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When Helen San Jose-Catibog, RN, team leader in robotics at Sherman Hospital in Elgin, IL, was approached by the marketing department last spring to see if she'd be willing to partake in the facility's first live Twittercast during a robotic hysterectomy, she didn't hesitate to sign on. Her motivations were a little more altruistic than letting her friends know how she was spending the day.
"A lot of people don't know we use robotics, or they think hysterectomies are old fashioned. There are a lot of advantages to having it done robotically, like less pain and quicker recovery, and we wanted to make people aware," she explained.
The idea to "tweet," or type 140-character updates along with Twitpics, or photos, during surgery is catching on fast. Early in 2009, Detroit's Henry Ford Hospital became the first in the nation to provide a running commentary during a robotic surgery to remove a cancerous tumor. Sherman's April 2 tweets were the first from an Illinois operating room, and Aurora St. Luke's Medical Center in Milwaukee scheduled Wisconsin's first live Twitter surgery April 16. Sherman and Aurora were both featured on Good Morning America, and Aurora was mentioned on The Oprah Winfrey Show. Numerous other facilities followed suit in the weeks that followed.
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| KEEPING POSTED: Sherman Hospital's "Twitter Team" updates followers on a surgery's progress via IPhone. courtesy Sherman Health Care |
Beyond Blogging
With public relations professionals behind the camera's lens and typing the updates, the surgeons and nurses were free to proceed as usual during the operation at both facilities. At Sherman, the hourlong procedure was described in 350 updates and 70 questions and comments from followers.
The patient was fully draped and unconscious throughout the Twittercast.
Tweets included statements like, "They just cauterized the [infundibulopelvic] ligament, which contains the ovarian artery." To update the patient's husband and mother, who were waiting in the cafeteria, the team assured "Patient is doing great." Photos captured suturing the vaginal cuff and dissecting the fallopian tubes.
Aside from making sure they were wearing lipstick for the pictures, the nurses changed very little from their normal routines. "We just had to be aware that there were physically more people than usual in the OR," said Debbie Lemieux, RN, at Sherman Hospital.
During Aurora's first successful broadcast of a bilateral knee replacement surgery April 16, many departments collaborated in addition to the surgical team, including information services, compliance, corporate affairs and human resources. Aurora posted 250 text updates, answered 180 questions and posted photos, but no videos.
Generational Shift
Mirroring the four-generation workplace prevalent in many hospital atmospheres, the Aurora department managed by Nanette Johnson, MBA, RN, was split in half in their enthusiasm for the Twitter project.
"When it first came out in the Aurora newsletter that we were going to be broadcasting on Twitter, the younger nurses were saying, 'It's about time.' Some of our older nurses reacted the same way they did when we went to online charting last fall and couldn't believe they were being made to do this," she said.
However, once the surgery started and the Twitter updates were rolling in, many of the skeptical nurses were captivated by the drama unfolding on their screens.
Ferocious Feedback
Staff members were part of Aurora's list of followers who had signed on by the time the surgery was complete (totals jumped from approximately 930 to more than 2,600). The rest of the audience consisted of patients, press and medical personnel worldwide.
Johnson said the initial Twittercast demonstrated the need for caution in what's published on the Internet. During the operation, the patient had a femoral nerve blocked, and the anesthesiologist was photographed holding a sample of the needle/catheter combination used to place the block. The needle was just that -- a sample -- and not being inserted into the patient, so he held it up for the camera with a bare hand. Instantaneously, someone asked why he wasn't wearing sterile gloves, and the doctor had to explain the situation.
"Creative services was in the OR taking pictures the entire time. Something like having sterile gloves on for that sample picture was something we didn't even think about," she said.
Both Aurora and Sherman will have plenty more opportunities to perfect their online publishing policies. Aurora is planning more Twitter surgeries with pre- and postcoverage of each procedure on its YouTube channel. Sherman currently informs the community about its upcoming events and services on its YouTube station.
Like her counterpart at Sherman, Johnson hopes the new technology will help increase transparency and educate patients about possible procedures.
"Instead of making patients come to us for teaching materials, especially at far distances, it would be a good idea to educate them on Twitter, where we could sit and answer individual questions," she said.
Robin Hocevar is regional editor at ADVANCE for Nurses.
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