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The Sahlgrenska University Hospital Multidisciplinary Hybrid Room due to their efforts that the hybrid OR has had such a successful start. The pilot hybrid OR was originally one operating theater and two adjacent rooms that were combined to make a 100 square meter room. The Artis zeego and Siemens OR table were installed diagonal to the walls so that in the most common working position (table at 15˚ to patient’s right, Artis zeego from patient’s left) the table is parallel to the walls and the anesthetists have the maximum amount of space at the patient’s head. Two large displays on both sides of the tables and two additional monitors on each side of the room were positioned so that all staff have an optimal view on the intraoperative and preoperative images as well as the vital parameters. A laminar airflow field providing the highest hygienic standards was installed along with additional ambilight function for a better contrast on the monitor displays. Team Work from the Beginning Before the installation of the Artis zeego, SUH created an OR education group headed by Christina Ekroth who has a background as an OR nurse. In a two year collaboration between Siemens and the hospital an education plan was produced. This had the aim of introducing the different groups (assistants, nurses, interventionalists and anesthetists) to the hybrid room concept and the advantages for their patients. Ekroth, Dr. Roos and Dr. Zachrisson all stress that training and communication are both key to a smooth hybrid OR beginning. Ekroth recommends having a vision of what you want to achieve and clear your mind of preconceptions about workflow. “Working in a hybrid room is challenging and requires you to adapt and be Sahlgrenska University Hospital is one of six teaching hospitals in Sweden. It provides specialized care for the 1.7 million inhabitants of West Sweden and basic care for the 700,000 inhabitants of the Gothenburg region. AXIOM Innovations spent 3 days with the team observing cases and talking about their multidisciplinary experience. The Gothenburg multidisciplinary journey began in approximately 1996 when the vascular surgeons of that time recognized the benefits of a hybrid operating room. This idea started to become more concrete in the early 2000s when Sahlgrenska University Hospital (SUH) envisaged a new interventional imaging building with some rooms earmarked as hybrid OR. With traditional Scandinavian planning and attention to detail, it was decided to make a comparatively small investment and install an Artis zeego in the established operating theater complex so they could understand the process, learn from the experience and limit the mistakes in their new multi-lab installation. In this pilot hybrid lab, over the past two years nurses, cardiologists, vascular surgeons, spine surgeons, interventional radiologists, and anesthetists have evolved their workflows and communication to work in harmony. Planning the Pilot Hybrid Operating Room As soon as the multi hybrid lab proposal became more than just a dream, Karin Zachrisson, doctor of interventional radiology, and Håkan Roos, doctor of vascular surgery at Sahlgrenska University Hospital, wanted to work together to ensure the needs of both vascular surgery and interventional radiology could be realized. It is in no small part flexible. People who say ‘we want to do it this way because we’ve always done it this way’ will not be able to benefit from all the advantages of a hybrid OR.” The majority of the interventionalists were familiar with the Siemens systems that are in different departments of SUH. The transition to the Artis zeego was easy with just one extra joystick to control the robot. For those surgeons who were unused to angiography systems the learning curve was a little steeper. A “couple of months” is often cited as the amount of time it takes to be fully accustomed to the Artis zeego if starting with zero Artis experience. Interventional Radiology The interventional radiologists are led by Dr. Karin Zachrisson who has been an interventional radiologist for 20 years and at SUH for ten years. She and her team perform vascular, embolization, and TIPS procedures on the Artis zeego and highlights that it is mainly used for procedures where the patient is at high risk of uncontrolled bleeding. On inter-specialty interaction Dr. Zachrisson stated; “One of the most unexpected but rewarding advantages of the hybrid lab is the improved collaboration between IR and other departments. We always had a strong relationship with the vascular surgeons but for example once we started working with the cardiologists helping them with fusion on the Artis zeego during TAVI (trans aortic valve implantation) cases, we found that they also sought our opinion for cases such as renal denervation. We grow from this cross specialty interaction.” Cardiac Interventions The cardiologists regularly perform TAVI procedures in the hybrid lab to Surgery Multidisciplinary Use of Orthopedic OR 66  AXIOM Innovations | December 2013 | www.siemens.com/angiography


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