By Xiaoyi Liu
Medill Reports

Optimal teamwork in the operating room (OR) can be hard to achieve. Inexperienced team members, poor information transfer, mid-case handoffs, and improper room preparation can all result in delays and disruptions during the operation.

The result can cost the patient increased exposure to infection, according to Dr. Alexander Langerman, head and neck surgeon and associate professor of otolaryngology at Vanderbilt University. “If something is not in the [operating] room as it should be, then someone has to leave the room and come back to get it, and so that could translate into a higher risk of infection,” he said.

This is corroborated by a study published on American Journal of Infection Control, by authors with University of Gothenburg, Sweden. An elevated airborne bacterial counts in the surgical area is clearly linked to door openings in conventionally ventilated ORs, thereby providing the scientific evidence needed to initiate interventions aimed at preventing surgical site infection (SSI) by reducing traffic flow in the OR.

“Significantly longer operating time is also associated with a higher risk of infection,” Langerman said. Duration of operation is one of the other risk factors of SSI, according to CDC’s Guideline for Prevention of Surgical Site Infection.

Chicago-based ExplORer Surgical, an interactive surgical playbook, aims to solve these problems by providing the surgeons and their teams with detailed, real-time guidance on how to set up the room, what tools are needed when, and what steps to anticipate, boosting communication and coordination between all members of the surgical team.

“I think healthcare is an industry that is incredibly meaningful – it touches all of us and our lives,” said Jennifer Fried, chief executive officer of the startup. “It’s an industry that dramatically needs more technology advancement,” she said.

She and Langerman co-founded ExplORer Surgical in 2015, when Langerman was directing the Operative Performance Research Institute at the University of Chicago.

As a software solution for surgery, ExplORer Surgical is a real-time surgical workflow management tool that serves as a centralized information source for all OR team members. It offers an iOS and Android-based app used during live procedures in the OR to provide previously programmed surgical technique guides that can be tailored to any surgery and any procedure. The guides give specific instructions for each team member.

During the operation, ExplORer Surgical is applied to a “big board” view that includes case progress and key notifications on a large screen, so the whole surgical team can follow the progress of a case. Each team member in the OR will be equipped with their own team device, which shows information specific to their role at each step of the case, according to the preference of the surgeon. As the case progresses, each screen simultaneously advances at the click of a button step-to-step, and customized information for each member allows the whole surgical team to parallel processes.

Preference cards, a traditional checklist for positioning each member of a team and specifying what supplies and equipment are required for a procedure, are lagging behind the modern surgical workspace as a result of the outdated information and lack of updated process and methodology. Moreover, it doesn’t provide information for contingency plans needed in the operation.

ExplORer Surgical is designed to better support teams in real time by providing a “reliable, interactive, ever-present” document for the surgical team. If a surgeon’s checklist changes out of emergency during the operation procedure, a time-stamped comment can be instantly created, producing a way to follow up that change after the procedure, so as to safeguard the smoothness of the operation.

It requires optimal teamwork in the OR to carry out plans created to decrease time under anesthetic, so as to improve patient care. However, Langerman experienced various miscommunications that resulted in delays and disruptions in the OR during his clinical experience, that he saw as barriers to achieve efficiency. Therefore, he began to research intra-operative efficiency in 2011.

Fried, then an MBA student at the University of Chicago Booth School of Business, began to collaborate with Langerman – the company’s chief medical officer in 2013 to commercialize a solution for the findings.

“It started as a project while I was in business school,” Fried said. “I felt really passionate about it, and interested in learning more, and it became bigger and bigger.”

The company took shape with a National Science Foundation Small Business Innovation Research Phase 1 grant and with funding from venture and angel investors.

ExplORer Surgical has created the first nationwide intraoperative data set across dozens of procedure types and surgical specialists. “We are doing this because we believe there is a need in the healthcare system for more efficient procedures, and for more data,” said Brittany Genelin, director of strategy and business development.

While electronic medical records (EMR) collects general data such as when the procedure starts and finishes, ExplORer Surgical also collects granular data in between, such as how long does every single substep of the procedure take, which instrumentation is used, when is it used, and who is in the room.

“We think it is actually very important to collect data during the training, because that helps surgeons to set goals for themselves,” Genelin said. For example, if surgeons know that a procedure should take 50 minutes and, in the training setting they are actually taking 90 minutes, they can start to dig into their data to understand why it takes a longer time and address their procedures.

“We believe that by providing people guidance on what they need to be doing and when they need to be doing it, we can actually make operating room more efficient, meaning it runs more to schedule, you have fewer delays and disruptions, because the team is on the same page, and the team is more prepared for the case,” Genelin said.

The company is constantly getting requests from customers for adding new features, new functionality, and updating the analysis tools on the back end, according to Fried. “We have a long list of things that we are going to be continuing to add.”

Here’s a short video from ExplORer Surgical showing how the surgery workflow tool works: