When you're planning a new surgical facility, you hear about dozens of products that are supposed to save you time and money and make your operation more efficient. To help you navigate this sea of products, we asked our readers which technologies really live up to their manufacturers' claims. You'll find rankings on the next page. Here's a look at some of the products that rated as must-haves.

Closed fluid waste systems
With a closed fluid waste management system, there's no risk of splashback from infectious waste, as with a sink or hopper, and no need for solidifiers, which increase your red bag bill and take up landfill space. However, closed systems need to be plumbed into the walls, so including the system in your build-out can save you the cost and disruption of retrofitting your ORs with a closed system later. Depend-ing on the system, canisters or a mobile suction unit can be drained at a dedicated wall unit or port.

When the Texas Institute for Surgery built a new facility 4 years ago, the ORs were equipped with a closed system. The system — 6 portable suction units for 9 ORs — has worked well for the center, which does a lot of wet orthopedic cases, says Debbie Hay, RN, BSN, CASC, president of the Texas Institute for Surgery at Texas Health Presbyterian in Dallas. A unit eliminates the need for costly disposable suction canisters and rolls from one OR to another. "You don't have to empty it between each case," says Ms. Hay. "Make the decision before you open." The mobile unit, however, does have a disposable cost for a manifold that needs to be changed after each case.

Digital ORs
Surgical procedures today generate more digital data than ever, from video captures of colonoscopies to ultrasonic views of nerves and blood vessels for regional anesthesia and minimally invasive surgery.

Add to this the arrival of EMRs and suddenly you have a lot of information that needs to be routed in and out of the OR. Like a good air-traffic controller, an integrated digital OR can make sure that the right information ends up in front of the appropriate eyes. A digital operating room system can improve efficiency because the OR team can easily access stored medical records, diagnostic images and lab results and can archive digital images for documentation, insurance reimbursement, referral and education.

When shopping for a system, make sure that you really have a need for all the add-ons before you buy. "We paid for the conferencing feature for physicians that has never been used," says Christi Rousseau, RN, clinical analyst at Magnolia Regional Health Center in Corinth, Miss. During construction, the center installed cameras in all the ORs for video conferencing. But it didn't install a control monitor at the charge nurse's control desk. The physicians didn't want it. "That was a mistake," says Ms. Rousseau. "This installation would have saved the charge nurse an incredible amount of time that she spends rounding to determine which will be the next room to have down time."

Ultrasound for regional anesthesia
Ultrasound guidance helps anesthesia providers navigate through tissue, locate nerves and avoid blood vessels and other structures unseen when using a nerve stimulator. As more anesthesia providers become proficient with regional blocks, ultrasound is becoming more popular. Younger anesthesia providers receive training in regional anesthesia techniques as well as using the ultrasound machine. Orthopedic surgeons use it for diagnosis, too.

About 35% of survey respondents have portable ultrasound machines and 93% have a generally favorable impression of ultrasound guidance. But not all administrators consider a portable ultrasound device worth the $24,000 to $50,000 price. "The anesthesia provider can get additional fees for doing the block using ultrasound if they dictate their note, but the ASC can't get any additional funding to make this a worthwhile investment," says Stuart Katz, FACHE, CASC, executive director at the Tucson (Ariz.) Orthopaedic Surgery Center.

High-definition imaging
High-def imaging has become more of a standard than a luxury. Nearly 60% of our survey respondents use high-definition imaging in their ORs. As surgeons become more accustomed to high definition, the systems are becoming a valuable recruiting tool. "Our physicians were so thankful when we upgraded to HD. They can see clearly now that the 'fuzz' was gone," says Emilie Keene, MHA, administrator of the Parkridge Surgery Center in Columbia, S.C.

With HD chromatic scopes, the image can be converted to blue, which makes arteries and blood vessels more visible. This helps the surgeon avoid nicking a vessel when gathering a biopsy or when removing a polyp, says Jane Diezi, RNC, MSN, MSHA, administrator at the Charlotte Surgery Center in Port Charlotte, Fla.

OR booms
One of the drawbacks of introducing new technologies into the OR is that each piece of equipment brings a new box, data cables, electric cords and sometimes a monitor into the room. OR booms help cut down on the clutter by getting the cords off the floor and the equipment boxes off of carts.

"This has been a great investment. It keeps rooms less cluttered and keeps equipment in one place," says Ms. Hay. One problem: Staff bash the booms into the wall when they're moving them. So the center affixed rubber rub rails to the spots where the booms hit the walls, says Ms. Hay.

"Go on as many site visits as possible," is the advice of Deana Miller, BSN, the director of surgical services at Monroe Clinic in Monroe, Wis., which is building new ORs with video integration and OR booms to hold equipment. The facility is purchasing a boom system with a lock-on trolley that will hold electrosurgical equipment. The trolley can be pushed from OR to OR and then docked on the boom.

Mobile workstations
Computers on wheels (COWs) help make sure that a computer is available wherever needed in the surgical facility. COWs are helpful when charting during procedures. "The nurse doesn't have to have to have her back to the surgical field," says Jan Weaver, RN, CNOR, clinical manager of surgical services at St. Joseph Medical Center in Bloomington, Ill. The hospital uses standard laptops running EMR software on a mobile cart. One important thing to remember, says Ms. Weaver, is to create a system in which the laptop batteries are charged each evening. Otherwise, you'll have to plug the computers into wall sockets.

You'll need a solid cart, good computers and a good wireless system, says Mr. Katz. "It'll cost you a little more but it's worth it in the end." The cart should be sturdy and not roll or wobble when you use it. Mr. Katz's center has 5 COWs for 4 ORs. One cart is for physicians. One pain specialist uses the cart for transcriptions throughout the day so that he doesn't have to enter his notes at the end of the day. "When he's done, he's done," says Mr. Katz.

Electronic medical records
The federal government has called for electronic health records to be in place for all patients by 2014. Many surgical facilities are still deciding how they're going to implement EMRs in the middle of some sort of transition to all-electronic records.

Ninety-three percent of survey respondents said that, to some degree, EMR systems improve efficiency by reducing redundancy in gathering patient data, creating physician orders and streamlining the coding and billing process. About 51% of respondents use EMRs.

If you're building a new facility, go paperless and start off with EMRs, says Ms. Hay. That way the only transition is from startup to EMRs, rather than a startup with paper, then another transition from paper to EMRs.

"It takes extra staff training, but it saves time in the long run," says Kelli Noble, RN, surgery manager at Grossnickle Eye Center in Warsaw, Ind. "There's no more tracking down missing charts from department to department. You can access the charts from any authorized computer in the facility at any time."

Make sure your EMR system is compatible and can "talk" with other electronic systems such as scheduling and billing software, your digital imaging system, the picture archiving and communication system (PACS) and the anesthesia record system. If you're buying a new anesthesia monitor and want to include anesthesia records in your EMR, make sure that it has a USB, COM or serial port for downloading the anesthesia data to the EMR system, says Charles Ricks, DDS, owner of the Children's Dental Surgery Center in Visalia, Calif. Otherwise, says Dr. Ricks, "you have to use the paper printout, paste it to a sheet and then scan it into the record."