Surgical tables with portable tops that can be wheeled in and out of the OR on a trolley and adjusted to fit almost any type of procedure are designed to spare nurses' backs from the strain of lifting patients, protect patients from falls and enhance your facility's efficiency and flow. Installing these table systems requires both a significant financial investment and a commitment to a whole new way of transporting patients throughout the perioperative process. We recently traveled to Washington Township, N.J., to tour Kennedy Memorial Hospital's new 9-OR surgical suite with Nurse Manager William Judge, RN, (pictured, with yours truly playing the part of patient) to show us, step by step, how these tables work in practice.

Step 1: Putting the pieces together
Kennedy's portable-top table system consists of 3 parts.

• (a) A fixed base bolted to the floor of each OR.
• (b) The portable tabletop, which consists of a frame and a fixed pad in the middle. Additional pads and pieces can be added to adjust the table to accommodate a variety of patient sizes and positions. Kennedy also has some specialty tops for specific types of procedures.
• (c) The trolley, consisting of 4 wheels, a handle and a foot pedal, which is used to wheel the table in and out of the OR, connect the tabletop to the base and remove it from the base after the procedure.

One of the trickiest aspects of implementing portable-top table systems is determining the ratio of bases to tops to trolleys, says Marcia Redden, BS, RN, corporate director of perioperative services at Kennedy. Obviously there's 1 base located in each OR. The base is the only element in the system that doesn't move once it's in place, so choosing where you want to position the base in relation to lights, booms and other equipment in the OR is a decision you need to make early in the design and construction process if you're building or renovating an OR, says Ms. Redden.

How many tabletops and trolleys you'll need depends on a variety of factors, including your case mix, case load and average case times. A consultant from the table manufacturer helped Ms. Redden sort out an appropriate mix of tabletops, attachments and trolleys based on her facility's needs; they ended up with more tabletops than bases and more trolleys than tops. For the most part, Ms. Redden says, the consultant's original predictions about the facility's needs have proven correct. They've only had to make a few adjustments, which the manufacturer was more than willing to accommodate, since the new surgical suite opened in July.

Step 2: Smoothing the transition
The healthcare industry's aging workforce has surgical facilities seeking alternative ways of lifting, positioning and transporting the growing number of overweight patients presenting for surgery. "The average age of the OR nurse is 50, and it's inching toward 55," notes Ms. Redden, explaining why she chose to go with the portable-top tables and a mechanical patient transfer system that nearly eliminates the need for manual lifting in the OR.

In theory, portable-top tables are similar to stretcher tables in that they let the patient remain on the same surface from pre-op to PACU. You may choose to use them in this manner at your facility, but because the tables are used for both inpatient and outpatient procedures at Kennedy, and the tabletops don't provide enough comfort and protection for patients' skin integrity over long periods of time, surgical staff use the mechanical transfer device to move patients from pre-op stretcher beds to the OR tables, then back to beds for recovery. The transfers occur outside of the OR in an area specifically designated for that purpose. All members of the surgical nursing staff at Kennedy were trained to use both the new portable-top table systems and the transfer device; all were required to test the system out from the patient's point of view, too.

Step 3: Getting in and out of the OR
Once patients have been transferred to the surgical tabletop mounted on a trolley, they're wheeled directly into the OR. The table operator aligns the trolley holding the tabletop (with patient aboard) over the base affixed to the floor and "clicks" the tabletop into place using a foot pedal and a remote control. The transition is so smooth that the patient can barely feel the change when the trolley is then removed, leaving just the base and the tabletop and freeing up space for other equipment, such as C-arms, to slide underneath the table as needed. When the top is fixed in place, operators can use either a remote control or the control panel on the side of the base to tilt, rotate or otherwise move the table into the optimal position for the procedure to be performed.

Step 4: Parking the tables
If you're considering portable-top tables, think about how and where you're going to store the various moving parts. Ms. Redden says the convenience of standardization — using the same basic table system in every OR, with the ability to make adjustments for different procedures and patient needs — was a big factor in her decision. "I've been to facilities where they had a specialty table for everything, but where do you put them all?" she asks. Storage is always an issue with large equipment like tables, but Ms. Redden says Kennedy purposely designed the halls of its new surgical suite with many alcoves that provide convenient parking spots for tables and trolleys when they're not in use. And since the tabletops can be converted and adjusted to fit just about any procedure done at the facility — Ms. Redden likens them to "Transformers" — none of them end up sitting in storage wasting precious space for very long.

Ms. Redden says the tables are delivering on their promise to streamline patient flow and relieve nurses' backs from the strain of manual lifting. She also sees the facility beginning to recoup its significant investment in the table system. For example, she says it will cost the hospital about $55,000 less to purchase an attachment that lets the existing tabletops be used for spinal procedures than it would to purchase a whole new specialty table for spine.