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Shedding Light on LEDs
They're brighter, they're cooler and they're being hung in an increasing number of ORs. Is it time for you to upgrade?
Daniel Cook
Publish Date: July 13, 2008

After bathing incisions in their incandescent light for more than 20 years, the OR lights at Baptist Hospital Northeast in La Grange, Ky., finally began to give out.

"They were functioning poorly, they were hard to service because we could no longer get parts, they'd wander during surgery and were hard to move back because they were so heavy," says Barbara Ritchie, RN, Baptist's director of surgical services.

It was time for a lighting upgrade, but to what? Should the hospital install newer, costlier LED lights in its three ORs or buy an updated version of the conventional lights already in place? Here's advice to consider when your time to answer that question comes along.

Three month-long trials
Ms. Ritchie visited facilities in her area to see different systems in action, but decided to trial three models in her hospital, in her ORs, above her surgeons. She did her due diligence, asking the high-volume surgeons for the performance features they desired, then researched the market to find the brands that matched their requests: bright, high-quality light that's easy to adjust during surgery. Ms. Ritchie focused on three systems, two conventional lights and one LED model, that meshed with those needs and her own bottom line — the bottom line.

"It was going to be a big purchase for us. The lights had to be cost-effective and durable," she says. Ms. Ritchie asked each brand's rep to install a system her surgeons and staff could trial for a month, and had them placed in adjacent ORs. A key to the trial's success: The reps provided training after the installation and were available throughout the month for further instruction.

How LED won over this surgeon
Controlling the intricate LED system required more coaching than was needed for mastering the conventional lights, but it was the ability to manipulate the brightness, intensity and focus of the LED lights that sold general surgeon Thomas Hart, MD, in the side-by-side comparison. Conventional lights, he says, cast shadows on different areas of the table, necessitating multiple adjustments around OR personnel to keep the lights' brightness focused on the surgical site.

That constant maneuvering can break a surgeon's concentration, slow case efficiency and create possible breaks in sterile technique. LED lights, on the other hand, are more versatile and offer multiple configurations that focus intense light onto the surgical site from various angles, minimizing shadows in the sterile field.

The LED lights also provide multiple intensity levels, letting surgeons adjust not only the light's brightness but also its intensity and color — from a more yellow light to a more white light, for example — to give physicians improved visibility of the surgical site, regardless of their preferred light settings. Dr. Hart says LEDs not only give him a truer look of the surgical surface, but let him look deep into the body cavity with unmatched clarity.

Justifying the expense
The LEDs installed at Baptist are rated for a service life of 20,000 hours — about nine years — says Ms. Ritchie, so although the lights were more expensive than the conventional option — they cost about $99,634 to install in three ORs — she believes she'll realize significant savings on the back end. When one of the incandescent bulbs burned out in the hospital's former light systems, it had to be replaced on the spot before a case could continue. If you factor in the cost of both the bulbs and wasted OR minutes, installing the more expensive LED lights may make ultimate financial sense.

Consider that each system is comprised of a three-pod light and five-pod light, containing 111 and 184 separate LED light sources, respectively. All told, Baptist's LEDs use 295 watts of electricity. That's a favorable amount when compared to the lights they replaced, which burned 750 watts to 1,000 watts.

And unlike conventional surgical lights, LEDs emit very little heat, keeping surgeons and staff cool during surgery. "Especially now that we're keeping OR temperatures warmer to decrease the risk of surgical infections," says Dr. Hart. "Add the intense heat of conventional lights and the rooms feel very warm. After the LED installation, that hasn't been much of a problem."

Ms. Ritchie asked the surgeons to complete feedback forms throughout the hospital's month-long trial, giving her the user insights she needed to move forward with the decision-making process. Notably, Dr. Hart, who, by his own admission, doesn't get exceedingly happy about much, was impressed with the LED lights. In the end, after weighing cost against clinical performance, the hospital's administration chose to install LED lights in the facility's three ORs.

Increased demand
These new, cool, bright lights are still a burgeoning technology, says Lynne Ingle, RN, BS, MHA, CNOR, of Gene Burton and Associates, a medical equipment planning firm located in Franklin, Tenn.

"I used to tell my clients to wait, to let others experiment with the lights," she says. That's no longer the advice she gives.

Ms. Ingle is currently working on completing a hospital build in California that broke ground four years ago. At the time, LEDs weren't an option.

The new hospital's administration now wants to hang the latest lights before opening the ORs for the first time. "We added to the equipment budget for the light upgrade," she says. "I'm seeing that trend in projects I've already started and in brand new construction. More and more facilities are sold on the idea of transitioning from incandescent or halogen lights to the LEDs."

That idea is centered, in her mind, on surgeon and staff comfort. "How many times have you heard surgeons complain about a hot OR?" she asks. The LEDs do help keep surgeons and staff comfortable, especially during long, complicated cases. Ms. Ingle remembers seeing a surgeon walk out of an OR after a seven-hour procedure that he performed under LED lights for the first time. His usually drenched scrub top was bone dry. "A cooler light can make a difference to the OR team," she says, even during cases of shorter duration.

Ms. Ingle also points to the light quality offered by LEDs as a major selling point. "The reds are redder," she says, and the light is brighter than conventional options. "When incandescent bulbs burn brighter, the brightness is almost glaring."

Lighting the future
Ms. Ingle says you should expect to increase the surgical lighting line item in your capital equipment budget by 15 to 20 percent to cover the cost of LED systems. Broken down to a per-OR cost, she estimates you'll spend in the high 20s to low 30s for your surgeons to work under LEDs. Like any new technology, the prices may eventually drop when the "wow" factor wears off. For now, you'll likely pay a premium for the light's higher quality.

That additional expense, says Ms. Ritchie, has been worth every extra penny. "When you make an expensive purchase, you want the equipment to last a long time, even as equipment advances so quickly," she says. "LED is the newest technology and it's the technology of the future."

The future of LEDs is bolstered by marketing claims of bulbs lasting for upwards of 30,000 surgical hours — that would be about 10 years from the day you're reading this — and light quality that remains constant over the life of the system. Those claims are obviously hard to corroborate. "How can we know that now? Those are things we'll have to prove further down the road," says Ms. Ritchie. "But I do believe that incandescent and gas lights will eventually go away completely."

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