GO TO THE ORIGINAL SOURCES Ask your surgeons and staff what they want in an ortho table, says Kate Gillespie, MBA, RN, NE-BC, administrator of the Virtua Joint Replacement Institute in Voorhees, N.J.

Around this time last year, I began the task of outfitting our new, state-of-the-art joint replacement center — all 53,000 square feet of it. I had a lot of rooms to furnish: 4 of our 6 ORs, 30 private inpatient rooms and a therapy gym. My most critical capital equipment decision? Hands down, which OR tables to buy.

After all, the tables I selected would be the centerpieces of our orthopedic ORs for years to come. They'd have to handle the heavy pounding of around 1,500 total hip and knee cases each year. And they'd have to please our divergent group of surgeons, one of whom was most concerned with how low the table could go and one of whom was most concerned with how high the table could go.

Four tables and more than $150,000 later, I'm here to share what I learned about buying ortho tables that will satisfy your surgeons, techs and nurses, and position your patients safely and securely. I can condense my advice to 3 steps:

• Do your homework. Find out which features matter most to your OR team. The only way to do this is to sit down with those who'll be working around the table and ask, "What do you like? What are your requirements? What do you need in a table?" As Mark Twain said, supposing is good, but finding out is better. Your job is to collect facts and to understand the features that matter to your customers (yes, your surgeons are your customers and your staff are your associates), and then find the tables that best match up.
• Let your surgeons test-drive before you buy. More so than any other piece of OR equipment, your surgeons will want to take a table for a test-drive. Buying a table is just like buying a car: You want to drive it before you buy it. Make it your responsibility to arrange for your surgeons to visit a nearby facility that's using the table you're considering. Let your docs work the table's controls and test out its motor after the day's cases are completed.
• Follow manufacturers' recommendations when you clean your table pads. Who knew that residue from the bleach in the wipes we use to clean our tables between cases would slowly disintegrate our table pad covers? More later on that costly lesson we learned the hard way.

TABLE SAFETY
Beach Chair or Lateral Position for Shoulders?

BEACH CHAIR Is it dangerous to perform shoulder arthroscopy in the beach-chair position?

How do you position your shoulder arthroscopy patients? A couple of our doctors prefer the lateral position, but most use a beach-chair attachment on our standard OR table for their shoulder cases.

It's been reported that beach-chair patients can become hypoxic being in the upright position, but you can maintain cerebral blood flow by carefully monitoring the patient. Most surgeons like the access and the comfort the beach chair affords them. It's a little harder to manipulate the shoulder and pressure points when patients are in the lateral position, so the beach chair is a preferred choice at our facility. The advantages of the lateral position are decreasing the patient's risk for adverse neurologic events due to cerebral ischemia and not having to secure a big attachment to the bed.

As a safety precaution, we'll secure a beach-chair attachment the night before so it's ready to go first thing in the morning. And as a policy, we have 2 staff members check that the attachment is secure before we position a patient on it.

— Harriet H. Willoughby, BSN

Ms. Willoughby ([email protected]) is the administrator of the Gadsden (Ala.) Surgery Center.

Go straight to the end users
Probably the greatest piece of advice I can give you is to thoroughly research what your surgeons and staff want in a table. Remember, you're not buying the table for you; you're buying it for them. Take your notebook and pen and go interview as many of your end users as you can — not just your orthopods, but your OR techs and nurses as well. You'll likely find that your surgeons and staff value different things in a table.

Your surgeons want a powerful motor. They'll want to push a button and count backwards from 5 to see how long it takes to move the patient up or down. They'll want controls that are easy and intuitive to use, and they'll want those controls to be the same in each OR — even if the tables are different makes or models. Table pads? See, this is why I'm glad I went straight to the sources. I'd assumed that we'd want soft, cushiony pads for patient comfort. Just the opposite is true, I learned. Surgeons want firm, sturdy pads so patients won't sink down when they're placing hardware or implants firmly into place. So, yes, we went with standard table pads rather than upgrading to thicker, softer pads. Also in the glad-I-asked category: One of our surgeons prefers the anterior approach for total hip replacements, so I made sure that one of our tables came with the sliders he needs for improved access to the joint.

Techs and nurses, on the other hand, want different things from a table. How easy is it to remove and secure attachments into place? How easy is it to get patients on and off of the table? Can the table easily accommodate a C-arm? What about the table's weight capacity? Ours have a 600-pound weight limit. When you shop for a table, keep in mind that you'll likely be treating many obese patients. The last thing you want is to cancel a case because your table can't accommodate a patient's weight.

Of all the equipment we purchased for our new joint replacement center, our surgeons were most interested in inspecting the tables to ensure that they'd work for them individually. In fact, they insisted on it. The rest of the equipment we easily reached a consensus on. Not the tables, however. Our docs wanted to see them in action and play with all the buttons. Talk about an hour well spent.

About those pads
We ended up buying 2 different types of tables from a single vendor: 3 top-of-the-line ortho tables and 1 slightly more expensive table that came with a slider to accommodate our anterior approach surgeon. All 4 surgeons can use both types of tables. We priced out attachments, but ended up negotiating them into the bundled purchase price.

As the administrator, I was certainly concerned about the price, the warranties and the timeline for delivery. As a new facility, we had to have the tables in place for our department of health inspection. Thankfully, our vendor delivered on time.

Four of our 6 ORs are open 4 days a week (we operate Monday through Thursday). If our case volume continues to exceed our forecasts — we did more than 800 cases in the first 6 months this year — by the end of next year or early 2015 we'll bring a 5th surgeon on board and open up ORs 5 and 6. Those rooms are shelled out and wired, so all we will have to do is buy the movable equipment. I'll know just what questions to ask when we're ready to buy 2 more ortho tables. Will it be easier the second time around? Yeah, I think so!

Now, about those table pads. Per the table manufacturer's cleaning instructions and our infectious disease department's evidence-based protocol, we wiped our pads down between cases with bleach-impregnated wipes. But rather than wiping off the bleach residue with a damp cloth, we let it air-dry. Over time, however, the bleach seeped into the fabric and caused all 4 pad covers to disintegrate and crack. The pads were never part of the warranty, so we had to pay to replace all 4 of them. I consider this a small setback in an otherwise highly satisfactory transaction. Our new policy is to wipe the residue off the pad with a damp cloth after the bleach has air-dried.