Equipment booms can serve many needs in the OR, but at Saratoga Hospital in Saratoga Springs, N.Y., their main appeal to surgical staffers is that they'll make sure a room's video equipment stays right where it is.
"Booms keep nurses from having to be hunter-gatherers," says Sharman Lisieski, RN, CNOR, the hospital's OR and PACU director. "We're not pushing the cart from room to room. Turnover time is a big piece of the day, and in the time it takes to retrieve and set up the video equipment, we can already bring the image up in the field."
Acquiring this advantage, and the other benefits of booms, depends on choosing a suitable system to install, which is no simple task. "It's a big investment. It's a huge change in culture," says Kelly Spivey, vice president and project manager at healthcare technology consultants GBA, Inc., in Franklin, Tenn. "It's not a cookie-cutter solution. Every operating suite and endo suite is different." Here are some of the factors that can determine the boom that fits your OR.
Ceiling or floor?
Recent decades have seen ORs increase in size and integrate significantly more technology. Equipment booms can offer flexibility, safety, more efficient use of space and easier room turnovers. While the selection and installation of a boom system primarily depends on the room's dimensions, particularly its height "from deck to deck," this decision quickly leads to an equally pressing question: Should it work from the top down, or from the ground up?
"What kind of ceiling does your OR have?" asks Arthur Ano, BSN, RN, CNOR, CST, clinical educator for surgical services at Long Beach (Calif.) Memorial Medical Center. "A hospital's old, reinforced ceiling can probably support a ceiling-mounted boom. But an ASC occupying a drop-ceilinged office space doesn't have that kind of ceiling."
Even if your ceilings are sufficiently high and supportive, boom installation is hardly a plug-and-play process. It may require in-depth renovation, which may require local authorities' approval, the construction team's advance evaluation and, worst of all, expensive OR downtime, says Mr. Ano, who previously served as his hospital's OR manager during a surgical construction project. "Having to reinforce the ceiling can be a huge ordeal," he notes.
"Most people just assume that if you want a ceiling-mounted boom, you have to build it into new construction," says Ms. Lisieski, whose hospital is in the midst of a 10-OR addition that is doing just that.
ORs that can't accommodate ceiling-mounted booms aren't excluded from the equipment's efficiencies, though. Floor-mounted booms can be installed without tearing up ceilings or even room renovations, and they don't take up much more of a footprint than the video carts they're replacing. "These can be put in within 48 hours," says Mr. Ano. Because they're bolted to the floor, they offer stability without the permanence of a ceiling-mounted fixture.
If, however, you're open to the concept of a portable boom system, for flexibility's or economy's sake, that option now exists. One manufacturer has recently introduced a boom mounted on a rolling cart. Like floor-based systems, it can be put to use anywhere that it can be plugged into electrical power, but unlike them, it can easily be moved within a room or to another. "If I were a small ASC, I would give serious thought to a cart boom," says Mr. Ano. "Its portability could be a huge asset."
For OR occupants, the question of ceiling- versus floor-mounted booms might actually take a back seat to considerations of practical use. "All that above-ceiling structure and support, that's the concern of the engineer and the architect," says Ms. Spivey. "For clinicians, that's not their biggest concern. They know what they need and are very particular."
Your choice of booms may be heavily influenced by the types of procedures to be conducted in the rooms, and the preferences with which physicians carry them out.
At Saratoga Hospital, booms are the key to creating cutting-edge minimally invasive surgery suites. "We're doing a lot of laparoscopic procedures, so video integration is a big factor and our physicians were most interested in the AV aspects of the booms," says Ms. Lisieski, including the number, size and positioning of display monitors that its arms could accommodate.
"Surgeons want to know if equipment will reach to where they want it," says Ms. Spivey, recalling the facility that mocked up a model of a boom in the space that would become an OR. "A surgeon came in he was very tall and asked, 'Will these 2 lights come over here so I can do a hip on this side of the table?' He pulled them over, said, 'Yep, I can,' and then he left."
Nurses and techs, on the other hand, have ergonomics on their minds. "The ease of use. How heavy the arms are, how easy it is to move them," says Ms. Spivey. "We hear a lot that that will make their decision."
Ms. Lisieski agrees. "You don't want to have to push the arms feeling like the brakes are always on, and you want them to stay stable where they're placed."
Booms are designed for efficiency, but that efficiency may come with unintended consequences. "Like any large piece of equipment, it can change the workflow of a room," says Mr. Ano. "At one hospital we visited, it took some time for staff to get used to it. They had to bring stretchers in the door at a different angle."
That's why site visits and sit-downs with other boom buyers are so important. "I toured the manufacturing plant, I visited hospitals to see them in use, to see them being placed, I took a zillion pictures," says Mr. Ano.
"For our visits, we sent a well-rounded group: a physician, a biomedical engineer, our purchaser, 2 administrators, some nurses and the architect went. The same group went to each visit, to keep it consistent," says Ms. Lisieski.
"Be sure to ask, 'Was there anything you purchased that you're thinking twice about now?' as well as 'What didn't you get, that now you wish you did?'" says Ms. Spivey.
But what's the best way to figure out how a boom will actually fit in your own OR? Ms. Spivey says that, given the availability of a support structure, it's possible to install booms for trials. To many facilities, though, surgical or construction schedules make this impractical. And while manufacturers can provide drawn plans and even 3D renderings, "walking through an OR is a great way for surgeons to truly get a feel for the space," says Ms. Spivey.
"We figured out the footprint and put cardboard shapes on the floor," says Mr. Ano. "This is the base ?we taped it down these are the arms, this is the floor space and air space they'll take up. The big thing with any boom system is, you've got to check your clearances," he says. "You don't want your thousand-dollar monitor to crash into the wall every day, and you have to make sure the boom doesn't rotate into movable equipment."
In the end, installing a boom system comes down to knowing what you need and collaborating with manufacturers, equipment planners and/or builders to get it. "It's their space," says Ms. Spivey. "We tell them, 'You're the one that's going to live here for 8 to 10 hours a day. Let's talk about how we can make it work.'"