By Robert M. Van Haren, MD, MSPH | March 2, 2022
Innovation and new technology are essential to the progress of any specialty. Within cardiothoracic surgery, the development of cardiopulmonary bypass in the 1950s was critical for shaping our field with new operations and improved patient outcomes. Emerging technologies remain a staple of the specialty and early career surgeons play an important role in the process. This article will discuss how to introduce new technology to an institution.
Getting Started with Buy-In
During their surgical training, early career surgeons are exposed to numerous emerging technologies such as transcatheter valves, minimally invasive cardiac surgery (coronary/valve), minimally invasive thoracic surgery, and advanced endoscopic procedures (peroral endoscopic myotomy). When bringing new skillsets and technology to an institution, there are several important factors to consider.
It is critical to get support for a new clinical program on two levels: the Division Chief and Department Chair/Institution. Clinically, your Division Chief should support patients being treated with a new technology and help with developing a clinical program. They also need to have “buy-in” and support for dealing with complications that might arise. As an early career surgeon, you don’t want to be left on an island without the backing of your partners and department leaders.
Institutional support is important and the hospital system should be aligned if large capital investments are required. This process can take time, and if you are starting a new position, it should start during contract negotiations. Another level of institutional support is marketing. As you are establishing your new procedure or technology, you will need to get the word out. Without patient referrals, you won’t have the clinical volume to support your new program.
As an early career surgeon, you don’t want to be left on an island without the backing of your partners and department leaders.
In the operating room, it is important to develop a consistent team including nurses, anesthesiologists, physician assistants, and surgical assistants. A cohesive team can help with standardization of the procedure, which will reduce variability and ultimately improve outcomes. A consistent team is even more important for early career surgeons who are still developing their techniques and leadership in the operating room.
Support from your partners in the operating room also is vital. Even if they have no experience with the new technology you are introducing, they are experienced with the gold standard technique. They can be very helpful getting you through some of the learning curves of a new procedure.
Case Selection, Careful Monitoring of Outcomes
With any new technology and technique, it is important to have proper patient selection. Your faculty in training may have safely performed redo valve replacement with a minimally invasive approach, but starting with straightforward cases is better for early career surgeons. A conservative approach is best to ensure excellent outcomes, develop technique, and gain confidence.
Careful monitoring of patient outcomes is important for continued quality improvement. This can be accomplished with a clinical database of outcomes such as operative time, complications, and length of stay. Reviewing video recordings of the procedures can be an important quality improvement tool as well. Don’t hesitate to review your cases with your partners or mentors to find ways to continually improve.
Early career surgeons are often in a position to bring new technology to an institution and following these steps can help ensure successful implementation.