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How the Experts Equip Their ORs
From budgeting to booms and from scopes to service: a selection of good advice.
Outpatient Surgery Editors
Publish Date: January 10, 2009

Once you've begun planning a surgical construction project, it's time to start thinking about the equipment that'll fill the new space. Here's a sampling of the advice on capital purchases that we published in 2008.

Beat the Equipment Budget Blues
Because budgets are slim, most facilities have instituted a process for evaluating capital equipment requests. Although the process differs from facility to facility, here's how it typically works:

  • Request. The physician or staff member who wants the piece of equipment submits the request in writing, with a rationale. "The surgeon must personally present his case. It's up to him to justify his needs over his wants," says the perioperative director of an Ohio hospital.
  • Evaluation. A clinically trained manager evaluates and researches the request. Job one is doing a cost-benefit analysis or a pro forma. The research may also include examining like competitive products, obtaining price quotes, researching service contracts, checking the product for safety and risk management issues, and sometimes running the purchase by the biomedical and IT departments. Other important items include the cost of associated disposables and how the facility will be reimbursed and by whom.
  • Trial. If the product is deemed worthy, the manager will arrange for a trial of the product.
  • Budget. If the product looks like it will return a profit and it's popular with the facility's surgeons and staff, the manager adds the item to her capital equipment budget. But it's still not a sure thing. This person then prioritizes the item on the budget. Low-priority items often don't make it.

— "Capital Equipment Crackdown" (August, page 76)

Meet the future ahead of time
If you're about to build new ORs or renovate existing ones, prepare each room for the eventual addition of integrated surgical video and centralized OR controls. Even if outfitting an integrated surgical suite is low on your wish list, designing the space, conduits and basic infrastructure ahead of time will ease the later installation of hardware and cabling. Given the continued rise in minimally invasive and scope-driven procedures, you'll definitely need video and information routing and recording, remote communication for consulting and educating or central access to equipment functions someday.

— "Thinking of Buying ??? Centralized OR Controls" (July, page 74)

Wants vs. Needs

Help physician-investors understand how much more equipment you can buy if they sacrifice their name-brand equipment wants and settle for what they really need. Educate the physicians about how much you can save by using remanufactured equipment; this is especially important for physicians that have been completely hospital-dedicated.

Gayle R. Evans, RN, CNOR, CASC, MBA
Continuum Healthcare Consultants
Kennesaw, Ga.
[email protected]

Budget for LED lighting
Equipment planner Lynne 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.

— "Shedding Light on LEDs" (July, page 36)

The language of high-def
High-definition, as opposed to standard-definition, and digital, as opposed to analog, cameras are the state of the art right now, and if you buy brand new equipment, it may be difficult to find anything that doesn't feature those technologies.

HD incorporates as many as 1,080 vertical lines of pixels in an image, as compared to standard definition's 480, for a sharper resolution. In the descriptive term "1080p," frequently used in product marketing to signify "true HD" or "full HD," the "p" stands for "progressively scanned," which means that each line is refreshed in each cycle, as opposed to interlace technology (seen in 1080i devices), where alternating lines are displayed in each cycle.

Image capture and display devices are also described in terms of "aspect ratio," which represents the image's width versus its height. An aspect ratio of 4:3 is squarer, like a standard-definition monitor or television set, while 16:9 is more rectangular or widescreen, and often adopted for high-definition uses.

— "Thinking of Buying ??? An Endoscopic Camera" (September, page 88)

Compatible controls
When selling cameras and scopes, manufacturers often claim they offer open architecture, then suggest that others' video components aren't compatible with them. The reality is, integrated OR systems are generally intercompatible. Everyone's handheld devices work with everyone else's systems, and most systems are able to control most tables, lights and other adjustable equipment. We've found, though, that some products' controls are proprietary and unable to be directed from a central station, so providing the manufacturers you're considering with a list of your equipment and asking about their systems' compatibility with those items can provide data for comparison during your request-for-proposal process.

— "Thinking of Buying ??? Centralized OR Controls" (July, page 74)

Will a boom fit in this room?
When installing booms in existing facilities, consider three points:

  • What are the structural materials of the building? It's not uncommon for people to convert office buildings that were never intended for medical use into surgery centers. Buildings with wood frame construction may not be capable of supporting ceiling-mounted booms, which are intended to support heavy loads of 500 to 1,500 pounds of equipment. Steel structural systems are more conducive, but concrete buildings are the best.
  • How big is your boom? Booms are available in different sizes, and the type with longer arms puts more stress on the ceiling support system. The long arms act as long levers — the further from the center-point they are located, the greater the increase in stress.
  • Do you have enough space? Booms require additional clearance above the ceiling for the structural supports as well as space within the OR to function. A small OR may not be appropriate for booms because of the additional space they take up.

— "New Booms in Old Rooms" (May, page 75)

Involve Your Clinical Staff

Whose advice should you seek when it comes to layout, storage and equipment placement? Your clinical staff. They're the ones who work in the environment you're creating and know what improves their efficiency better than administrators with no clinical background.

Carrie L. Frederick, MD
Plastic Surgery Center, PA
Portland, Maine
[email protected]

Keep patients moving
Outfitting your facility with stretcher beds means patients will remain on one surface from pre-op to PACU. Nurses don't have to transfer patients from stretcher to OR table and back again. Take this time-saving concept a step further by adding a footplate to each of your stretcher beds. The footplate is a raised shelf that holds vital signs monitors. Patients are hooked to the monitors only once — in pre-op holding — and remain attached to the equipment throughout the procedure and recovery period, eliminating the need to unhook patients from the monitors between pre-op, the OR and PACU.

— "Secrets to Our Cataract Case Efficiency" (January, page 32)

Refurbished tables
If you're looking to cut costs, buying a refurbished table is one option to consider. The ideal refurbished table will come complete with a warranty. Perhaps it's only a limited warranty, but that still offers some purchase protection. Carefully examine whether you're buying a table with the original motor. Tables are a good option for a refurbished buy because there are so few parts to rebuild — the tabletop, the base and the casters can easily be replaced — but the motor's the part that tends to expire first. And when the motor goes, you'd just as soon buy a new table.

— "Thinking of Buying ??? An Imaging Table" (April, page 70)

Two table accessory buying tips

  • Many table accessories attach to the table via table clamps or sockets. Some of the equipment has a round end or flat end. Be sure that you have the correct clamp or socket.
  • Many table accessories are heavy. Consider investing in carts to store your accessories so that your staff can roll them from room to room rather than carrying them. Not only will this improve efficiency, but also it will cut down on staff injuries.

— "Great Tables Need Great Accessories" (September, page 71)

Scopes in succession
If you're thinking of buying a new ophthalmic microscope, whether to outfit a surgical startup or to upgrade your existing ORs, most manufacturers will bring their latest offerings direct to you for demonstrations and trials. But I always recommend that surgeons and administrators visit association conferences to check out the scopes on the exhibit hall floor as well. That way they can test them all, back to back, and compare the advantages and disadvantages of each while the trials are fresh in memory, not spread out over the course of several weeks.

— "Thinking of Buying ??? An Ophthalmic Microscope" (November, page 87)

Mock Up Your ORs

We worked with our architect and rented a warehouse where we were able to draw out our floor plans and actually mock up our new suites, complete with cardboard figures for anesthesia machines, booms, laser machines and robots to best determine the placement of large pieces of equipment, recessed stainless steel cabinets, doors and computers. It really gave a much better projection of what we felt we wanted, and then we were able to make changes (in advance of construction) based on our mockups.

Anne H. Bradner, RN, MSN, CNOR
Director of Surgery
Winnie Palmer Hospital for Women and Babies
Orlando, Fla.
[email protected]

Don't buy individual service contracts
It's customary to enter into a service agreement with the manufacturer for the first year after purchase as part of the warranty. But while many manufacturers offer discounts if you sign a multi-year agreement, you may be able to save more by getting a local, third-party biomedical contractor to cover multiple pieces of equipment under one contract. Besides cutting costs, the consolidation approach eliminates the tangled web of paperwork that results from having a separate contract — and contact — for each piece of equipment.

Third-party biomed companies are small service providers or hospital engineers that follow the recommended guidelines for equipment repair and maintenance. They're typically certified as biomedical engineers, and they've been trained either by one of the major equipment manufacturers or by a local hospital. As an added bonus, their local presence likely means a prompter service response.

Finding a local, third-party biomedical engineer may be as easy as looking at who's currently providing service for your equipment. Many manufacturers use regional subcontractors to provide local service. You may be able to cut out the middleman and contract that local engineer directly.

— "Business Advisor: Consolidate Your Equipment Service Contracts" (September, page 24)