Background
Arbutus Medical has developed and patented a radically affordable orthopedic drilling kit to combat rising healthcare costs and improve access to safe surgical power tools around the world. In September 2019, the kit was implemented at a leading trauma center in the United States for use in damage control procedures.
Fig. 1: Arbutus Medical product family.
From L to R: SawCover oscillating saw system, HEX Drill/driver, PRO Drill 2-speed cannulated drill/reamer.
The HEX Drill (Figure 1) is a surgical drilling system that combines a nonsterile hardware drill and a sterilizable covering. The device was launched in 2016 and is a registered medical device with Health Canada and the US Food and Drug Administration (FDA). Arbutus Medical products are now trusted by Forward Surgical Teams within the US Army and Canadian Armed Forces and have been used by surgeons across more than 30 countries, in an estimated 48,000 surgeries. The HEX Drill implementation occurred at a leading trauma hospital and pioneer in the field of trauma medicine. The trauma hospital specializes in emergency surgery, resuscitation, intensive care, and acute surgical care, with emergent patients treated directly in the Emergency Room (ER). Patients of gun violence, motor vehicle accidents, and varying other severe traumatic injuries are treated in the ER. The priority in such polytrauma situations is damage control, often using external fixation to stabilize the patient. External fixation, or ex-fix, is a faster treatment method to stabilize patients and thereby reduce additional blood loss – vital to patients in a critical state.¹ Further evidence suggests that early fixation for damage control, and later definitive surgical care, can increase survival of some patients with severe multisystem injury.²
Opportunity
Skeletal traction and other orthopedic damage control procedures require the use of a power drill. This trauma hospital does not have surgical drills dedicated for use in the ER and requires that residents and fellows borrow equipment from the OR inventory. The equipment needs to be retrieved and returned, costing time and efficiency in both the ER and the OR. This problem arises at least once daily, with the ER conducting 5-15 traction pinning cases per week. The HEX Drill was evaluated by the clinical operations team and approved for use in their ER. The system offers a sterile and cost-effective power drill solution, and dedicated equipment for the ER further improves operational efficiency and time-saving improvements for both the ER and OR.
Implementation
The HEX Drill was launched in the ER of this trauma centre in September of 2019. The HEX Drill units were introduced on the ER floor, with complimentary replacement parts for any lost or damaged equipment during the implementation period. The launch included in-service training sessions for nurses, residents, fellows, and sterile reprocessing staff. The ER completed 16 cases using the device in the first month of operation and 25 in the second month.
Key Takeaway
Skeletal traction by external fixation is a common damage control procedure performed in the ER, however surgical power drills dedicated to performing this procedure in the ER are often too expensive. Alternative options include borrowing sterile equipment from the OR, reducing operational efficiency, or pin driving using non-sterile techniques, which does not meet the standards set by Infection Prevention & Control units. As confirmed at this hospital, the DrillCover platform offers a simple, cost-effective, and sterile solution to address this challenge, which arises at least daily at trauma centers across the United States.
¹ Taeger, Georg, et al. “Damage Control Orthopedics in Patients with Multiple Injuries Is Effective, Time Saving, and Safe.” The Journal of Trauma: Injury, Infection, and Critical Care, vol. 59, no. 2, 2005, pp. 409–416., doi:10.1097/01.ta.0000175088.29170.3e.
² Pape, Hans-Christoph, et al. “The Timing of Fracture Treatment in Polytrauma Patients: Relevance of Damage Control Orthopedic Surgery∗∗This Manuscript Is Dedicated to Harald Tscherne, Who Has Influenced the Discussion and the Standards of Fracture Treatment Substantially.” The American Journal of Surgery, vol. 183, no. 6, 2002, pp. 622–629., doi:10.1016/s0002-9610(02)00865-6.
