As with any piece of major OR equipment, the wrong surgical table can throw a monkey wrench into the best-laid surgical schedule, not to mention the budget. Before buying your next table, consider these six lessons our readers learned.
Get input from everyone
Get input from your entire OR staff, not just surgeons and anesthesia providers. "RNs and techs have their own needs," says Mary Schafer, RN, CEO of Dupont Surgery Center in Fort Wayne, Ind. Many who responded to an Outpatient Surgery survey cited weight as a top concern among staff who have to manipulate patients and tables. "Use the demo table as much as possible, involving staff, surgeons and anesthesiologists, and consider your aging staff members who will be using the table," says MaryAnn Conlon, director of perioperative services with Huntington (N.Y.) Hospital.
Staff should evaluate the weight and ease of use of accessories, which can vary substantially from one manufacturer to another. "Several types of tables we trialed had very heavy attachments that were hard to manipulate and difficult to attach, like the foot board," says Donna Walker, RN, surgical services manager with Highland District Hospital in Hillsboro, Ohio. Also evaluate whether the new table will work with any existing attachments you may want to continue using.
You're less likely to overlook factors that may become relevant later when you involve the entire team. Many of our survey responders who didn't opt for battery backup, for instance, say they now wish they had. Others stress the importance of ensuring durability, reliability and cleanability. A reader who discovered that her surgical lifter doesn't align with the base of her new table says her staff has to pull gynecologic patients up on the table before they can move the lifter into place.
Remember your patients' needs
In our reader survey, those who had regrets about their table purchases cited insufficient weight capacity as their top concern. "We do not do bariatric surgery, but we have many large patients (usually shoulder patients in our center) who need a bariatric weight span," says Mary Jane Patterson, RN, director of surgical services with Fisher Titus Medical Center in Norwalk, Ohio.
Most agree that a table with a lifting capacity of 300 pounds just doesn't cut it any more, and many are opting for a lifting capacity of 1,000 pounds - in part because the actual patient capacity (or the articulation capacity) declines substantially to as low as 500 pounds to 600 pounds after you add on accessories and place the patient in any position other than supine.
Issues like padding and ergonomics of accessories are also important considerations. "We recently switched our stirrups because I didn't feel like patients were secure enough in the prior stirrups," says Eloise Whitton, nurse manager with Higgins General Hospital in Bremen, Ga. "When the patient is secure, the surgical team is more confident."
Go versatile, but don't take it to the extreme
Versatility is the key feature of surgical tables: A full 85 percent of our survey responders ranked versatility as "very important." In fact, many recent purchasers of surgical tables tell us they're very happy with the variety of surgical procedures their tables can be used for, thanks to radiolucency, easy-to-use attachments, sliding tops, adjustability and articulation. "We purchased a carbon fiber extension to be used with our image guidance system. This extension lets the table be very versatile," says Olivia Wescott, RN, the perioperative materials manager with Glens Falls (N.Y.) Hospital.
Joyce Hartner, RN, CNOR, the director of surgical services with the Susan B. Allen Memorial Hospital in El Dorado, Kan., says her new table easily accommodates procedures across the spectrum, including urological procedures, orthopedic cases and laparoscopic cholecystectomies. "Our new table lets us alter the patient's position on the table to accommodate the C-arm, thanks to articulations and extensions that we can add to either end," she says.
But don't take versatility to the extreme and ask a single table to do more than it's able to. Paul Aitken, director of Valley Hospital in Palmer, Ark., says his surgeons can do urological and arthroscopy cases back-to-back on his new table. But fractures pose another issue. "It takes up to a full hour to modify our table to accommodate the major fracture component," he says. His advice: If you can justify a specialty table because of high volumes, don't compromise function for versatility.
Give it time
A thorough evaluation is the only way to get what you need, our readers say, and that means allowing time for as many of your surgeons and staff to do as many procedures as possible on a demo table, says Patty Sebald, director of surgical services with Saint Louise Regional Hospital in Gilroy, Calif.
For example, if you use lots of fluoro, use the demo table for many C-arm procedures. "This will help you determine how well the C-arm maneuvers under the table in all positions," says Ms. Walker. "Some tables require more manipulation than others, like having to move the patient down on the table to make the pelvis accessible for fluoro."
Many managers praised sliding tabletops, which eliminate time-consuming and sometimes backbreaking patient manipulation.
Table consumers advise standardizing tables and accessories. "Everybody needs to know how the bed works, no matter what room they're in and no matter what the clinical situation," says Ms. Hartner. "You need the ability to have an immediate response from everyone, and you need to be able to trade parts from one room to another because you never know what will come up."
Deborah Linafelter, RN, the director of perioperative services at Saint Anthony's Health Center in Alton, Ill., says standardization has also helped her ensure better service. "We used to have four different brands of tables," she says. "Now we buy from one manufacturer, in part because this lets our biomed folks learn the tables and make basic repairs."
Bundle your purchases
Once you decide on a make and model, bundle your accessories and add-ons into one purchase, and use your buying power to leverage a better deal.
"When we purchased our table, we didn't get the headpiece and other accessories we need to do cataract surgery," says Ms. Whitton. Although she couldn't have known her cataract volume would skyrocket after she bought the table, she advises you buy tables and accessories together, especially if you work in a bureaucratic environment. "We had to scramble to add the accessories into the budget, go through a lengthy administrative approval process and fill out lots of paperwork, and this delayed our purchase," she says.
Another director of surgical services tells us she had to buy an extra-wide kit for obese patients, yet she also paid for the standard kit, which she removed, stored and has never used. In retrospect, she says, she might have been able to turn her need for a bariatric weight span into a better deal for her facility.
Now or later?
Our panel says these six lessons are best learned before, not after, you buy. A final consideration: your service contract. "It does no good to have a Cadillac table with Yugo support," says Maggie Murphy, RN, surgical services manager with Mem-orial Community Hospital in Edgerton, Wis.