As Steven Brown, the AdventHealth Palm Coast physician who’s performed innumerable surgeries with the hospital’s da Vinci robot since 2011, patients can sometimes be apprehensive about such procedures. They imagine a robot springing out of the closet and going to work on them, which is not quite accurate: the robot would not fit in a closet.
“But really the robot is just following the hand motions of the surgeon,” Brown said. “The difficult sell was telling them they were actually going to be about 15 feet away from me as I’m doing their hysterectomy.” The robot, just recently upgraded to the latest generation at the hospital, is brought over to the patient’s bed, “you dock the robot arms, it’s a lot quicker than the older device. It’s a lot more user-friendly than the older one. You can actually sit down at the console and get it to work quicker, and then afterward there’s less sewing because the incision is smaller than the previous device.”
Brown, who also owns the Palm Coast Women’s Center, was describing the da Vinci robot to some 35 people who’d gathered this morning for the Flagler Chamber of Commerce’s Common Ground breakfast at the Hilton in Palm Coast, the periodic event focused on public, social and business affairs. AdventHealth annually appears at such breakfasts to highlight various aspects of hospital operations. The da Vinci machine got a lot of attention when it was introduced locally nearly nine years ago.
“To have a robotic device, the da Vinci robotic device in a hospital of 99 beds is unheard of,” Brown said. “It truly put us on the radar map. Between Jacksonville and Orlando there was one robotic device at an institute south of us. Not to name names–Halifax Medical center, a fine institution, I used to work there myself. But we are outgunning them numbers wise. We are running circles around their numbers.” Referring to the hospital’s former CEO, now a regional CEO in the organization, he said it was “very telling about the foresight that David Ottati had when he first talked about bringing a robot–it’s just unheard of, bringing it to a rural community hospital at that time. Since then it’s taken off. We’ve done over a thousand cases.”
Brown was the first robotics surgeon to champion the first da Vinci, and was a driving force behind the acquisition of the latest generation of the da Vinci, the XI, whose cost ranges between $1.85 and $2.3 million. It’s used routinely for bowel resections, gallbladder procedures, hysterectomies, and so on.
“What does this translate into for the patient? Recovery time is quicker. I’ve had patients that we’ve operated on for a hysterectomy on Tuesday and she was at work on Friday,” Brown said. Pre-robots, hysterectomies required a five-day hospital stay. “Loss of revenue is less, they get back to work and all their responsibilities at home. Pain wise, the pain after the surgery is a lot less compared to an open incision because you have these small skin incisions and the pivot points don’t move much with the robot machine, and so there’s much less tugging on the abdominal wall, so the recovery pain-wise is a lot better. We used to send patients home with 20-30 tablets of narcotics. Now we send them home with eight.” Blood loss during surgery was measured in pints. Now it’s measured in tablespoons. Cost-wise, a patient in the hospital three to five nights versus “a few hours in the recovery room and off they go is incredible.”
“If you factor in going back to work, staying in the hospital less, resuming your family life quicker, less narcotics nowadays with the problem we have, it’s a win-win situation,” Brown said.
Both Brown and Wally de Aquino, the hospital’s chief operating officer, addressed the perception among some in the community that the hospital is unsafe. Brown described an encounter with a patient’s husband who questioned him about his privileges and spoke of his apprehension about the hospital. “We’ve heard things,” the patient’s husband told Brown. “You know, the infection rate is just a disaster,” Brown quoted the man as saying. Brown challenged the man to do a little research and return in a week. “He came back with his hat in his hands and said, it is the lowest infection rate in Central Florida,” Brown said. “So then they agreed to have their surgery there. Sometimes you just have to serve it up. The rumor mill out there is not as bad as it used to be, but it’s still out there. It surprises me when it bubbles to the surface.”
De Aquino focused on a recurring rating system that looks at the hospital’s safety record. “For the fifth time in a row we have been recognized and have received the letter A grade for safety as a hospital,” he said. “Leapfrog, the way it works, they look at all types of metrics for outcomes from our hospital. And I know, I take it a little personal, as an employee of AdventHealth today, to still hear the legacy comments from–yes, don’t use their hospital because it’s not good quality. Well, the data says otherwise, and this organization recognizes that as they use the data from the outcomes we have today to give this grade.” He said that between St. Johns, Volusia and Flagler, “we are the only ones with a grade A for safety.”
De Aquino also summarized the state of the hospital as a business and job creator. “Just about a year ago we brought a new cardiologist to our community, about seven months ago we brought a new orthopedic surgeon, a hand specialist, and with that obviously we need to recruit more support services,” he said. “So that’s creating more jobs for the people in our community. That’s interesting because many of us, of about 60 providers we have in our community today, many of them we have to recruit from outside of our community to move into our area. With that, it creates demand for support. We are proud to say that today we have about 1,000 employees, and this makes me very proud as a resident of Flagler County to say that about 75 percent of our employees live in our county.”
AdventHealth works with 60 charitable organizations, requiring its leaders to volunteer with at least one organization in the community, netting 3,500 hours of volunteer work in the past year. The hospital invested $10 million in the past year, much of it in technology, including a $1.6 million CT scanner and the latest version of the da Vinci robot. The hospital donated its old CT scanner to the Dominican Republic, along with a team from the hospital to install it and to train hospital staff there.
And of course de Aquino mentioned AdventHealth’s hoped-for partnership with the University of Florida and Palm Coast government–the university’s effort to open a satellite presence in Town Center that would train nurses for the local and regional market. “The conversation about UNF, this is a big deal for us too,” de Aquino said. “If we can provide that here and in our region provide jobs, that would be a benefit for all of us.”