Provider with the State of California Board of Registered Nursing. License #16623

The Georgia Council of perioperative Registered Nurses Annual Meeting is a can’t miss event.

“I visited with more people today than I did all last week at the OR Manager conference,” is how Eric Brown from C Change Surgical described the 2002 meeting.

“It had been a while since we have had fantastic face-to-face conversations with attendees and we will definitely be coming back next year,” Encompass Group LLC. Vice President of Product Strategy and Development Michelle Daniels said at the 2022 event.

More information about the 2023 annual meeting, including a call for presenters, is online at gacouncilnurse.org.

In addition, OR Today is proud to have the support of AORN Connecticut Chapter 0701 for the inaugural Periop ConneCT conference to be held September 8-9, 2023 at the Omni New Haven Hotel at Yale in New Haven, Connecticut.

The partnership between OR Today and AORN Connecticut Chapter 0701 will provide perioperative professionals throughout Connecticut and New England an opportunity to come together for CE-accredited education, exhibits with leading vendors, and great networking events.

Details, on the schedule of events, education, exhibit opportunities and more can be found at periopconnect.com.

INDUSTRY INSIGHTS

Healthmark Offers New Robotic Instrument Protector Card

Healthmark Industries has introduced the Robotic Instrument Protector Card to its ProSys Instrument Care product line. Designed to be used in conjunction with a sterile barrier, the single use Robotic Instrument Protector Card is a backer board component that provides enhanced structural integrity of a sterile packaging solution for robotic instruments.

Manufactured from SBS paperboard, the Robotic In -

strument Protector Card is equipped with a mounting surface, minimizing the possibility of packaged items compromising the sterile barrier. The Robotic Instrument Protector Card comes with a finger hole on each end for easy retrieval of items from packaging. This item is available for purchase in a box of 25.

For more information, visit hmark.com.

Aspen Surgical Acquires Symmetry Surgical

Aspen Surgical Products Inc., a portfolio company of Audax Private Equity and a leader in disposable surgical products, announced the acquisition of Symmetry Surgical from RoundTable Healthcare Partners. Symmetry represents Aspen’s fifteenth acquisition in total and sixth since Audax’ initial investment in Aspen in 2019. Financial terms of the transaction were not disclosed.

Based in Nashville, Tennessee, with additional operations in Louisville, Kentucky; Tuttlingen, Germany; and Melbourne, Australia, Symmetry is a leading provider of high-quality surgical and specialty instrumentation, electrosurgery products and minimally invasive surgical devices.

“Symmetry has a longstanding history of providing high-quality surgical devices and value-added services to the health care community, including iconic brands such as Bovie, Bookwalter and Greenberg,” said Jason Krieser, CEO of Aspen. “The portfolio is synergistic with Aspen and supports our mission to deliver es -

sential products that improve safety and efficiency in the surgical environment.”

The acquisition of Symmetry augments Aspen’s broad portfolio with additional clinically preferred brands; provides diversification into attractive adjacent categories; and adds new commercial competencies and routes-to-market with a national direct-sales infrastructure across both acute and non-acute settings of care.

Integrated Endoscopy has launched its second generation NUVIS (pronounced “nu-vee”) single-use arthroscope, a first-of-its-kind 4K endoscope designed for use in arthroscopic surgical procedures.

“The release of the Gen II NUVIS features a patent-pending simplified optical train design which reduces the number of optical elements by over 60% while boosting image quality to 4K,” according to a news release. “Not only is the image quality superior, but the Gen II NUVIS will also be substantially faster and less expensive to manufacture and amenable to high-volume automation. As part of the Gen II launch, Integrated Endoscopy is releasing multiple versions of NUVIS to make the technology compat -

ible with most cannulas on the market. NUVIS is also compatible with most installed video towers and will support a 4K camera system without requiring additional capital equipment. NUVIS has a built-in battery powered LED, which eliminates the light box and bulky light cord.”

Integrated Endoscopy’s Gen II NUVIS single-use, 4K, battery operated cordless arthroscope is FDA 501(k) cleared, CE marked and is being registered in a number of markets around the world. As manufacturing capacity increases, the company will continue to expand its global distribution network to provide this technology to the arthroscopic surgical community.

INDUSTRY INSIGHTS

AAAHC Prepares Clients for v42 Standards at Achieving Accreditation

Upholding its ongoing commitment to the improvement of the patient care environment, Accreditation Association for Ambulatory Health Care (AAAHC) its v42 Standards Handbooks for Medicare Deemed Status (MDS) and Ambulatory Accreditation. The updated editions provide guidance for health care providers seeking practical knowledge of changes to relevant Standards in the specific ambulatory settings for their organizations. Revisions in the v42 handbooks introduces new terminology and streamlines Standards architecture across all programs.

“For more than 40 years, AAAHC has provided facilities with relevant Standards and education for improvement of the patient care environment,” said Noel Adachi, MBA, president and CEO of AAAHC. “Our v42 Standards reflect the collaborative efforts of a large team of experts, including our surveyors, and address input from accredited organizations that put these Standards into action every day. The handbooks are the guiding resource for the accreditation journey and allow organizations to perform targeted and continuous assessments of their prac-

tices throughout the 1,095 days of the accreditation term.” In keeping with its commitment to ongoing self-assessment and improvement, AAAHC updates its Standards regularly to reflect proven developments in medicine, technology, and specialty practice. Updated v42 Standards align AAAHC programs and include valuable insights from AAAHC surveyors and Standards Development Committee, along with client organizations, partners and staff.

“AAAHC Standards Handbooks exemplify AAAHC’s 1095 Strong, quality every day philosophy, a call-to-action to equip ambulatory leaders with the best of what they need to operationalize quality practices,” added AAAHC Immediate Past Board Chair Edwin Slade, DMD, JD. “The refined v42 Standards present clear guidance and the latest direction for upholding and maintaining compliance to accelerate improvements in quality of care.”

For more information, visit aaahc.org/v42Standards.

ACE Xtend Remote Control Unit Earns FDA Clearance

XACT Robotics has announced that its ACE Xtend Remote Control Unit received U.S. Food and Drug Administration (FDA) clearance, allowing users to robotically insert and steer the XACT ACE Robotic System remotely from the control room. The first-of-its-kind feature for CT-guided percutaneous procedures is designed to improve physician workflows while limiting physician and other users’ exposure to radiation and reduce physical strain.

“The XACT ACE Robotic System has already allowed users to make percutaneous procedures, such as ablations, drainages and biopsies, more accurate, consistent and efficient,” said Shai Meltzer, CEO of XACT Robotics. “The addition of ACE Xtend has the potential to further increase efficiencies for the care team with a streamlined workflow that helps reduce the time in which physicians and other users are exposed to harmful radiation during standard procedures.”

“Interventional radiology is among the medical specialties that are facing a physician shortage in the coming years and technologies that can improve their efficiencies are crucial,” said Jeffrey Solomon, MD, vice president of

medical affairs at XACT. “By equipping different users with tools that can standardize the procedure and potentially shorten procedure times, we can maximize the number of patients they see and help to mitigate the gap between the patient population and the physician population.”

The comprehensive XACT ACE Robotic System is the first and only technology that combines image-based planning and monitoring with patented S-Drive technology, which enables the system to quickly adapt from a linear to a non-linear trajectory with its robotic insertion and steering of instruments during interventional percutaneous procedures. It precisely delivers instruments to the designated targets with unparalleled accuracy, unmatched consistency, and unlimited efficiency.

The XACT ACE Robotic System has been proven to achieve unparalleled 1.7mm tip to target average accuracy upon first insertion based on data obtained from company clinical studies for biopsy procedures. By providing accurate and actionable results for medical diagnosis, the system aims to enhance early detection and improve patient outcomes.

INDUSTRY INSIGHTS

CensisAI2 Productivity Provides Actionable Intelligence for SPD

Sterile processing departments (SPDs) are under increased pressure to deliver more sterile trays to operating rooms in less time, but managers often lack the insight into where improvements can be made. The new CensisAI2 Productivity platform is the next generation of analytical reporting. It puts the power of artificial intelligence and actionable intelligence in the hands of organizations and delivers exceptional insights to achieve operational excellence across an enterprise. With CensisAI2 Productivity, sterile processing and perioperative leaders gain insights to streamline operations and make better, data-driven decisions faster.

CensisAI2 Productivity quickly pays for itself by giving leaders the insights they need – but haven’t been able to easily access – to boost organizational productivity which enables more surgical capacity. For example, a hospital with five operating rooms only needs to expand its surgical ca-

pacity by one case a year to realize a return on investment. “SPD managers struggle to attract and retain qualified sterile processing technicians while also managing increased demands to improve departmental throughput,” said Censis President Ankush Kaul. “With a combination of pre-built tools for daily visual management and enterprise-wide visibility to sterile processing operations, CensisAI2 Productivity delivers the actionable insights needed to quickly pinpoint issues and opportunities to make significant impacts in organizational productivity.”

The CensisAI2 Productivity interactive platform provides visibility into all aspects of SPD operations to discover what problems need to be solved and where. It allows easy comparisons of tech-to-tech, shift-to-shift, and site-to-site data to drive process refinements and enterprise-wide standards, encourage best practices, improve staff training and inspire continuous improvement.

LiveData Integrates Surgeon Preferences into Surgical Workflow

LiveData, a data-driven surgical care company, has announced the integration of PREFcards, a cloud-based, surgical preference card system, to add operational efficiency and accuracy to surgical workflows. Combining LiveData’s field-proven PeriOp Manager with PREFcards will increase surgeon satisfaction and lower procedure costs while continuing to enhance patient safety, mitigate the impact of staff shortages and meet the rising demand for operating room (OR) time.

As a cloud-based solution, PREFcards can be accessed from any laptop, desktop, mobile phone or tablet. Further, pre-op teams are able to customize every aspect of how each surgeon’s cards are organized.

“Every surgeon we talk to about preference cards has voiced that the right card can be as valuable as any single item on the card,” said LiveData CEO Jeff Robbins. “PREFcards shares our vision of increasing surgeon efficiency, protecting operating margins, and enhancing patient safety. We are well aligned to meet this pressing need.”

“PREFcards addresses the challenges associated with the labor-intensive workflow of creating and managing preference cards,” said Ethan Nobbs, PREFcards CEO.

“Scrub techs love the ability to add pictures of the back table, surgeons love that their cards are always up to date, and administrators love the ability to generate real-time reports such as procedure cost comparisons and surgeon contribution margins. But at the end of the day, it’s really about the supply and labor savings that our clients are seeing in the OR.”

LiveData PeriOp Manager provides real-time situational awareness to optimize the perioperative experience for patients, their families, clinicians and the OR support team. It simplifies scheduling, provides real-time data on patient progress and operational status to improve communication, and gathers data to help streamline workflows and empower clinical teams to deliver the best care.

“Virtually every hospital is grappling with how to restore their elective surgery calendars, especially considering the perioperative staff shortages affecting many providers,” added Robbins. “We’re excited to be in person at ORMC this year, showcasing the LiveData PeriOp Manager product suite and learning more about how we can help hospital and ambulatory surgery center leaders with the challenges they face.”

INDUSTRY INSIGHTS

ACHC

ACHC Perspectives:

Due Diligence Leads to Better Decisions

By patrick horine

W hen considering a purchase for your OR suite, most organizations follow a process of due diligence to investigate the benefits and risks of available options. Even when the decision resides with a designated administrative leader, those who will use the equipment are usually engaged at some level in an evaluative process. The most cursory “comparison shopping” is designed to ensure that your investment will produce a return – in greater efficiency, increased throughput, or improved safety, for example.

Are you applying that same degree of purposeful analysis to other purchases that impact your surgical setting? Whether seeking initial accreditation, considering switching to a new accreditation organization (AO), or preparing for a renewal, you owe it to your team and your organization to make sure it’s an informed decision. Due diligence

applied to your process can maximize the benefit of this significant investment.

By definition, an accreditation organization with “deemed status” is an independent third party that has been given authority and responsibility by the Centers for Medicare and Medicaid Services (CMS) to ensure that patients are safe while in the care of a specific provider or supplier organization. Accreditation is validation that a health care organization meets a range of requirements for processes that correlate with improving the quality of care it delivers to its patients.

Health care is a relationship business. The relationship between health care organizations and their AO often has been characterized as adverse, controversial or combative. But just as your organization seeks to foster a positive relationship with patients, you should expect the same from your AO. Research related to accreditation outcomes suggests the relationship with the accrediting organization is foundational to achieving coherence, organizational buy-in and organizational action for effective performance.

What you should consider

From the administrative point of view, key details to research when choosing an AO would include confirming deeming authority, identifying what to expect from the survey, and comparing cost, plus evaluation of reputation and available support for initial accreditation or transition. Front line employees may have additional concerns such as accessibility and responsiveness to questions, guidance in interpreting standards and availability of resources.

As an employer, you look for soft skills in your staff in addition to clinical experience. High patient satisfaction is largely a result of their individual interactions with staff across multiple encounters and differing roles. Similar soft skills from your AO elicit greater satisfaction and more value for your teams. You may want to investigate whether an AO is collaborative as shown through an approach attitude, accessible staff and timely responses. Does it build confidence in your team through accurate information and relevant clinical and administrative expertise? Does it demonstrate

flexibility and partnership by showing authentic interest in what makes your organization unique? And, in general, does the relationship foster trust across all levels of your organization?

For most organizations, three years pass between on-site surveys. This can lead to a habit of performing a just-in-time ramp up which stresses “passing the survey” as the ultimate goal. Not to imply this is the case for every organization, but some organizations may go through the triennial exercise of signaling compliance rather than committing to an ongoing process of continuous self-evaluation and improvement. This makes for stressful surveys and little lasting benefit.

Because it is imperative to the sustainability of your organization that accreditation be maintained, a continuing rather than intermittent relationship with the AO and the standards better supports quality and adds value.

To ensure you are receiving what should be expected from the relationship with your accreditation organization, transitioning and renewing ambulatory surgery centers and hospitals may want to step back and question whether working with their current AO has had a positive impact and facilitated the need to promote the health, safety and best possible experience for the organization and its patients.

There are AOs that serve limited niches. Others offer more comprehensive programs and services. Getting the greatest possible value from this unique relationship depends on your effort to discern the right fit for your needs.

PROBE TURNAROUND

SIMPLIFIED COMPLIANCE

SIGNIFICANT SAVINGS

Patrick Horine is vice president, acute care services at Accreditation Commission for Health Care Inc. Before performing his own due diligence and joining ACHC, he was the founding president and CEO of DNV Healthcare.

AI is Coming to Your Hospital. Will Clinicians Trust it?

T here is “tremendous enthusiasm” about disruptive innovation – as long as it is clinically validated. When it comes to AI in health care, transparency in how these tools are designed and validated will be essential to establishing that trust.

That was the message from the first keynote address at the 2022 AAMI/ FDA/BSI International Conference on Medical Device Standards and Regulation, given by Jesse Ehrenfeld, MD, MPH, president-elect of the American Medical Association and cochair of the AAMI AI standards committee on October 18.

“This is a lesson that we have learned across the industry over and over and over, whether it’s electronic health records, digital wearables, other devices, that not every tool, not every device, not every app lives up to its promise. And while digital health and AI tools, in particular, have nearly unlimited potential to change medicine, to change medicine for the better … physicians increasingly understand the stakes, what is ahead of us as we think about using these tools in

our practice,” Ehrenfeld said.The regulatory environment, however, has failed to catch up to the pace of change, according to Ehrenfeld.

“We’ve got to make sure that we work together with intentional and great purpose to ensure that patients and their care teams can trust what they’re using,” he said.“There’s not a day that goes by that I don’t see patients, deliver care, where I don’t see opportunities for the technology to do better. And there are real gaps that only will be achieved if we can come together through the standards community to make sure that we’ve got the right tools and technologies to work on,” he added. “Unfortunately, for the patients that we serve, there continues to be a lot of uncertainty around the direction for the regulatory framework for digital health tools and AI in particular … we’ve got to ensure that the regulatory framework only allows safe, highquality, clinically validated tools to come into the marketplace. And AI simply cannot allow us to lower the quality of the tools that show up at the patient’s bedside, or to introduce bias into the results that we use as practitioners.”

Hospitals, Meet AI

Interest in AI tools among physicians is growing, according to a recent Digital Health Physician Survey from AMA, cited by Ehrenfeld, with adoption of these tools growing by all physicians regardless of gender or specialty, or age of the end user. Plans for adoptions of the most emerging technologies are high, but actual usage remains low. Nearly 1 in 5 physicians is currently using AI for practice efficiencies.

A reported 2 out of 5 want to adopt them in the next year.

Nearly 3 in 5 physicians think these technologies can help them in key areas like reducing the impact of chronic disease.

“How clinicians integrate these things into the delivery models of the future is going to be dependent though on a lot of other factors like cost of their clinical practice, having an appropriate evidence base to support the use for an individual patient. And those are messages that come through loud and clear in our digital health work,” Ehrenfeld said. “Improving clinical outcomes and improving efficiency of the workflow are the key drivers

of physician adoption. But, increasingly, coverage for issues like malpractice insurance continues to be an important requirement across all physicians in our surveys.”

Digital technologies, wearables and AI offer “almost limitless potential” to transform the health care delivery system, both for clinician practice as well as for the patience experience.

“But without direct input from the physician community throughout the design life cycle, we will see that these technologies will fail to deliver. Or even worse, they’ll further complicate health care or actually impede the delivery process for patients. We ought to be working towards the quadruple aim, improving patient care [and] clinical well-being, lowering health care costs, and having better outcomes for patients,” Ehrenfeld said. “And I would say that every single new healthcare technology ought to be designed to accomplish at least one of these

goals, hopefully more.”

In addition, when an AI system is added to a medical workflow, those working in it must be made aware of the AI and properly trained in it. Ehrenfeld cited the tragic loss of hundreds of lives due to the Boeing 737 Max airliners that crashed in 2019 because of automated technology that the pilots were unaware of.

“We have to know that the AI is there. We’ve got to have training about the expected function and anticipated dysfunction of the system. People working with AIenabled tools and devices can only supervise and correct them if we know that the AI is there and what the outputs are that it’s producing.

And I will tell you that it’s been well documented that the flight crews of those two June airliners did not know about this new AI system on their aircraft. It was not in their operations manuals. There was no specific training. You simply cannot repeat that same mistake in

health care,” he said.

The sensitivity around trust in technology places us at a “critical juncture” when it comes to establishing trust at a time when skepticism in science, regulation and government agencies is high. In such an environment, expertise may even be deliberately ignored.

“We cannot allow any openings in the regulatory framework or in the product development life cycle to exacerbate this new global problem,” Ehrenfeld said. “When I look out at the current development and implementation landscape for new digital tools [and] AI-enabled technologies, where it can be much more difficult to understand when an algorithm is working as expected and when it is not, as a community, a collective community of developers, regulators, and users, we’ve got to ensure that we do not lose the public trust, the confidence of the public in the tools that are coming into the marketplace.”

INDUSTRY INSIGHTS

HSPA

Instrument Tray Optimization: Improve Quality & Bottom Line

By David Taylor III

R ising health care costs and increasing demands for waste reduction and improved organization-wide efficiency are driving hospital administrators and departmental leaders to seek new opportunities to cut costs and improve their profit margins. It is estimated that nearly one-third (30%) of health care costs are lost to wasted efforts, costing $49 billion a year.1 Specifically, inefficiencies in the operating room (OR) and sterile processing departments (SPDs) can cost health care organizations tens of thousands of dollars in wasted effort, and far more if negative patient outcomes arise.

It is critical for health care organizations to enhance their daily workflows by consistently evaluating opportunities and working collaboratively with key stakeholders on process improvement (PI) initiatives. Instrument tray optimization is one notable practice that not only adds significant dollars to the organization’s bottom line, but also reduced workload for both SPD and OR professionals. Tray optimization streamlines instruments more effectively to reduce the number of instruments opened and used with each surgical procedure, which subsequently helps eliminate the need for costly and time-consuming processing of duplicate and unused devices. SP professionals – along with surgeons from all specialties – play a shared and significant role in this process. While organizations strive to provide surgeons with the tools they need to

perform their procedures safely, effectively and efficiently, many health systems and facilities struggle daily to provide adequate instrumentation levels to support the rising number of surgical procedures. Along with the soaring surgical volumes, the number of instruments in a single set has grown significantly, with some sets having hundreds of instruments, which require time (and money) to properly inspect, clean, process, wrap, sterilize, store and deliver for patient use (SPD’s responsibility), and set up, account for, maintain, and prepare for delivery back to the SPD (OR’s responsibility). The OR is also responsible for keeping track of the instruments used during surgical procedures. All instruments must be counted and accounted for before an incision is made, during the procedure, when a cavity and skin are closed, and the procedure is completed. All instruments must be counted, regardless of whether they were used during the procedure.

Accounting for instrumentation is time consuming for both the OR circulator and scrub technician. When one considers that the average surgical procedure requires a minimum of three instrument counts (and, in some circumstances, additional counts), the benefits of instrument set optimization become clear.

Literature shows that in a single procedure only 13-21.9% of instruments are used.2 If the average instrument set contains 100 instruments, for example, one can see how much time is wasted accounting for unused (78-87%) instruments. Note: According to literature, it costs between $0.51 and $0.77 to clean, package and sterilize a single instrument

in the U.S., and European studies cite those costs between $0.59 to $11.52.3 -5When one considers that most costs are associated with unused instruments, it can be surmised that the SPD and OR teams could benefit from working more collaboratively and effectively to optimize instrument trays.

If an organization reduces its instrument size by half, it will not only allow more time for the surgical team to focus on the patient and procedure (instead of extra instruments) but also reduce set-up and tear-down times, make pointof-use treatment more efficient, lighten instrument tray weights) increase an organization’s instrument set inventory by being able to repurpose extra instruments, and reduce time needed to reassemble and process instrument sets in the SPD.

Many health care organizations base their inventory counts and instrument usage solely on manually estimations, which is not only laborious but can also prove inaccurate. Automated or computer-based container and instrument/ tray tracking systems, when combined with manual processes, are more robust and effective at helping organizations attain more accurate data. Sharing this data with surgeons can be a powerful tool in getting their buy-in and helping them understand how more streamlined instrument trays benefit the OR, SPD and the patients being treated.

Conclusion

Health care organizations are increasingly pressured to deliver high-quality, affordable care and services. Focused instrument tray optimization is one way

to avoid unnecessary costs and process waste and keep day-today operations running more smoothly in the OR and SPD. Both departments must understand which instruments are needed for each surgical procedure and then work collaboratively to reduce redundant devices that typically go unused. Positive results may include faster OR setup, counts and tear down; improved instrument counts during procedures; more on-time procedure starts; faster set turnover times; increased quantity of instrument sets and replacement devices; improved instrument and set quality (maintenance); faster reprocessing times (pretreatment, decontamination, inspection, assembly, sterilization); reduced instrument set weights (not to exceed 25-pound weight limit, which includes the container); and enhanced patient safety by allowing surgical staff to focus more on the patient and procedure instead of the instruments in the tray.

References

1. https://orthospinenews.com/2018/12/10/the-49-billion-year-ofwaste-in-healthcare-spending-we-can-solve/ 2. https://pubmed.ncbi.nlm.nih.gov/30846251/

3. Adler S, Scherrer M, Ruckauer KD, Daschner FD. “Comparison of economic and environmental impacts between disposable and reusable instruments used for laparoscopic cholecystectomy.” Surg Endosc 2005;19:268e272.

4. Demoulin L, Kesteloot K, Penninckx F. “A cost comparison of disposable vs reusable instruments in laparoscopic cholecystectomy.” Surg Endosc 1996;10:520e525.

5. Prat F, Spieler JF, Paci S, et al. “Reliability, cost-effectiveness, and safety of reuse of ancillary devices for ERCP.” Gastrointest Endosc 2004;60:246e252

David Taylor III, MSN, RN, CNOR, is an independent hospital and ambulatory surgery center consultant and the principal of Resolute Advisory Group LLC, in San Antonio, Texas. He has served as an HSPA contributing author since 2019.

Joint Comission

Preparing for Unexpected Emergency in the OR

By elizabth even

A ccording to The American College of Surgeons, every year, more than 15 million Americans undergo some type of surgery. Each patient awaiting surgery expects a surgical team to fully assess and evaluate their individual case. They also assume that their procedure has been appropriately planned, which means operating room (OR) staff has prepared what is necessary for their specific surgical procedure and its expected outcome. Further, patients rightfully expect that their surgical team has developed a plan to react to the unexpected.

While the OR is no stranger to lifethreatening emergencies, proper planning, training, and education can help to ensure that unexpected emergencies end with safe outcomes. Health care organizations’ leaders must consider the various types of patients and procedures performed, to ensure they are properly equipped with necessary supplies in the event of an emergency.

The Joint Commission standards require that health care organizations obtain a surgery patient’s medical history and have them undergo a physical examination, as stated in Provision of Care chapter of The Joint Commission’s “Comprehensive Accreditation Manual for Ambulatory Care.” Joint Commission standards require that health care staff comprehensively assess a patient’s current physical condition as well as indicate any changes in their health or medical history that may affect their procedure. The patient’s comprehensive assessment enables a care team to adequately prepare for an upcoming case.

Surgical procedure preparation can include testing emergency equipment

such as a properly functioning suction or defibrillator and gathering supplies such as available blood products and life-saving medications. It is critical that all equipment and supplies within an ambulatory surgery center (ASC) remain consistent despite the differences in services offered. Equipment and supply consistency provides ease of use for staff who operate and utilize them. Also important is determining the appropriate number of competent providers assigned to a procedure. This detail can make the critical difference between a tense phase during a surgical case and what could possibly turn into significant adverse event or even patient harm or death.

That said, how can health care organizations’ leaders ensure their surgical centers are ready to deliver excellent care even when procedures do not go as planned? The term “risk assessment” is regularly used in health care, but what does it mean? Thoroughly understanding risk assessment and how to successfully complete one is key. A risk assessment entails simply gathering information about a process (e.g., procedures and surgeries performed), identifying risks, and prioritizing those risks along with developing efforts to mitigate them.

Surgeries and other high-risk procedures carry a higher probability for adverse outcomes; therefore, health care leaders should plan for such as often and as carefully as possible. For example, staff should inventory emergency supplies as well as medications that may be needed (as referenced in Provision of Care and Medication Management chapters of The Joint Commission aforementioned manual), and most importantly, identify staff and providers who will be using them. After all, emergency medical equipment lacks value without trained, knowledgeable staff who know how to use it during an emergency.

Competently trained and experienced staff is an invaluable asset to any health care organization, and many would argue that staff members are health care’s most precious resource. However, health care organizations’ leaders often question the difference between training, education and competency. As stated in The Joint Commission’s Frequently Asked Questions (FAQs), education is the process of receiving systematic instruction resulting in the acquisition of theoretical knowledge; Training differs from education in that “training” focuses on gaining specific – often manually performed – technical skills; Competency requires a third attribute – ability; Ability is simply described as being able to “do something.” The ability to do something “competently” is based on an individual’s capability to synthesize and correctly apply the knowledge and technical skills to a task.

Competency differs from education and training in that competency incorporates all three attributes: knowledge, technical skills and ability. All three elements are required to deliver safe care, correctly perform technical tasks and more. Assessing competency is the process by which a health care organization validates, via a defined process, that an individual possesses the ability to perform a task, consistent with the education and training provided. It is important that the completion of competency is documented in the staff members personnel files.

Several Joint Commission requirements featured in its “Comprehensive Accreditation Manual for Ambulatory Care” address clinical care emergencies. As clinicians, we often ponder how we should respond to them. Nationally recognized guidelines such as American Heart Association’s Advanced Cardiac Life Support (ACLS) provide algorithms that address issues with

anesthesia. But, what if a medical gas panel suddenly malfunctioned? Or a fire broke out during cauterization? Would surgical staff know how to respond and safely resolve the situation? To ensure the answer to these questions is “yes,” many health care organizations may choose to perform staff drills for specifically identified risks, or practice table-top exercises to determine appropriate emergency procedures for various “what if” scenarios. Specific additional drills or exercises those surgical centers choose to perform above and beyond the required drills (such as fire drills) is an organizational decision and should be based on that facility’s internal risk assessment.

Oftentimes in health care, it is the procedures that we perform often, that we perform well. For example, many ambulatory surgery centers that have a designation as a center for excellence or an advanced certification have standardized processes and guidelines that allow for all staff and providers to be on the same page

when providing excellent patient care. This is another reason why planning for rare emergency events is so very important. For example, while running a mock code drill, perhaps it is discovered that a facility’s suction machine is no longer working or that the emergency medication in the crash cart is expired or missing. Knowledge gained during such exercises is an important part of a health care provider’s journey to safer patient care. Health care organizations often make the mistake of conducting simplified drills which may not expose the unique failures that could present during a real-life emergency. Since real-life situations can expose those weak points, it is important to “test to failure” when conducting drills. This allows health care organizations to learn at what point their procedures will break and allow them to mitigate the identified risk point.

Above all else, health care organization leaders must establish a culture of safety that allows for empowerment of “stop

the line” types of programs, if any safety concern is present during a procedure. Additionally, they should support nonpunitive reporting of events such as near misses, to continually improve the safety of care delivered. Transparent and supportive leadership is one of many ways that leaders can mitigate emergencies within their ASCs.

The Joint Commission is proud to partner with our accredited ASCs as they continue their journeys to zero patient harm and are grateful for their continued hard work and dedication to patient safety each day. Joint Commission-accredited ASCs can reach out to our Standards Interpretation Group with any standardsrelated questions.

– Elizabeth Even is a Team Lead, Standards Interpretation, Standards Interpretation Group at The Joint Commission.

INDUSTRY INSIGHTS

The Assessment of Noncognitive Competencies

By James X. Stobinski

I n my column this month, I would like to speak about the assessment of noncognitive competencies which have been the topic of some recent discussion in the certification industry. These competencies have been described as “… a range of personal attributes that are referred to under various labels, such as personality characteristics, soft skills, social and emotional competencies, or 21st century skills.” 4 For the sake of readability let us use the term “soft skills” to refer to these noncognitive competencies.

Many of us are familiar with the acronym KSA referring to Knowledge, Skill and Abilities as the components of competency.³ Credentialing bodies, like my organization the Competency and Credentialing Institute, have traditionally focused on measuring knowledge and skills which are cognitive or psychomotor properties. Knowledge-based tests – which are a staple of certification programs – are, by default, used as proxies for competency. However, knowledge, even if tested

well, is but one segment of competency within the KSA framework. A fuller picture of competency emerges when we also examine the soft skills which are inherent in a role such as perioperative nursing. Although extensively used in human resources functions the use of soft skills assessments are new for certification bodies and few nurses have had extensive experience in such assessments. Some certification bodies are beginning to take some early steps in the use of soft skills assessments. At CCI, a soft skills assessment is one of the four segments of the newly accredited Certified Foundational Perioperative Nurse (CFPN) certification. Early career perioperative nurses take the 16pf assessment provided by Talogy and receive a detailed score report outlining their relative strengths, areas for improvement and suggestions for additional training. ² CFPN applicants then write a graded Reflective Learning Exercise on these results and other feedback received in the CFPN credentialing process.

The work of CCI in this early use of soft skills assessments was recently detailed in the publication Credentialing Insights. 5 The

assessment of soft skills facilitates a more comprehensive assessment of candidates. Traditional examination processes have been refined for decades and do a very reliable job of measuring knowledge. Noncognitive skills may be developed through the application of knowledge and skill in purposeful practice. Thus, if an efficient method were devised for measuring the requisite soft skills essential to a given role such as perioperative nursing it is theoretically possible to enhance these noncognitive skills and therefore increase the competency of the practitioner.

There is some data that suggests noncognitive assessments can serve as predictors of training success. If these predictors could be ascertained for perioperative nurse education and training activities soft skills assessments could be used to screen candidates for these resource intensive orientation programs. The employer could then screen candidates and select those who surpass a minimum threshold which would give a higher likelihood of successful completion of the training. This would allow for more efficient use of scarce education and training resources.

O*NET OnLine, a resource maintained by the U.S. Department of Labor, informs us that deductive reasoning, problem sensitivity, inductive reasoning and originality are among the soft skills of registered nurses. ¹ But this resource does not list the soft skills for perioperative nursing. These skills could be identified through job practice analysis methods commonly done by certification boards. This is the opportunity for credentialing bodies, linking the data from soft skills assessments to individualized learning or skill development identified in a job analysis. This has the potential to increase the competency of the certificant, but these individualized professional development plans are not yet widely used.

– James X. Stobinski, Ph.D. RN CNOR CNAMB CSSM(E) is CEO of the Competency and Credentialing Institute (CCI).

References:

1. National Center for O*NET Development (2022, October 18) Registered Nurses. https://www.onetonline.org/ link/summary/29-1141.00

2. Talogy (2022). Reveal the potential in personality with 16pf®. https://www. talogy.com/en/talent-management-solutions/assessments/16pf-personalityassessment/

3. United States Department of Veterans Affairs (2009, November 9) What are KSAs?

4. KSAs Knowledge, Skill, Ability. https:// www.va.gov/JOBS/hiring/apply/ksa.asp

5. Weiner, J., Gray, G., Friedman, C. & Stobinski, J.X. (2017). [technical paper]. Assessing Non-Cognitive Competence. Institute for Credentialing Excellence, Research & Development Committee.

6. Weiner, J., (2022, February 4). The Increasing Importance of Noncognitive Competencies: Opportunities for Credentialing Assessment. The Institute for Credentialing Excellence. Credentialing Insights. https://www. credentialinginsights.org/Article/theincreasing-importance-of-noncognitivecompetencies-opportunities-for-credentialing-assessment-1

INDUSTRY INSIGHTS

ASCA

Assessing Medicare’s 2023 ASC Payment Policies

By bill prentice

S ince the first of January, ASCs and hospital outpatient departments (HOPDs) that provide care to Medicare patients have been operating under new payment rules the Centers for Medicare & Medicaid Services (CMS) finalized last November. Some of the provisions in the new rules help promote patient access to care in the ASC setting and help the Medicare program take advantage of the cost savings ASCs make possible. Others fall short of those goals.

expanding the patients’ options for obtaining the care they need.

Good News, Bad News

When it comes to procedures added to the ASC Covered Procedures List, there is good news and bad news for Medicare patients who want to take advantage of the many benefits ASCs provide. The good news is that CMS added four new procedures to this list:

• CPT 19307 (a mastectomy procedure)

• CPT 37193 (a transcatheteral procedure)

• CPT 38531 (an excision procedure on the lymph nodes)

HOPD updates are currently based on the hospital market basket, both received, on average, a 3.8 percent update (a hospital market basket increase of 4.1 percent reduced by a 0.3 percentage point productivity adjustment both entities are subject to at this time).

assert, however, that since data collection for this measure requires a burdensome collection process involving outreach to outside offices that are not under the direct control of the ASC and this measure involves data the physician, rather than the ASC, already collects and assesses over time, this measure should be removed from the ASC quality reporting program.

We also continue to question why the ASC and HOPD quality reporting programs still do not include more directly comparable outcomes measures that are reported in the same way to allow patients to make direct comparisons between the two sites of service.

What ASCs Can Do in 2023

on Capitol Hill in Washington, D.C., February 27-March 1, for National Advocacy Day – an event that will be in person for the first time in three years – please consider joining now. You can find more information on ASCA’s website or by contacting Maia Kunkel.

If you want to be involved but can’t make it into Washington, D.C., that week, consider conducting a facility tour for your members of Congress or your state and local officials. ASCA can help. Please contact Maia Kunkel to find out how.

There are two more ways you and your ASC can be involved:

please make sure to renew your ASCA membership in 2023. We cannot do the advocacy work we do on behalf of your ASC and the entire ASC community without our members’ support.

Expanding Access

One very positive development affecting patient access to care in ASCs is CMS’ decision to provide complexity adjustments for combinations of certain service codes and add-on procedure codes that are eligible for a complexity adjustment under the hospital outpatient prospective payment system (OPPS). While add-on codes do not receive additional reimbursement when packaged into primary codes, the addition of the add-on codes to a primary procedure code often changes the complexity and the cost of the procedure. This new policy bumps reimbursement for the procedure to a rate that better reflects the actual costs involved in providing all the procedures involved in the case, making it possible for ASCs to provide more of these services for Medicare patients and

• CPT 43774 (a laparoscopic bariatric procedure)

The bad news is that this short list means that CMS decided not to add 43 other procedures ASCA requested. Since those other procedures are being performed safely and successfully for privately insured patients, this decision means that Medicare beneficiaries who could have these procedures safely in an ASC are being denied that opportunity and forced, instead, to seek these services in higher-cost settings, costing the Medicare program and its beneficiaries more. ASCA will continue to reach out to CMS to discuss the rationale behind these decisions and ways to effect change.

The payment updates ASCs and HOPDs received for 2023 to account for inflation also contained some good news and some bad. Because ASC and

The good news is that the final rate was higher than the rate contained in the original proposal. The bad news is that this update falls far short of accounting for the rising costs ASCs are confronting in staffing, services and supplies. CMS needs to do more to support ASCs in confronting the rising costs of providing care or risk losing access to the many benefits ASCs offer, including outstanding patient outcomes and significant cost savings. ASCA will continue to talk with CMS about solutions.

Quality Reporting

ASCA and the ASC community continue to support CMS in its efforts to improve the ASC quality reporting program. We also support making both the ASC and HOPD programs more actionable for care providers, as minimally burdensome as possible and more useful to patients trying to select the best site of service for the outpatient surgical care they need. To that end, we commend CMS’ decision to suspend mandatory reporting for ASC11: Cataracts: Improvement in Patient’s Visual Function within 90 Days Following Cataract Surgery and keep the measure voluntary at this time. We continue to

If you work in or with an ASC and haven’t already made plans to join ASCA

Make sure your ASC is a member of ASCA. If you work in an ASC that is not already a member, please contact Mykal Cox for information and join today. If your ASC was an ASCA member in 2022,

Join ASCA in Louisville, Kentucky, for ASCA 2023, May 17-20, this year. There, you will have multiple opportunities to learn more about ASC advocacy and have access to 2½ days of top-quality education developed specifically for ASCs. You will also have formal and informal networking opportunities you can use to connect with your colleagues from across the country and learn how they are managing the many challenges confronting ASCs this year.

–

(ASCA).

Bill Prentice is the chief executive officer of the Ambulatory Surgery Center Association

analysis

Wound Care Market Expanding

Staff report

A Fortune Business Insights report is one of several predicting growth in the global wound care market over the next few years.

“The global wound care market is projected to grow from $18.51 billion in 2022 to $28.23 billion by 2029, exhibiting a CAGR of 6.2 percent,” according to the report.

According to a market research report published by P&S Intelligence, the advanced wound care market was worth around $8.05 billion, and it is predicted to advance at a 5.8 percent CAGR from 2021 to 2030, to hit $13.4 billion. This is because of the surging count of injuries due to surgery and other reasons including increasing cases of diabetes.

Advanced wound dressing accounts for the largest share, owing to the growing incidence of healthcare-related infections and surging awareness among the population of their effects. Moreover, the growing incidence of pressure ulcers, venous ulcers and diabetic ulcers is escalating the growth of the category.

The acute wounds category holds an over 55 percent share of the market, owing to the snowballing incidence of

road accidents. Additionally, the number of non-fatal injuries requiring appropriate medical care has increased recently around the world.

Further, because of the increasing prevalence of venous pressure ulcers and diabetic foot ulcers, the chronic wounds category is projected to grow at a higher CAGR, of around 5.9 percent, in the coming years. For instance, more than 2 million diabetics have foot ulcers in the U.S. annually.

With a market share exceeding 40 percent, hospitals led the market in 2021. This was because of the comprehensive care that patients with wounds receive from trained personnel in inpatient hospital facilities.

Moreover, due to the trend of home isolation brought on by the COVID-19 pandemic and surge in the senior population, the home healthcare category is predicted to register the highest rate of growth, of more than 6 percent, in the future.

In the past, North America held an over 43 percent share in the global advanced wound care market, driven by the growing elderly population and rising rates of obesity, diabetes, burns and motor vehicle accidents.

Halfway across earth, the aging

population, growing diabetes prevalence and rising burn cases are set to drive the product demand in APAC at the highest CAGR. In addition, the increase in the chronic illness prevalence brought on by the changing lifestyles is driving this growth in the region.

The “Advanced Wound Care Management Market – Growth, Trends, COVID-19 Impact, and Forecasts (2022 - 2027)” report from ResearchAndMarkets.com states that the advanced wound care management market is mainly driven by technological advances, ageing population, problems associated with ineffective traditional wound healing methods, initiatives taken by the government, and a pressing need for swift and safer treatment of chronic wounds.

In addition, benefits such as shorter hospital stays in order to reduce the surgical health care expenses and the growing inclination toward products that enhance therapeutic outcomes are also driving the demand for the advanced wound care management market. However, the high cost associated with the treatment and reimbursement issues for the new technologies serve as factors which hinder the market.

THE OR product focus

Applied Medical

Alexis Protectors and Systems

3M

V.A.C. Ulta Therapy System

3M V.A.C. Ulta Therapy System is an integrated wound management system that provides four separate and distinct wound treatment options in the convenience of one device: 3M V.A.C. Therapy, 3M Veraflo Therapy, 3M AbThera Therapy, and 3M Prevena Therapy. The 3M wound care portfolio includes innovations in negative pressure wound therapy, surgical incision management, advanced wound care and skin integrity. More than 2,000 peer-reviewed medical journal studies support the value of 3M negative pressure technology.

For more information, visit www.3m.com/npwt.

ADM

Surgical Draping

Avery Dennison Medical offers adhesivebased surgical draping solutions, including surgical drape tape, pouched drapes and incise films. The draping solutions are compatible with ETO and gamma sterilization methods. They are ideal for surgical products requiring bordering, construction and fenestration, and fixation applications. Solutions come in a range of patented adhesive technologies, including high-performance, gentle adhesive which adheres to skin and wet drapes for extended periods. The company also offers solutions for negative pressure wound therapy. In addition, Avery Dennison Medical BeneHold CHG antimicrobial adhesive technology is currently featured in a portfolio of IV cover dressings and post-operative dressings.

Applied Medical is commemorating 20 years of wound protection since the first Alexis wound protector-retractor was introduced. Over the last two decades, Alexis devices have protected 17 million wounds in over 75 countries. Alexis protectors are available in numerous configurations and used in a wide array of surgical specialties, including general, thoracic, colorectal, obstetric and gynecologic, among others. The full-line of Alexis protectors and systems includes Alexis wound protectorretractors, Alexis O C-section protector-retractors, Alexis orthopaedic protectors, Alexis laparoscopic systems and Alexis contained extraction systems.

For more information, visit appliedmedical.com/Products/Alexis.

DrySee Liquid Indicating Bandages

DrySee, a medical technology company dedicated to improving wound care, created the first patented wound dressing that will change colors to indicate it should be changed. DrySee was the focus of a new clinical study published in the September issue of Journal of Wound Care DrySee wound coverings have many uses, but the study was acutely focused on the potential to reduce surgical site infections (SSIs). According to the CDC, SSIs have an estimated annual cost of $3.3 billion and they are the leading cause of rehospitalization following a surgery. DrySee’s liquid indicating, waterproof bandages provide a secure, waterproof covering for low exudate wounds. If water or other liquids make their way into the bandage, the gauze barrier around the perimeter of the bandage will turn from a light blue to a dark blue color. The color change alerts the user to change the bandage, knowing that the perimeter seal is broken. If liquid passes through the second adhesive ring and reaches the wound site, or if the

wound seeps fluid or exudate, the internal gauze pad will turn a dark blue color, alerting that a bandage change is necessary. DrySee liquid indicating bandages are waterproof, sterile, disposable, breathable, non-latex, made in the USA, and are available in three sizes.

For more information, visit www.drysee.com.

ADAPTING TO THE EVOLVING SURGICAL ENVIRONMENT

Innovative Medical Products

he orthopedic healthcare industry is moving forward on an everchanging course, challenging sterile processing logistics in facilities performing orthopedic procedures for the first time, while also experiencing expanded adoption of advanced robotic technology in operating rooms around the globe. Specializing in patient positioning devices for surgery, Innovative Medical Products, Inc., covers all these advancements. The positioning equipment that IMP manufactures provides another “pair of hands” to increase efficiency and convenience for the surgeon and surgical team.

Innovating to Support Orthopedic Service Lines

Many ASCs and outpatient clinics report that the smaller autoclaves, limited storage space and smaller soak sinks present a variety of logistical and sterile processing challenges. While outpatient facilities are insisting on maintaining consistency in training and how they approach procedures, they need a new solution to overcome the limited resources in smaller facilities.

The De Mayo Adapt2Fit™ Modular Knee Positioner, which solves these pain points with a twopiece baseplate that quickly separates the positioner down to half of its overall length, has created an instant impact in the OR, creating several advantages for the surgeon and their facility.

When stored in its standard ster-

ilization tray, the resulting smaller footprint allows the positioner to fit in smaller autoclaves typically found at Outpatient Centers. When disassembled, the Adapt2Fit’s reduced size also allows it to be fully submerged in standard sinks and cleaning vessels in a single pass, saving SPD valuable time.

In order to accommodate longer legs and overcoming space con -

straints, IMP’s engineers designed the Adapt2Fit to be the longest positioner on the market when assembled. The end result is that the Adapt2Fit is a full 2-7” longer than previous models. The increased length provides more surface area for full flexion and extension without moving the baseplate.

of the challenge. This idea made the De Mayo Knee Positioner® the market-leading positioner used in orthopedic ORs today.

For years IMP has included a distractor block on the posterior side of the aluminum boot with the De Mayo Knee Positioners that enables a surgeon to install the IMP De Mayo Universal Distractor® between the lower calf and the patient’s thigh above the knee while flexing to approximately 90 degrees. A hand lever on the distractor enables a surgeon to apply force from the boot’s distractor block, approximating the tibia, through a patented patient protective pad approximating the distal femur. The resulting controlled extra-articular distraction force moves the femur away from the tibia, improving visibility into the joint during surgery.

structive hip surgery was traditionally accomplished using various positioning aids, from bean bags to pegboards to rigid clamping frames using experience as the guide. In 1984, Innovative Medical Products became the gold standard with their original IMP McGuire Hip Positioner, many of which are still in use today. In 2001, IMP improved hip positioner stability by partnering with orthopedic surgeon Ed De Mayo, MD. He invented the De Mayo Hip Positioner® as advanced technology began to support implant placement accuracy in total hip procedures.

IMP felt initial scientific data was needed to better understand how rigid positioners behave to stabilize the pelvis and correctly match the positioner to the surgeon’s procedure objective.

Adapt2Fit® included Sterilization Tray

Robotic Surgery Requires Improved Limb Stability and Access to the Knee Joint

The introduction of robotic-assisted surgery in knee replacement continues to increase the value of the De Mayo Knee Positioner to increase limb stability during a total knee procedure, being used with systems from companies such as Stryker, Zimmer Biomet, Smith + Nephew, and CUREXO.

Holding the leg in a fixed position in a total knee procedure had always required a second set of hands to assist the surgeon until IMP developed a knee positioner capable

In the traditional use of the De Mayo Knee Positioner®, the boot secures motion of the ankle, leaving two joint locations where movement can produce limb instability. This instability would then affect the navigation system used to determine the robot’s movement during bone resections, the knee, and the hip joints. Initial research at IMP, in collaboration with a valued business partner, has demonstrated that the use of the De Mayo Universal Distractor reduces varus/valgus swing at the knee to better isolate movement at the hip joint. The De Mayo Knee Positioner used in conjunction with the De Mayo Universal Distractor effectively stabilizes the leg to improve the robot’s efficiency during surgery.

REDefining Rigid Patient Positioning

in Total Hip Reconstruction

Patient positioning during recon -

While in the early stages of development, IMP brought its lateral positioner to St. Mary’s Medical Center in San Francisco, California, for further research. It concluded that minimizing pelvic rotation, an objective thought to improve implant accuracy during total hip procedures, is directly influenced by the positioning device used during surgery.

IMP’s newest lateral positioner,

Shown: De Mayo Adapt2Fit™ Modular Knee Positioner

De Mayo Universal Distractor®

Adapt2Fit® vs. previous IMP De Mayo models.

the Exact-Fit® De Mayo Lateral Positioner®, delivered the best pelvic stability when compared to existing options.

assuring that they meet AORN and AAMI standards for using the manufacturer’s recommended pad as defined in the IFU.

Customer Valued Products Remains the imp Focus

MVP: IMP’s Value Added Commitment

Transforms into the Most Valued Partnership

As part of IMP’s shared commitment to its customers, Orthopedic facilities will now be able to gain special access to IMP’s premiere partnership level service and support by using genuine IMP patient protective pads for

each procedure.

MVP, otherwise referred to as “Most Valuable Partner,” is a new program that helps facilities maximize their initial investment. Perks like discounted or complimentary upgrades, complimentary service loaners, repair exchanges for out-of-spec hardware, and even on-site service are just a few of the perks that facility administrators will find helps protect the initial investment’s value.

IMP’s patient protective pads have been extensively tested during clinical trials to provide maximum patient protection from pressure sores and ulcers. By consistently using IMP’s premium patient protective pads, like their proprietary gel-infused memory foam pads, orthopedic healthcare providers may reduce liability by

IMP’s vision for success has always been to collaborate with customers to design, manufacture, and distribute unique, innovative products where surgical patient positioning or supporting logistics has been problematic.

IMP’s solutions to universal positioning problems come from years of collaboration with busy orthopedic surgeons, marketleading orthopedic companies, and hands-on med/surg support teams. Ideas have been shared for product improvements with perceptive opinions on improving patient positioning in the surgical environment. Having completed ISO 13485 registration successfully in 2021 to expand IMP’s products outside of the US, the company is now supporting surgeries in new global markets and the rapidly growing outpatient facility network in the US.

For more information, please visit www.IMPmedical.com.

Exact-Fit®

De Mayo Lateral Positioner®

eliminates the presence of lint and fibers in the operating room, which are identified as contributing to *Please

MACHINE LEARNING IN THE OR

BY DON SADLER

Technology

advancements in the 21st century have transformed practically every industry, including health care. These advancements include machine learning (ML) and artificial intelligence (AI).

“Operating rooms today are becoming a high-tech discipline and things like machine learning and artificial intelligence are no longer abstract ideas or hypothetical applications,” says David Taylor, MSN, RN, CNOR, president of Resolute Advisory Group LLC. “They are empowering tools that can give ORs across the country advantages that they never imagined.”

“Using machine learning and artificial intelligence can help OR managers go from a reactive to a proactive approach,” adds Beverly Kirchner, BSN, RN, CNOR, CNAMB.

Orthopedic and Interventional Procedures

Machine learning in the OR is currently being used in hard tissue procedures such as hips, knees and spine, while some augmented intelligence-based technologies are used in interventional procedures, says Anthony Fernando, president and CEO of Asensus Surgical.

Fernando distinguishes between artificial intelligence and augmented intelligence: “Artificial intelligence describes algorithms that are capable of making intelligent decisions, while augmented intelligence is designed to enhance, not replace, human intelligence.”

Lots of different variables come into play when it comes to using machine learning and AI in the operating room. “Every patient is different and surgeons and perioperative team members have different skill sets,” says Fernando. “Machine learning and AI bring consistency and reduce variability, which leads to better surgical outcomes.”

Modern operating rooms use digital and interconnected equipment and advanced imaging and robotic procedures.

“Each of these produces data,” says Taylor, “resulting in a huge potential to improve patient therapies and surgical outcomes by means of machine learning and artificial intelligence.”

Taylor believes that machine learning empowers health care organizations to make sense of their data with purpose. “It can be leveraged to analyze large volumes, variety and velocity of data while supporting evidence-based decisionmaking in hopes of reducing medical errors and improving care coordination,” he says.

“When integrated properly, machine learning and artificial intelligence will accelerate the pace of innovation and improve efficiency in the perioperative environment,” Taylor adds.

Practical Uses in the OR

There are many practical ways that ML and AI are being used in operating rooms and ambulatory surgery centers (ASCs), starting with scheduling. “Machine learning and artificial intelligence use algorithms to staff the OR, which lowers perioperative costs,” says Kirchner.

“Artificial intelligence and machine learning can optimize OR slots based on the procedure performed and the time and length of the procedure,” says Francisco Rodríguez-Campos, MSc, Ph.D., MRSO (MRSC), principal project officer, device evaluation team at ECRI. “They can also predict patient outcomes and discharges based on optimization of surgical scheduling, which may improve OR utilization.”

Chad Ramos, the CEO of Privado Health, says that OR scheduler software uses AI to analyze upcoming cases and create the most optimal staff schedules.

“Using artificial intelligence to optimize OR utilization and block time management is one of the best use cases for AI in an ASC,” he says. “It’s a no brainer if a facility has enough cases to justify it.”

“Things can get quite complicated when you have more than three or four operating rooms, especially when the facility is busy,” adds Ramos. “Utilizing the OR scheduler can reduce valuable OR manager time that can be devoted to patient care, providing an immediate return on investment.”

“Instead of using complicated spreadsheets, we can pull and analyze data from electronic medical records such as block utilization, which will help control block schedules and eliminate large gaps in the surgery schedule,” says Kirchner. “The data can be used to predict staffing for all shifts so you are not understaffed or overstaffed.”

A study led by Rodney A. Gabriel, MD, MAS, aimed to develop machine learning models that predicted outpatient surgery end times and recovery room discharge times at a freestanding academic ASC. Or in other words, whether surgeries would be finished by the end of surgical block time and whether patients would be discharged by the end of the recovery room nursing shift.

The study demonstrated improvement in predicting the outcome at a range of start times when using various machine learning algorithms versus regression techniques. “Machine learning may be adapted by operating room management to allow for a better

determination of whether an add-on case at an outpatient surgery center could be appropriately booked,” says Gabriel.

Gabriel believes that the utilization of machine learning to aid in OR management has much potential for ASC managers in an effort to improve efficiency and patient outcomes. “Various studies have demonstrated improvement in case duration accuracy, cancelation prevention and recovery room management,” he says.

Taylor agrees, noting that the postanesthesia care unit (PACU) often becomes a bottleneck. “If the PACU reaches capacity, subsequent procedures are delayed or patients who are already in the OR must wait until PACU space becomes available,” he says. “As a result, the OR is delayed, or even worse, there are possible cancellations for subsequent procedures.

“Machine learning algorithms result in the highest predictive capabilities, which enables them to improve scheduling by predicting case duration estimations,” Taylor adds. “This improves OR efficiency while also reducing costs.”

Machine Learning and Robotics

Kirchner lists a few more potential uses of ML and AI in operating rooms and ASCs. “Robots use a form of machine learning to assist in neuro and orthopedic surgery,” she says. “The robot can be programmed to take specific actions, but it can also learn to do new tasks through machine learning and artificial intelligence. X-rays can also be read in real time using AI.”

Ramos and his team at Privado Health are using AI to predict what materials need to be ordered and when to ensure that they have proper stock levels of implantable items and other materials on hand without spending too much on shipping or overloading precious storage space.

“We are using case scheduling, stock level, preference card and vendor data to calculate what, when and how much we should order,” says Ramos.

ASCs and hospitals can also use AI to examine OR utilization rates and

shift volume, reallocate resources and optimize OR block time with predictive analytics. “This is a huge area of benefit that most ASCs are not taking advantage of yet,” says Ramos.

Scott Jackson, vice president of surgical solutions for Henry Schein, encourages ASC operators to investigate what ML and AI solutions are available on the market.

“Pay especially close attention to AI systems that can assist with block scheduling, OR optimization, staff utilization and supply ordering,” says Jackson. “These are all very important areas for ASCs to manage and there are AI systems available that address each of these areas.”

Benefits of Using ML and AI in the OR Ramos points to cost savings as one of the biggest benefits of using ML and AI in the perioperative setting. “ASCs are running on razor thin margins so they need to be hyper aware of the money they spend on labor, supplies, patient communication and just about every area of the business,” he says.

Using ML and AI also gives back precious time that nurses and other staff desperately need for patient care. “Burnout is real, so anything that can help reduce the workload is not only welcomed but should be prioritized,” says Ramos.

“A key benefit in any health care application of AI is that for diagnosis and treatment planning, it removes bias and promotes standardization and consistency,” says Bruce Lieberthal, vice president and chief innovation officer for Henry Schein.

Fernando concurs.

“It’s all about standardization and consistency,” he says. “For example, you know that a gall bladder surgery should take 20 minutes if you follow certain procedures. Surgeons and team members can plan their workflow better, which gives everyone greater peace of mind and reduces cognitive fatigue.”

“In short, machine learning and artificial intelligence decrease costs and improve patient outcomes,” says Kirchner. “They have also been shown in research to improve knowledge retention

among perioperative staff and boost team engagement.”

Reducing waste is another big benefit of using machine learning and artificial intelligence in the perioperative setting.

“At Privado Health, we use artificial intelligence and machine learning to identify opportunities to reduce wasted supplies and time by digging into surgeons’ preference cards,” says Ramos. “These preferences are often outdated and incorrect so things are being opened that should not be.”

In addition, using ML and AI automates manual tasks that perioperative nurses no longer have to perform.

“We are facing a massive nurse shortage in this country and a lot of the tasks nurses are asked to perform, like staff scheduling and material management, can and should be done by software and algorithms,” says Ramos.

Fernando uses a driving analogy to illustrate what he believes is one of the biggest benefits of using ML and AI in the OR.

“For surgeons it’s kind of like having lane assist or a backup camera in your car,” he says. “Having a historical lookup for a case increases surgeons’ confidence so they can worry less about making a mistake.”

Success Tips for ML and AI Implementation

Ramos recommends that health care organizations start by taking a fresh look at all of the perioperative processes they are currently following. “If you’re doing things the same way you have

for the past couple of years, there’s a good chance you aren’t doing them as efficiently as you could be,” he says.

These processes include case and staff scheduling, case costing, patient communication, material management and revenue cycle management.

“Each of these areas has legitimate AI uses that already exist,” says Ramos. “Look at the options and how AI can be added to existing processes to make things run smoother and take the burden off staff. They will be thankful of this and ASCs will see it in their bottom line.”

“To have a successful implementation, data needs to be standardized as well as the metrics that will be used to determine the success of the scheduling,” says Rodríguez-Campos. “Such metrics might be interpreted differently across different institutions.”

Kirchner has two words of advice when it comes to implementing ML and AI in the OR: “Educate and communicate,” she says. “Always be transparent with your team.”

Taylor stresses the importance of training perioperative staff in the use of machine learning and artificial intelligence. “OR staff are not machines and unless they are integrated, trained and managed as part of the process, both AI and ML could be compromised,” he says.

“Perioperative staff needs to embrace the technology,” adds Kirchner. “However, older staff may not embrace ML and AI as quickly as younger team member who have

grown up with digital technology.”

According to Taylor, perioperative nurses and nurse leaders are not being included in the development of machine learning algorithms. “As a result, technology that is being created to improve OR efficiency may not be useable for all members of the surgical team,” he says.Therefore, Taylor recommends that perioperative nurses and nurse leaders be co-creators, as well as implementers, of machine learning and artificial intelligence technology.

Overcoming Surgeon Hesitation

One of the biggest potential obstacles to widespread use of ML and AI in the perioperative setting is hesitation by some surgeons to try out the new technology.

“It’s going to take a little while for surgeons to trust the technology,” says Fernando. “The use of machine learning in the OR is relatively new so we need to give it a little time. Remember, we’re talking about patients’ lives.”

Fernando encourages surgeons who are hesitant to give the technology a try. “They can always override or ignore suggestions so it really doesn’t hurt anything to try it out,” he says. “I recommend a crawl, walk, run approach.”

There is currently tremendous untapped potential for the use of ML and AI in the perioperative setting. “Right now, surgery is one of the most underutilized areas for this kind of technology,” says Fernando. “So, the sky is the limit going forward.”

AnTHONY Fernando Bruce Lieberthal Francisco Rodriguez-Campos

Chad Ramos Scott Jackson

SPOTLIGHT ON: ROBERT MILLER

By Matt Skoufalos

today have become incredibly complex; it’s wonderful that it’s helping produce great patient care outcomes.”

rectly not only demand significant time and planning, but competency of staff who are doing it in today’s environment.”

Patients

served at St. Joseph’s Hospital and Medical Center in downtown Phoenix, Arizona, a 586-bed Level I trauma center with 36 operating rooms and four GI procedure rooms, rely upon the facility for a number of services. At the heart of its surgical lines are services ranging from gynecological, colorectal, and orthopedic procedures to neurosurgery, cardiovascular/thoracic, transplants, and robotics. Underpinning the OR teams that perform those duties is a sterile processing unit headed up by Robby Miller.

Miller’s role as manager of the sterile processing department includes oversight of medical device reprocessing on campus, including sterilization and high-level disinfection. As a subject matter expert in medical device reprocessing, he also co-chairs several councils within the CommonSpirit Health enterprise, the second-largest nonprofit hospital system in the United States.

For all his expertise in the field, Miller describes his entry into it as incidental to his pursuit of a career in firefighting. In pushing towards that goal, he became

an EMT while working at St. Joseph’s Hospital as a patient transporter. After a time, Miller transferred into sterile processing as a technician, learning the trade as he continued. His growing enjoyment of sterile processing soon diverted his focus, especially against the backdrop of dramatic competition in the career of fire service.

“I was working here as a technician and fell in love with the work, its impact on patient care, and what we do as far as process,” Miller said. “With hard work, commitment to becoming certified and a health administration degree, I got promoted into a supervisory role, and then a management role, and just stayed here. Twenty-five years later, I’m still here enjoying my work and have a great passion for what I do.”

“Ultimately, it was just about the passion, the people and the work,” he said. “Sterile processing is an unknown role in health care; there’s not a huge awareness of what it takes to keep an operating room going from an instrument processing perspective. This is where I belong, and this is where I’ve stayed. I continued to advance my skill set, sustain my commitment to learning, education, and knowledge; and support my personal patient advocacy by sharing my knowledge with my colleagues and others in my industry.”

Miller’s passion for instrument processing led to his continued expertise in the field and the length of his career in it. Throughout that time, he’s observed how sterile processing has gained in significance, even within the health care space. Awareness of patient safety, risk levels and the impact of sterile processing on patient care outcomes have all gained traction even in the past decade, he said. Miller believes this is partly because of nationally reported adverse events associated with reprocessing medical devices, which has resulted in increased attention from accreditation surveyors; and partly because of standards developed by and with federal regulatory bodies, from the FDA, CDC and OSHA, as well as with the insight of professional surgical specialty associations like AORN and AAMI.

“The world that we’re working in today is geared towards preparing invasive devices to be safe for use on patients,” Miller said. “A vast majority of devices used in surgery are reused from one patient to the next. It’s very important that they’re taken care of in accordance with manufacturer’s instructions for use. The regulatory bodies out there are really coming into alignment, but also providing much more clear guidance on what’s appropriate and what’s not appropriate as far as keeping patients safe. Invasive medical devices and instruments used

However, as technologies are developed and surgical devices become more complex, so too do the procedures for reprocessing them. Evolving standards offer meaningful clarity on how the expanding functions of surgical technology and surgical reprocessing technology offer additional possibilities for its application and management. Some of the most significant challenges are related to understanding the complexity of the devices and the various processes required to reprocess a contaminated instrument before it’s safe to be used on the next patient.

“The technologies and processes we’re using in sterile processing units are incredibly complex, as are the documentation that’s necessary for sterilization and high-level disinfection,” Miller said. “I’ve heard it a number of times in my career that we’re ‘washing dishes.’ These devices are a lot more complex than washing dishes. The regulatory focus and the risk associated with not doing it cor-

Developing staff competency requires continuous and ongoing education ranging from professional certifications to compliance with state and federal laws. For those reasons, Miller describes sterile processing as a career profession that requires a passion for working in perioperative services, sharp critical thinking skills, and an ability to confer with professionals in roles from technicians to providers.

“We’re one group working to provide care to our patients, and we’ve got to work together to be successful at it,” Miller said; “managing start times, turnover times, having instruments available, having enough assets on hand to meet the demands of the schedule. We’ve got to have instruments present to successfully perform the procedure that the patient needs.”

For sterile processing departments to continue to grow and develop in the future, Miller believes they need support to grow technologically as well as profes-

sionally. In the aftermath of the novel coronavirus (COVID-19) pandemic, staffing is at a premium, and recruitment and retention remain among the top challenges for departments of all stripes and sizes, including sterile processing.

“I think the biggest thing SPDs need to advance their departments is technology,” Miller said. “You need to be deploying tracking systems, tracking equipment, adequate automated equipment; you need steam and low-temp modalities for sterilization. And we really need to recruit talent in the field. Adapting to the rapid evolution of health care when it comes to technology itself impacts all of us in being prepared to manage that technology, keep it patient-ready and patient-safe. These are going to be enormous challenges in this landscape.”

When he’s not at work, Miller enjoys playing competitive baseball as an infielder with the Arizona Astros of the Arizona Premier League. He also enjoys spending time with his family in the outdoors, traveling, fishing, hiking and camping in Arizona Rim Country.

By Family Features

There isn’t a better time than now to start getting fit with health information and products so easily accessible. Simply incorporate the basics into your daily routine – good nutrition, adequate exercise and a daily supplement – and start down the path toward better health.

• The remaining one-fourth of your plate should be lean or low-fat cuts of meat, plant-based protein or seafood.

Get Regular Exercise

The Department of Health and Human Services recommends an adequate amount of exercise every day. This guide can point to the right amount of exercise to add to your schedule:

Plan a Nutritious Diet

The Dietary Guidelines for Americans describes a healthy diet as one that emphasizes fruits, vegetables, lean meats, poultry, fish, beans, eggs, nuts, whole grains and fat-free or low-fat milk products. It should be low in saturated fat, trans fat, cholesterol, salt and added sugar.

• Warm weather makes fresh produce more easily accessible. Eat more fruits and vegetables by setting freshly washed and prepared produce on the kitchen counter or at eye level in the fridge. At every meal, make sure half your plate is made up of fruit and vegetable servings.

• One-fourth of your plate at every meal should be made up of grains, such as wheat, rice, oats, cornmeal or barley. People who eat whole grains as part of a healthy diet have a reduced risk of some chronic diseases.

• Get at least 150 minutes of moderate aerobic activity every week. For best results, spread the time out over several days.

• Do strength training exercises at least twice a week. Lifting weights builds muscle, which means the body burns more calories – even at rest.

• It’s important to keep in mind that when people are active, they produce more free radicals. The antioxidants found in supplements can help buffer the negative effects of the workout.

Improving your diet, exercising regularly, taking a daily supplement and getting enough restorative sleep are all important steps to overall wellness. Work to incorporate each step into your daily routine until you reach your goal of good health, and find more healthconscious tips at eLivingToday.com.

Discipline Over Motivation

By Miguel J. Ortiz

T here is no such thing as a bad workout, because the only bad workout is the one you didn’t do. This is the exact reason why discipline is more important than motivation.

Discipline will drive a sense of consistency and that is important considering that the majority of people’s goals are focused on longevity, quality health and vitality.

Motivation comes and goes, sometimes driven from within, sometimes being needed from external sources. Motivation can be fleeting and trying to rely on that isn’t a great plan.

Discipline is the quality that gets the job done even when we don’t want to. Now, understandably, there are a lot of things that can get in the way. Life has a unique way of throwing a curve ball. Nonetheless, we need to be prepared. Here are three exercises for a rainy day or for when you just don’t feel like working out. Knock out these movements for a solid workout to ensure you stay active.

The first thing we need to understand is how much time we have because what I’m about to suggest will take 15 to 20 minutes of work with appropriate rest included. So, the point is you can make this as long as you’d like, or you can use this workout simply to help get moving and maybe do additional exercises after. We want to

focus on getting the body moving.

The first exercise is the Goblet Squat. This movement is crucial for overall leg and core development and can be easily manipulated for progression. For example, if the current weight you have at home is a little light, or you are timid to increase your weight but want more of a challenge, try focusing on your tempo. Give me 3 seconds down, 2 second pause at the bottom, then drive up and repeat. What you’ll notice is that the exercise will take longer to complete and you’ll naturally be more focused on breathing because of the core bracing.

The second exercise is a Kickstand RDL & DB Row. This movement is great because it focuses on working one hip at a time with some assistance. It adds to the core focus because of the balance and offset weight. It also provides great upper body strength when preforming the row. This isn’t a exercise that you initially want to be super heavy with because of the core balance needed. There is a time and place for heavier lifting. It your are using this workout to wake you up and just get moving it is best to keep the weight challenging enough for your hips and core to handle, but also strong enough for the upper body pull during the row.

Our last movement is another total body focus with some mobility. However, it can absolutely be a strength movement depending on how

fast you continue to move through the exercise. The Downward dog, wave unload & Cobra flow is great because it can help you continue to load the legs, core and shoulders while also loosening up the spine as you unload the weight from the legs into your upper body. I put this exercise last to show that it can still be done with the intention of strength. For example, if you never let your knees or hips hit the ground your shoulders and upper body will go through more strength work. You could also slow this movement down and maybe do it first to start to loosen up if you decide to linger through the different phases of the exercise to provide more of a stretch. Either way you have some options.

Have fun with these movements and remember to stay disciplined this year. If you don’t want to work out for an hour, all good, just knock out the above for 15 minutes and call it a day.

The only bad workout is the one you didn’t do, stay consistently active and let’s make it a great year for quality change.

- Miguel J. Ortiz is a personal trainer in Atlanta, Georgia. He is a Master Trainer for Pain-Free Performance and a Certified Nutritional Consultant with more than a decade of professional experience. He can be found on Instagram at @migueljortiz. You can find videos of the exercises mentioned in this column on his YouTube channel at tinyurl.com/ORTfitness.

OUT OF THE OR EQ Factor

By Daniel Bobinski

A lmost everyone has heard that cooperation is necessary for a workplace to function well. People on teams work better when individual team members are assisting each other. And if we take a broader view, teams are more productive when they collaborate with other teams. Can it get any better than that? If we proactively look for ways to capitalize on our differences, the answer is yes.

Let’s start by discussing what we can do in urgent situations. Imagine that work projects have been coming at you from all angles and suddenly you find your plate is overflowing. You might look at the workload and realize there’s no way you’ll be able to accomplish everything that is required in the time window available. Our prioritizing skills are helpful in such circumstances, but if you’re on a team, you can ask people for help. Here’s where it’s beneficial to know the strengths and blind spots of each person on your team, as you can create better and faster results if you ask people to help in their areas of strength.

Cross-training is beneficial, but in crunch time, we’ll get faster and better results if we ask someone mechanically inclined to assemble a piece of equipment and ask

an analytical person to rectify a billing problem.

A phrase foundational to this basic idea is “value the differences,” but I want to underscore that this way of thinking is a choice. Everyone has strengths and everyone has weaknesses, which I tend to call blind spots. An effective and efficient workplace is much more likely to occur when people are working in their areas of strength.

Naturally, everyone has their own unique set of strengths and blind spots. The thing to remember is that each strength has a corresponding weakness, and if we start focusing on people’s weaknesses instead of their strengths, we weaken our team overall. Another way to look at this is we should be valuing differences instead of criticizing them.

Think about making a hiring decision. We often chose people to work on our teams because of their strengths. But as I said, every strength has a corresponding weakness. If we stop valuing the strengths and start criticizing the weaknesses, we’re creating division, not unity. It’s imperative for solid teamwork and optimal productivity – as well as everyone feeling respected, appreciated and engaged – that we value the differences and adapt to them.

But to really optimize a workplace, we can choose to capitalize on the

differences. This is part of what Stephen Covey meant in Habit 6 of his book, “The 7 Habits of Highly Effective People.” Covey names Habit 6 “Synergize,” and unfortunately, it’s become somewhat of a nebulous buzzword at corporate meetings. In practice, I see two important facets to synergizing. One is a valuable key to successful conflict resolution (which I will address in this space next month), and the other is what I’ve described above: proactively capitalizing on the different strengths people bring to the table.

It’s one thing to work alongside someone and help each other when asked, but we reach an entirely different level when we actively seek ways to capitalize on others’ strengths. The whole really can be greater than the sum of its parts.

Daniel Bobinski, who has a doctorate in theology, is a bestselling author and a popular speaker at conferences and retreats. For more than 30 years he’s been working with teams and individuals (1:1 coaching) to help them achieve excellence. He was also teaching Emotional Intelligence since before it was a thing. Reach him by email at DanielBobinski@ protonmail.com or 208-375-7606.

It’s a New Year and Time to Detox!

By grace o

W hen I was growing up, my aunt taught me the value of cleansing my body of toxic substances to prevent illness and help in the healing process. So, for me, detoxing is second nature. I do understand, however, that some people are skeptical of the concept of detoxifying.

The sheer number of products on the market claiming to miraculously detox your body doesn’t inspire confidence. I can help you detox without those packaged teas or harsh drinks.

You see, your body detoxifies itself daily. Your liver is working constantly to clean your system. It uses compounds from the foods

you eat to turn toxins into less harmful substances that can then be safely excreted. Because of poor diets and environmental pollutants, most of us can benefit from a little help with this detoxification process. Once every few months, or whenever I’m not feeling well, I go on a detoxification regimen. I like to cleanse my whole system through herb-spiked liquids and healing foods.

Occasionally, I go on a master cleanse – a multi-day regimen of drinking nothing but water spiked with lemon juice, maple syrup and cayenne pepper. It cleans out my colon and helps me lose weight. The lemon juice contains vitamin C – one of many antiaging properties I call FoodTrients – which transforms toxins into

water-soluble agents that can be easily flushed out.

Vitamin C, found in all citrus fruits, also gives the liver a boost and jump-starts the digestive tract. Maple syrup helps keep my blood sugar from completely crashing. And cayenne pepper helps cleanse the bowel, kill bacteria and encourage sweating. I don’t recommend it to everyone. It’s rather harsh and headaches can result from allowing your blood sugar to get so low.

Another naturally cleansing spice is turmeric, a member of the ginger family. Turmeric is a source of the FoodTrient curcumin, which helps prevent disease through its anti-inflammatory and antioxidant properties. You can make turmeric juice from turmeric root, and then

Detox Juice

INGREDIENTS:

• 1 cup watercress (or 2 Tbsp. spirulina powder)

• 4 beets (peel on) stem and root removed, cut in pieces

• 4 oranges (peel on) cut in pieces

• 2 Tbs. fiber powder

• 8 oz. water

mix it with orange juice for extra Vitamin C – and detoxifying –benefits. My easy Fresh Turmeric Juice recipe shows you how.

Certain foods can also help your body rid itself of unwanted chemicals. I’ve already mentioned the power of citrus fruits. Garlic, like citrus, helps the liver produce detoxifying enzymes. Okra is known for its ability to flush out the intestines.

Chia seeds and flaxseeds have a similar bowel-cleansing effect because they are loaded with natural fiber and omega-3 fatty acids – two other FoodTrients –that absorb toxins in the intestinal tract and help eliminate them from the body. I like to soak chia seeds in water for 20 minutes and then add them to juice or iced tea to make Chia Frescas. Drinking a chia-laced beverage three times a day can really help stabilize blood sugar and bring down cholesterol levels.

Bitter melon has a similar effect on blood sugar and cholesterol. Chinese herbalists have been prescribing it for centuries. I soak bitter melon in salted water to make it more palatable. Then I toss it with vinegar for a cleansing Bitter Melon Salad.

PROCEDURE

1. Place watercress, beets, and oranges in a juicer.

2. Stir the fiber powder into the water until it dissolves completely.

3. Mix the fiber water into the juice

SOURCE: Age Gracefully Cookbook by Grace O

Fresh watercress, cilantro and parsley are good for detoxifying the kidneys and liver because they contain the FoodTrient chlorophyll, which also helps protect against certain cancers. Cilantro can even pull metals like mercury, lead and aluminum out of the body. Almost every salad can benefit from a handful of fresh raw watercress, cilantro and/or parsley. My Detox Juice recipe takes advantage of the power of watercress and/or spirulina powder blended with healthy beets and vitamin-C-rich oranges. Wheatgrass juice is full of detoxifying chlorophyll also. The next time you stop by a juice bar, be sure to add a shot of wheatgrass juice to your order.

Artichokes and hops (found in beer) are good detox agents as well. Artichokes increase bile production, helping both the gall bladder and the liver do their jobs. Hops act as a diuretic, pulling water-soluble toxins out of the body. A grilled artichoke with a glass of beer makes a nice hearty detoxifying snack.

Pure water may be the ultimate detoxifying flush for kidneys, liver, lung and bowels. Green tea is also excellent. The catechins in green tea are great for helping the liver

work and for purifying the blood. Whether you make your green tea hot or cold, use clean, fresh water. Liquids definitely help pull poisons out of the body, so be sure to drink plenty of them.

Going into the new year, incorporate these simple ways to naturally cleanse your body. Be sure to eat whole foods that are free of pesticides and preservatives – they help promote a healthier you all year long!

– Grace O is the creator of FoodTrients, a unique program for optimizing wellness and longevity. She is the author of three awardwinning cookbooks. Her latest cookbook is “Anti-Aging Dishes from Around the World.” Recipes mentioned in this column can be found at FoodTrients.com.

involved.

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