Traditionally, endoscopy departments focus on procedures of the gastrointestinal system. When I joined this field at the end of 2023, that focus was evident in the expertise and training of my team. Many of my colleagues are experienced endoscopy professionals with strong backgrounds in gastrointestinal procedures.
In recent years, however, interventional pulmonary services grew, and a few team members learned these procedures, adapting as new technologies emerged. In early 2024, a switch in robotics providers impacted some of these procedures, and we decided to transition them from the operating room to an endoscopy suite.
As a newly appointed leader to the department, my motivation to focus on growing pulmonary procedures was driven by the combination of both the lure of untapped potential and the support of an exceptional team. With my background in cardiac and pulmonary nursing, I was naturally drawn to this area of care.
Beyond personal interest, I saw the hidden promise both in the geographic area and in the organization. Southern New Jersey, despite its proximity to Philadelphia and Manhattan, is densely populated enough to warrant its own local, expanded healthcare services. Our location is near several casinos (a known source of respiratory exposures) which further highlighted the need for specialized, accessible pulmonary care.
Our endoscopy team is engaged, intelligent and motivated to provide excellent care. The providers within interventional pulmonology possess all those qualities, along with a willingness to be flexible, teach and grow with the team.
Another key factor in success is that the program had executive support and aligned with organizational strategic goals. I embraced my role as both an advocate for the program’s growth and a facilitator of its operational success.
Assembling the Team
Knowing how few team members were specialized in robotic pulmonary care, we addressed this gap by focusing the initial deployment on team members who were engaged with the previous robotic implementation. The recipe to develop this pulmonary care team was a simple one, and we already had all the ingredients. With support from our partners at Intuitive Surgical, we facilitated on-site training in Atlanta.
We continue to fine-tune our processes, focus on cross-training more team members, and find ways to streamline turnover methods— which ultimately have increased procedural capacity. The more procedures we can do, the more diagnoses we reach—leading to prompt treatment, faster responses and better outcomes for our patients and communities.
This has been both deeply impactful and inspiring work, but translating progress into the day-to-day operations can be daunting. One significant challenge was ensuring this growth of pulmonary procedures did not feel like a burden for the team, but instead an opportunity for improved patient care, personal impact and professional growth.
Staffing presented another layer of complexity to consider. Balancing a steady volume of patients along with organizational and unit-ba- sed changes impacting team morale required thoughtful navigation.
Additionally, the operational shuffle of pulling team members offline for training in an intricate new process required strategic planning to maintain team cohesion and patient coverage.
Overcoming Obstacles
Our department, together with the operating room, previously utilized a different robotic system for navigational bronchoscopies. Although this was effective, it posed significant operational challenges. It required extensive setup and takedown, necessitating patient transport and at least an hour of preparation time.
Previously, all of these cases had occurred in the operating room, demanding the movement of equipment—such as protective lead aprons, specimen containers, medications, etc.—as well as staff across multiple areas of the hospital. This logistical burden decreased the amount of time our team could spend with direct patient care.
To address these inefficiencies, we held many discussions about how to more seamlessly integrate the program into the endoscopy unit. Clear communication was a priority, so I spoke with each team member involved to be sure they understood the rationale behind these changes. We talked through what was needed in an effective handoff.
I gathered their input on what an ideal implementation would look like. With their feedback as a guide, I worked to remove obstacles and secure whatever resources they needed to succeed. Strong representative presence helped the team in realtime. When I encountered challenges beyond my expertise, I sought advice from colleagues. I asked a lot of questions.
We collaborated closely with radiology, IT, IT security, and Intuitive’s team to ensure seamless integration with the PACS system. (A PACS, or picture archiving and communication system, stores medical images and reports).
We collaborated with sterile processing. Additionally, we engaged with colleagues from other disciplines to enhance the patient ex- perience, ensuring it was efficient and patient-centered. The dedication and investment of the pulmonary team to their patients and exceptional care delivery was evident throughout.
Milestones and Achievements
In just four months, our team achieved a remarkable milestone, completing over 50 cases and increasing our daily procedural volume from two navigational bronchoscopies per day to five. This was a testament to the team’s collective efforts and dedication.
We celebrated this together, with our providers emphasizing the difference prompt, accurate diagnoses can make in the life of a patient. In one instance, the pulmonary team was able to sample from a lymph node that would have previously required a sternotomy to reach. This was a significant clinical milestone for the endoscopy team to participate in and witness.
We learned to adapt as we saw issues arise. We adapted the scheduling models to ensure patient care coverage was more than adequate.
The outcome? Proficiency grew.
In five months, the percentage of the endoscopy nurses proficient in these cases grew by 250% and technicians showed a 100% growth, doubling their team’s proficiency! Team members were engaged and satisfied. To ensure efficiency and reduce fatigue, we implemented a buddy system for cases and room breakdown. This ensured refreshed perspectives and maintained high standards of care throughout the day.
Lessons Learned
The most important lesson learned throughout this process was that partnership and collaboration are tantamount to success.
Endoscopy teams already handle a complex workflow, managing high-level disinfection, and partnering with procurement for inventory management. The team routinely performs POUT (Peri-Operative chemotherapy versus surveillance in upper-tract urothelial cancer), manual cleaning, automated disinfection, forced air drying, protein-testing and storage management. In this case, a key partnership with the hospitals’ sterile processing department was essential for parts that cannot be immersed and needed sterilization.
The new robotic system introduced new challenges, such as parts with defined case-lives. This required reconfiguration of how the inventory for each of these parts were managed. The team devised a couple strategies to manage stock electronically, pivoting when necessary and partnering with our buyers.
Delicate Nature
Given the delicate nature of robotic parts—with sensors and small components—case setup and room turnover became more intricate. These and other processing challenges were met with training, repetition, troubleshooting support, more training, and ongoing collaboration to ensure the team was equipped to adapt effectively.
Procedural space constraints added another layer of complexity.
Geographic changes to the procedural room and on the unit are ongoing and prove critical to optimize turnover time and workflow efficiency. Even small adjustments, such as the direction a door swings, can significantly impact procedural flow. By working with facilities and construction management we explored new layouts for the equipment and procedural personnel. Regular check-ins with the team allowed their feedback to be incorporated in decisions about space utilization, workflow and room layout.
We made changes gradually to facilitate adaptation and align with budget constraints. We empowered the team members by involving them in decisions. This approach fostered a sense of shared ownership.
This implementation taught me a few things as well, such as that I work with some incredibly talented people. I also learned that over- communication is unlikely (but forgivable) when undertaking a process change.
Questions are essential.
My main summary after this process is that I’m so proud of my team and I’m inspired by their successes. They are truly phenomenal.
