SHARPER IMAGE Robert Zehr, MD, assisted by Mark Cannedy, CST, enjoys the benefits of 4K imaging during a knee arthroscopy performed at Seaside Surgery Center in Naples, Fla.

The paint's dry and the tables have been rolled into place. All that's left to decide is what kind of images will flash across the monitors that hang in the sparkling new ORs. For the Seaside Surgery Center in Naples, Fla., which practices exclusively in orthopedics and podiatry, the opportunity to provide surgeons with 4K images that burst off the screen in deep colorful hues was too tempting to resist. But for Aurora Health Care, a surgery center in Burlington, Wis., the need to handle a broad range of specialties led to an integrated high-definition-based system that addresses everyone's needs. If you're building, expanding or updating your ORs, learn from these facilities' experiences to find the system that works best for you and your surgeons.

Consider the options
There's no question that 4K, with resolution that's 4 times greater than that of high-definition, provides a wow factor — and many are convinced that it leads, or will lead, to better outcomes. But if cameras and monitors aren't compatible, the benefits of having a 4K monitor will be negligible.

"The technology will be fine once all laparoscopic cameras are 4K-compatible," says Yuman Fong, MD, chief of surgery at City of Hope (Calif.) Medical Center and co-author of the book Imaging and Visualization in the Modern Operating Room. "But most facilities have 1080 (high-definition) cameras or less, so 4K monitors don't help them."

That lack of universality was a deal-breaker, says Lori Dostalek, RN, BSN, CNOR, the OR manager at Aurora Health Care, which opened in October 2016 and offers a wide range of specialties. "We considered 4K, but it would have required investing in specialty cameras and lenses," she says.

Instead, they chose a universal system so all the lenses and camera heads in the facility would be interchangeable. "The system we got also had laparoscopic lenses and arthroscopic lenses," she says, "so that was very beneficial to all the surgeons who operate here."

COMFORT LEVEL Standardization was important to leaders at Aurora Health Care, because the center's surgeons also operate in nearby hospitals.

The cost of 4K continues to make it a big-ticket item — too big, says Dr. Fong, who remains skeptical of the price, though less skeptical than he used to be. "Two years ago, I'd have said it was a bad investment," he says. "It was very, very expensive. Now it's much cheaper, but I still think the price is too high."

Seaside Surgery Center, which opened in November 2015 and specializes in outpatient total joints, spent around $250,000 to add 4K imaging to its 2 ORs. It wasn't just a good investment, it was a great one, says Cindy Schuetz, RN, the center's administrator. "Insurance reimbursement is often sketchy," she acknowledges, "so cost is a big piece of what we consider, but we also want quality."

To be sure they'd end up with the quality they insisted on, her center trialed 4 different systems for at least 2 months each, including another with 4K capability. "Our physician partners ultimately made the decision, with our input," says Ms. Schuetz. "And not a day goes by that we're not thrilled to have 4K here."

More than meets the eye
The wow factor of the 4K system they chose has actually gone beyond crystal-clear visuals, says Chris Chase, CST, who works in sterile processing at the center. She ticks off numerous other benefits, including the sterilization capabilities, the ease of use for surgeons and staff, the kinds of warranties that are offered and having a platform that can be expanded as time goes on.

The entire system is fully autoclavable — including scopes, cameras and shavers — so there was no need to buy a low-temperature sterilizer, says Ms. Chase, who adds, "That would have been an expense both to buy and run."

4K technology is bound to attract physicians and impress patients. But will it lead to better outcomes? That's going to be really hard to prove, says Dr. Fong. "It might be that it adds to surgeon comfort, but even if he can move a little faster, is saving a few minutes in the OR going to make it worthwhile?"

Absolutely, says Ms. Schuetz. "You can't show documentation that says the technology is better, but you just know," she explains. "The patient is under anesthesia for less time because the doctor can see what he needs, and is able to do the job as quickly as possible."

The small advantages all add up, says Ms. Schuetz. Another example: Surgeons can download high-resolution images and email them to patients. "We get a lot of snowbirds down here," she says. "They may come to us to get their knee or shoulder scoped, then go back north and see a doctor for a follow-up appointment. This way, they have the pictures to show them."

STILL STUNNING Standard high-definition images provide more than enough detail to satisfy many surgeons.

Pre-planning is crucial
There's no question that whatever your imaging needs are, careful pre-planning is likely to be a crucial part of determining which system provides the right fit for you, both physically and procedurally.

"We toured other facilities and gained some knowledge, not only about what was working for them, but also about what didn't work out, so we wouldn't make the same mistakes," says Ms. Dostalek. "We also had trials where we set up a mockup of the OR in a big staging area. We had all the measurements, so we could get a feel of what it was going to be like to work in the space."

The final layout was the result of collaboration among the vendor, the architects and the frontline staffers. "It was important to have the staff involved, because they're going to be working in the room," says Ms. Dostalek. "They know how things flow and what doesn't flow."

Of course the support you get after the monitors are hung and the initial training is complete is also of paramount importance.

"They all did a good job," says Ms. Schuetz of the 4 vendors they trialed. "But the one we chose did an exceptionally good job. They educated our staff and told us everything we need to know. Our nurses can troubleshoot anything that can possibly come up."

And they've maintained their presence, says Ms. Chase, even though there have been no problems with the system. "It hasn't been just during the trial, or in the first month after purchase," she says. "They've continued that level of support."

It's like the old Maytag commercials with the lonely appliance repairman, says Ms. Schuetz. "Exactly," adds Ms. Chase. "If you pick the right system, the vendor will be the loneliest guy around. He'll just come by to see how you're doing." OSM

BRIGHT IDEA
Don't Hesitate to Lean on Lighting Experts

PROPER PLACEMENT Surgical lights shouldn't cast shadows over work areas and surgical monitors.

The cameras and monitors you choose for your OR are crucial considerations, but don't downplay the importance of carefully planning your lighting, too, says Yuman Fong, MD, chief of surgery at City of Hope (Calif.) Medical Center. The key, says Dr. Fong, is to include surgeons in the discussion, but ultimately to defer to lighting designers.

"In operating rooms there's only one operative zone," says Dr. Fong. "But you still need to light the nursing station and the anesthesia area. Nurses and anesthesia providers need to see what they're doing while the surgeon is working."

Surgeons, says Dr. Fong, may say they want 3 lights in a certain spot, not realizing that the third light simply creates shadows because the ceiling's too high or too low. "Some surgeons are very insistent on stuff that's not sensible," he explains. "But all lights are made to focus at a certain area, so lighting design should always be done in consultation with vendors.

"The only thing the surgeons should have to say is, 'I want this area to be bright,' not how many lights there should be or where they should be. Let the lighting designer figure out how many and where they should be for maximum illumination. Too many people don't take advantage of the vendors' expertise."

— Jim Burger