Evaluating a new instrument set, disposable drape or even an endoscopy system is fairly easy. You negotiate a loaner deal with the rep and you try out the new products in the OR. When it comes to trialing equipment booms, however, it's not so easy. Since booms must be designed into the OR, requiring special ceiling supports and hidden connections, you can't trial one until you've already built it into the room. Then it's yours, for better or for worse. How, then, can you be sure to select the right boom? Here are five tips for trialing equipment booms from three managers who've been there.

Know what you want
This may sound simplistic, but the managers we talked to strongly advise articulating why you want a boom and what you expect from it. The chief reasons for installing equipment booms are the increased efficiencies that come from freeing up floor space and the safety that results from getting dangerous cords up off the floor.

"In my prior place of employment, we moved portable towers from one room to another, hooking and unhooking the many cords and cables. The efficiency of easily moving the boom out of the way when you're not using it and the availability of immediately having it ready is a definite plus with room turnover time," says Marlene Brunswick, RN, the director of nursing at the Findlay Surgery Center in Findlay, Ohio. "Having the cables off the wet floor is also a safety advantage. They are electrified and pose a tripping hazard. When you're doing video cases, many surgeons prefer to have the room lights dimmed or off. I worked with a nurse who literally broke her ankle when she tripped on a video cable."

Ms. Brunswick recommends creating a list of specific functions you want your boom to perform. For example, will you need CO2 for insufflation now or in the future? What other kinds of connections will you need? Will you want to digitally transfer X-rays or MRIs to your flat-panel monitors? If so, are you going to need a second monitor for viewing these images? Or, you may need an additional monitor for a second surgeon who stands on the other side of the patient. Answers to these questions will help you determine exactly what equipment you'll need to install on your boom(s) and, thus, which connections and interfaces will be required.

"In my cardiac room, I initially had one flat-screen monitor hanging off the boom so the team could see the live picture during endoscopic vein harvesting," says Kathleen Brooks, PA, regional director of perioperative services with Bassett Healthcare in Cooperstown, N.Y. "But the surgeon came to realize he wanted to route the patient's vital signs to the monitor during critical times, like during warming and pump removal, and we had to mount a second monitor. The surgeon didn't understand how much value he'd find in this."

Importantly, adds Ms. Brooks, know how the boom fits into your overall vision for your OR. Ms. Brooks knew she needed booms for her four ORs because they fit into her larger plan to centralize nursing functions. "I watched nurses crawl under tables to get to the Bovie, shimmy behind surgeons to adjust the insufflator and generally run from one side of the room to the other adjusting the heat and lights," she says. "I wanted to create a centralized control station, sort of like an air traffic control station, and the booms were an essential step toward achieving this goal."

Get input from everyone
Our managers also advise soliciting input from each and every person who'll be in the OR - including nurses, techs and each surgeon. "You really must understand from everyone's perspective what goes on in the room," says Ms. Brooks. "If you have six docs doing lap choles, talk with all six of them. Where does Dr. X typically put the tower? Where does Dr. Y position the video monitor? How does this differ from Dr. Z's preferences?" This information, she says, will help you define the working area within which your boom must function, not to mention the number of booms you'll need and their placement.

That is, advises Ms. Brooks, evaluate the arm reach and arc of any boom system you're considering and be sure it works with every possible OR table placement and patient position. "We needed a boom system that would allow us to go from foot and ankle procedures to rotator cuff surgeries and allow us to switch from one total knee procedure to another. One key to this versatility was good arm extension," she says.

Insufficient arm reach is the most common complaint of equipment boom users, suggests an Outpatient Surgery Magazine reader survey. The experience of Nancy Gondringer, CRNA, MA, director of surgical services with St. Elizabeth Regional Medical Center in Lincoln, Neb., is a case in point. She regrets not getting input from everyone when she was looking for her orthopedic boom system, she says, because it doesn't work for all cases.

"Our orthopedic booms are not ideal," she says, "because the ortho surgeons move the table in so many different ways and we didn't think of everything beforehand. Now, when we position a patient for a right shoulder procedure, our boom just doesn't reach far enough. Sometimes we have to push it against the wall just to get it out of the way."

Still, adds Ms. Brooks, this doesn't mean you'll find a boom system that will enable every doctor to do everything the way he's always done it. For this reason, she says, the input process must work both ways. "A boom is a big change and despite its versatility, it requires some standardization," she says. "Sit down and talk with the surgeons about how they will use the boom to do each procedure. I had conversations with our docs and showed them how they could work with it."

Ms. Brooks call this process "change management," and she recommends having someone with a lot of OR experience act as the change manager. "Get someone who understands and who can ask the hard questions, who is confident enough in her clinical knowledge to propose new more, efficient set-ups and ways of doing things," she says.

Conduct investigative site visits
Site visits are essential, say our managers. And while you've probably heard this advice before, you may not have heard that the way you conduct them can make or break your boom purchase. That is, approach site visits as if you were an investigative reporter and speak to as many sources as possible.

"We visited a lot of different sites. We went into the ORs and moved the booms around," says Ms. Gondringer, "but we didn't talk to the people who used them. We relied on the directors or team leaders, but they're not the ones in the OR pushing the booms around."

Ms. Gondringer feels she may have avoided her problem with her orthopedic booms had she taken a deeper look during her site visits. "I encourage people to do more than visit. Be there when they're at their busiest," she says. Ms. Brooks agrees: "Go into the nurses' lounge, sit down and introduce yourself. Talk to them. You'll be amazed at what you'll learn."

Ensure compatibility
If you're not purchasing lights and booms from the same manufacturer, say our sources, be very sure they'll work together before you buy. And once you pull a system together, don't make any changes without first evaluating the domino effect of the change. Ms. Gondringer's experience shows that even small changes can create big problems. "At the end of our trialing process, our vendor gave us an upgraded set of lights. We didn't check to be sure they would swing freely. Now, our lights and boom arms don't cross," she says.

Ms. Brunswick says hospital-based managers should be especially conscious of the need for compatibility. "In the ambulatory setting, one person tends to handle the whole project, but in the hospital, many departments must work together. One person may be handling the video equipment, another may be handling the CO2 lines and each may not recognize the needs of the other," she says. "Share spec sheets throughout every step of the process and communicate."

Consider the whole picture
When evaluating booms, it can be all too easy to hone in on one feature at the exclusion of the big picture. While boom arm reach and range of motion are critical, say our managers, there's more to booms than that. Our reader survey showed that a common problem, for example, is boom arms that are too narrow to accommodate the many cables you'll need to run through them. "Our video monitor cords sheared off from the repetitive motion of the boom arms because the interior diameter of the arms was too small to carry all the cords and lines we needed. They were wedged in too tightly, and I ended up removing them and running them externally along the boom arms," says Ms. Brooks.

Outpatient Surgery Magazine's reader survey also showed that it's important to closely evaluate the following features: overall boom size in context of OR size; maneuverability; ability to adjust and lock the boom into position; ability to limit movement to avoid damage to equipment and walls; sufficient capacity; sufficient location, type and number of connections; adjustable shelves; expandability; cleanability; and good support and service.

"The vendor may tell you that you don't need stops on your boom, but you do," says Ms. Brooks. Without them, she says, the boom can go right through the OR wall. Service, too, is very important.

"We had one vendor that did a great job of selling, but they did not walk the talk, and I was badly disappointed," she says. "I should have checked into the service level of that company beforehand."

While trialing your boom, adds Ms. Brooks, take special note of ease of use. This, she says, is the biggest differentiating feature of the various boom systems. "You need the ability to move the boom around easily and keep it where it needs to be without drifting," she says. This is a function of boom weight, balance, proper installation and bracing and overall quality.

Boom or bust?
Our three managers agree you'll boost your chances of satisfaction if you take the time and make the effort to research your boom before buying. "Please, when going to see these booms, make sure you go to an OR that has them. Get the list of satisfied customers, as well as those who are having or have had difficulty. Do not rely on the showroom demonstration," says Ms. Brooks. "Be sure you understand all the costs to install, repair and maintain the equipment boom. Be sure your lights and booms work together and cross freely. Actively solicit nurse and staff input."

In a nutshell, open your eyes and ears and actively seek to learn from others' experiences. Chances are, you'll be glad you did.