It's early on a Monday morning, and Dr. John J. Greco is evaluating the knee of a 31-year-old woman in one of Huntsville Hospital's new outpatient operating rooms. He's wearing a lightweight, wireless headset that positions a microphone just in front of his mask.

"Light source," he says. "Brighter."

Immediately the live picture from the arthroscope wand, displayed in color on one of the flat-screen monitors suspended on a boom from the ceiling, gets a bit brighter.

"Brighter," he says again, and the picture brightens again, revealing details of damage inside the joint.

Welcome to the world of centralized OR controls, a set of software and hardware that lets surgeons operate with the touch of a screen or a voice command digital cameras, lights, drills, the flow of fluids into the surgical site and more.

Centralized OR controls are the brawn and brains behind today's high-tech OR suites. With the touch of a screen or a voice command, you can adjust surgical tables and lights or direct flat-screen monitors suspended from ceiling-mounted booms (thereby reducing the number of carts, cables, hoses and other equipment nurses and staff must work around). As an operational benefit, centralized OR controls extend the life of equipment, which is often damaged when moved. What's more, today's command-and-control systems eliminate the need for perioperative nurses to manually tweak knobs and buttons. Here's how these systems work and what to consider when integrating your OR.

Worthwhile investment
We asked administrators and surgeons to outline the many benefits of centralized OR controls:

• Ergonomics and efficiency. Getting equipment off the OR floor makes it easier to move and position, and makes it quicker to clean and prepare the room for the next patient, decreasing turnaround times.
• The wow factor. The ergonomics and efficiency of centralized OR controls excite administrators and are appreciated by surgical staff.
• Voice control. Dr. Greco says one of the nicest aspects of the voice system is the ability to dictate while in the OR. He can answer phone calls and dictate as he's closing from a procedure, and that saves at least five to 10 minutes every time. "In a busy day," he says, "that's really a time-saver."

"An integrated OR without voice activation ... wouldn't save me as much time," says Thomas Chambers, MD, the medical director and an orthopedic surgeon at the Ocean Ambulatory Surgery Center in Myrtle Beach, S.C.

• Surgeon pre-sets. "It used to take us 5 or 10 minutes to bring in the equipment for a case and set it up," says Heather Boling, the director of perioperative services at Baptist Memorial Hospital in Oxford, Miss. "With surgeon pre-sets, all the equipment is ready with three touches of the screen." Olympus America's EndoALPHA features one-touch pre-sets that save each surgeon's settings.
• Documentation. When Dr. Greco finds what he's looking for on the monitor, he simply says, "capture" and the centralized control takes photographs of the damage inside the knee and displays them. The digital photos can be printed instantly from the rack of equipment set into one of the OR walls or sent electronically anywhere they're needed in the hospital - or anywhere in the world, for that matter. Of course, the pictures can also be stored on hard drives or burned to discs. And calling up a digital movie is just as easy.
• Video routing and recording. Video routing lets you broadcast procedures via Internet or teleconference with another location. "It's not an everyday issue, but just the other day I had a colleague consult me on an unexpected problem, and I was able to help him handle it," says Gary Poehling, MD, chairman of orthopedics at Wake Forest University Medical School and surgeon at Wake Forest University Baptist Medical Center.

Most systems also let you capture and/or record video. "We upgraded the digital capture units to capture streaming video, which our surgeons can burn onto a CD and use in Power Point presentations," says Melody Montgomery, RN, MBA, assistant hospital director for perioperative services at Oregon Health and Sciences University. Dr. Poehling puts procedures on a VHS tape: "I record the procedure and edit it as I go. I explain what is happening and include post-op instructions. Our patients are more informed of their surgery and of what they can expect after it."

• Image archiving. "The system automatically saves images from the procedure," says Ms. Boling. "I can't tell you how many times nurses forget to print pictures or lose them. Now they can easily access and print them out again."
• Frees up staff. Centralized controls free at least one circulating nurse, who would otherwise be moving through the OR at the surgeon's command, to handle duties more important than turning up lights, running a cart of video gear or even changing the settings on surgical equipment. By voice command, some centralized OR controls instantly can perform anywhere from five to 15 actions usually handled by a nurse.

"It takes some getting used to," says Dr. Greco. "After operating for a number of years and doing everything manually, sometimes you have to think, 'OK, I've got to use the machine.' But it's nice to be in control, to not have to wait or stop what you're doing with your hands to change this or that."

Purchasing considerations
An integrated OR costs about $100,000 for the basics and can exceed $500,000 with all the bells and whistles. While an integrated OR can pay for itself relatively quickly, surgeons and facility managers say it's not a system you install if your OR is not busy.

The integrated OR starts with a control system, either a rack or a tower unit and wires running through the ceiling. Depending on the brand, a nurse operates the touch screen at a nurse's station outside the sterile field or a surgeon operates a touch screen with a disposable cover.

"Communications are sent from the touch screen through the wires to the control panel and from the control panel to the equipment," says Jeff Lipps, director of regulatory affairs at Conmed Integrated Systems.

If you're building a facility, incorporate the wires and wall mounts you'll need for an integrated OR into your building plan - even if you're not prepared to integrate the OR, says Joe Delligatti, director of new business development for Stryker Corporation. "New construction is a simpler process," says Harry Getz, product manager for the Karl Storz OR1. "In older facilities, there may be things in the ceiling, like lights or an HVAC system, that may prohibit you from installing wiring."

After all, you can retrofit your ORs. Oregon Health and Sciences University integrated its outpatient ORs because faster turnover and procedure times and convenience justified the cost, says Ms. Montgomery. A 500-square-foot OR with ceilings higher than 8 feet is ideal for retrofitting, but firms will work with other dimensions.

Whether you build or remodel, manufacturers agree it's never too early to involve a vendor.

"When the facility is designing an integrated OR, the architect has electrical requirements, other equipment in the room will have electrical requirements, and the centralized OR control system has its own set of requirements," says Mr. Getz. "If you develop the design plan without one of those groups, you'll have to do a change order to fix it."

Concludes Ms. Boling: "When you start to build or renovate an OR, decide whether you're going to integrate it and choose a vendor as soon as possible."