Royal Victoria Hospital is one of four linked hospitals that makes up Northern Ireland’s biggest and best-known hospitals complex. Almost two-thirds of the Northern Ireland population live within 40 minutes travel of the 70-acre site which is situated only a few minutes drive from Belfast city center. In addition to providing Level 1 Major Trauma services, it acts as a tertiary referral center for local District General Hospitals.
Innovation at its heart
Treating over 80,000 people as inpatients and 350,000 people as outpatients every year, the RVH is the regions busiest center. The umbrella organization, Belfast Health and Social Care Trust, is also the major teaching and training hospitals in Northern Ireland.
With a desire to reduce inpatient bed time, reduce surgical costs, elevate care standards and improve patient care, the hospital is committed to working with partners to innovate and to develop strategies to transform health and social care.
In 2018, The Royal Victoria Hospital looked to axial3D with an ambition to expand the 3D printing services that were already being delivered and establish an on-site 3D printing facility.
The hospital encourages high-level directives aimed at improving healthcare delivery on the ground and improving the quality and experience of care. This is leading to a cultural change, where quality improvement is second nature for all staff.
From the outset, there were some key elements that must be in place for any project to proceed.
- The initiative must be at least cost neutral, if not cost saving, this is due to the already stretched NHS resources.
- The initiative must be an improvement of current systems, and in this case, it related to surgical planning and preparation, but could also address the radiology reporting system.
- The program encourages a focus on “Marginal Gains” by all to deliver larger, enterprise impact.
- There should be a long term plan, ensuring the sustainability of the services delivered
3D Printing delivered on all these elements.
Step 1: Needs Analysis
Having worked with the Royal Victoria Hospital and the Royal Belfast Hospital for Sick Children for several years in providing dedicated service plans, axial3D had a clear understanding of the application areas and the volume requirements for the group. Already accessed by Pediatrics, orthopaedics & trauma, cardiology and neurology, we also knew the volume was likely to grow as more physicians and clinical specialty’s learned about the benefits that 3D printing could offer their patients.
In establishing Point of Care 3D printing capability, we needed to understand the resources and skills available as well as understanding the budgetary caps. Most importantly, we needed to understand how the group envisioned their growth and development.
Working in partnership with the hospital trust, together we reviewed 3 key options for the group.
- They set up a 3D printing facility onsite with industrial printers and in-house segmentation.
- They set up a 3D printing facility onsite with desktop printers and in-house segmentation.
- axial3D Managed Service
Reviewing capital and ongoing costs of hardware/software/people; the skills requirements; speed to competence; and the time/cost of learning, we evaluated all options. Working with front line physicians, management and technical staff, we agreed the best solution was an axial3D Managed Service, with an onsite 3D printing lab, monitored and managed by axial3D. This provided the rapid access to final prints, while also providing the capability for complex or time-consuming prints to be printed at axial3D’s facility. All segmentation and 3D file pre preparation was to be managed by the axial3D team off-site to reduce the increased workload on radiology and ensure printability.
Step 2: Implementation & Training
Following program initiation, a detailed project plan outlined each task and the key milestones. The main tasks were to:
- Set up axial3D insight software to provide a mechanism for requesting prints and tracking status.
- Integrated with the PACS software to ensure the fastest and most secure mechanism of sending DICOM data to the axial3D team
- Set up the 3D print lab in a dedicated space within the hospital site. axial3D monitoring all printing activity to deliver instant communications to staff and deliver consumables as required.
To leverage the available resources within the hospital and also ensure staff were becoming familiar with 3D printing, several Registrars (Residents) from each department were trained on how to post-process prints, troubleshoot printer errors and understand the key principles and requirements of delivering the best possible medical 3D prints.
To minimize the time needed by onsite staff, axial3D prepared models to be easily post-processed in a short time. More complex prints were fully processed at the axial3D facility and couriered to the requesting physician.
Implementation, testing, and training were completed within 4 weeks.
Step 3: Support and Project Management
Once all key staff involved were trained and onboarded, we supported the ‘physician onboarding’ process by running information days, 3D printing clinics and attending specialty audit meetings.
In the first 6 months of operation, 3D printing freed up almost 40 hours of theater time, resulting in the direct saving of approximately £100,000 in theater costs alone.
The hospital has received significant press coverage detailing the program, and staff have been prominent advocates of medical 3D printing, invited to speak at events globally.
In addition to the quantifiable impact of implementing the technology, feedback as shown the following benefits impacting staff and patients across the complex:
- Improved surgical decision making
- Improved patient compliance and therefore outcomes
- Improved patient care and safety allowing for surgical simulation in a consequence-free environment
- Reduced the time under anesthetic thereby reducing the risk of infection
- Reduced risk of litigation due to increased patient understanding.
- Solidified BHSCT position as a leader in surgical care nationally, and internationally, supporting the ongoing surgical standard improvements.
“We have found that 3D Printing improves the care we deliver to our patients. It delivers on all facets of Quality Improvement in Healthcare and it does this whilst allowing significant savings to be made.”
Mr. Brendan Gallagher
Specialist Registrar Trauma + Orthopaedics. Belfast Health & Social Care Trust