A surprisingly popular design feature of the surgery center I opened in 1990 was the patient family viewing rooms adjacent to one wall of each OR. I adapted the idea to incorporate viewing rooms into my practice from a concept cataract pioneers Howard Gimbel, MD, and Phil Hoopes, MD, had designed into their surgery centers. In my case, one wall of each OR was glass, letting the patient's family sit comfortably while watching the procedure performed on their loved one. A patient liaison would use an eye model and video screen showing images from the surgical microscope to explain developments as we went through the case. Upon completion of the surgery, I'd pick up a two-way phone for instant feedback with the family. The popularity of the viewing rooms convinced me to incorporate a similar amenity in my new facility. While I didn't have the space to construct a glass-walled area next to my OR, I equipped a room with a flat-screen monitor for the same purpose (pictured). We connected the monitor to the operating microscope in the OR and the excimer laser in the vision correction suite. Families can't look directly into each operating area, but they can still watch the procedures on the flat screen while using a switch to toggle between room cameras and the microscope-excimer laser cameras.

Paul Arnold, MD, FACS
Arnold Vision
Springfield, Mo.
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Better before-and-after visualization
As a facility performing cosmetic, reconstructive and orthopedic procedures, we needed to improve intraoperative visualization of before-and-after images and images generated by endoscopic telescopes.

To help guide visualization, we used to bring a printout into the OR with before pictures and projections (from a computer program). We usually hung that paper on a wall, so the surgeon would have to squint or stop to go look at it. You could always balance it on something nearby or have someone hold it up, but that's not efficient. For endoscopic work, you need a monitor, but those on the market are small or, if you want a larger one, expensive. With help from an information technology specialist, we achieved our goal for less than $10,000.

The IT specialist directed us to buy a large plasma screen monitor and a laptop designed for wireless networking. The laptop is equipped with a high-end processor that converts images from analog to digital. The network incorporates the physicians' office information system (their office is on the second floor of our building) and gives us access to the before pictures. The monitor can provide split-screen imaging, letting the physician easily compare the before shots with computer-generated images of the expected outcome in a side-by-side comparison. We can also access and view patient data; a top-notch wireless firewall makes the system HIPAA-compliant.

The system accommodates images generated during the endoscopic procedures and provides a much larger view for the surgeons than they had with the smaller monitors. In addition, the plasma monitor is connected to a digital-capture system, letting us permanently store images on DVD. As high definition television technology becomes more affordable, we will be able to incorporate it.

Heidi Facchini, RN
Director of Nursing
North Fullerton Surgery Center
Montclair, N.J.
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Treat them to surgery and a movie
We've discovered a service that lets our patients and their visitors rent DVDs and personal DVD players to view as they recuperate, visit loved ones or pass the time as they wait for the patient to complete procedures.

Best of all, we did so with little effort and no financial outlay. A company called Careflix coordinates our service. Careflix staffs (from 10:30 a.m. to 7 p.m.) and maintains the area where we store the DVDs - three-quarters of a closet in our lobby, as well as a counter where we distribute them. The company also stocks a few dozen portable DVD players and about 500 popular titles - mostly new releases, classics (such as "Casablanca" or "Gone With the Wind") and television shows (such as "The Simpsons").

Careflix updates the list of movies weekly. The Careflix staff delivers DVD players and movies to the patient's room or a waiting room. The cost of a rental is $7 for 24 hours; it includes the player and a movie. Additional DVDs rent for $3.

Patients and families have expressed great satisfaction with the new service; they feel the movies provide a distraction that helps reduce the stress and boredom of extended time in a hospital. An additional bonus: Our staff can rent movies for an evening or the weekend as well. More than 300 of our staff are signed up and get a discount rate, which is lower than the fees of the major video chains (not to mention having the service in our lobby eliminates the need to make a special trip to the video store). The hospital's revenue-sharing agreement with Careflix provides us with a small percentage of rental fees (between 5 percent and 20 percent) in exchange for the operating space. (In freestanding surgery centers, the financial model is different, says a Careflix spokesman.) What's more, our hospital doesn't have to upgrade to digital TV.

Steve Ikeler
Assistant Vice President of Support Services
Riddle Memorial Hospital
Media, Pa.
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