If you haven't already installed high-definition video systems in your OR suite, chances are you've given it some thought. And surely some of your surgeons have clamored to see in your operating rooms the crisp, high-quality images they've seen in other ORs where they perform their cases. But there are a host of factors beyond greater image quality — and costs — that should carry serious weight in your decision to make the move to HD. We asked administrators that have gone through the process for practical advice to help ensure a successful switch to high-definition at your center.

Get your doctors involved
Naturally, your surgeons have a significant stake in the HD equipment your center selects. So achieving some sort of physician consensus before choosing an HD system is obviously critical.

Getting all of your doctors in agreement on a system may be difficult, but not impossible, says Stuart Katz, FACHE, CASC, executive director of Tucson (Ariz.) Orthopaedic Surgery Center.

Tucson Orthopaedic got its physicians involved early and often when installing HD cameras and displays in its 4 operating rooms in 2008, says Mr. Katz. Firstly, surgeons at the center were encouraged to focus on what an HD system should provide rather than whose name was on the box, so to speak.

"Ask your doctors up front what they want in an HD system — ease of use, high-quality diagnostic images, a system that is operational 98% of the time or higher, for instance — without naming a brand," says Mr. Katz.

Urge your surgeons to keep those factors in mind when conducting trials to evaluate various HD systems, says Gregory DeConciliis, PA-C, CASC, administrator at Waltham, Mass.-based Boston Out-patient Surgical Suites, which installed HD video in its 3 operating rooms about 4 years ago.

He recommends appointing a materials manager, nurse manager or technologist to spearhead the trials, coordinating and collecting evaluations of various systems. Hold post-evaluation meetings to discuss each HD offering as soon as possible after each trial, he adds.

Surgeon involvement in evaluations and the subsequent review meetings is crucial, of course. Getting them to participate, however, may require some creative thinking on the administrator's part, says Mr. DeConciliis.

"Some tactics would be to 'threaten' them with distributing checks only at the meetings, or to entice them with food," he says.

But, above all, impress upon them that this decision figures to greatly impact their ability to deliver the highest quality care to your center's patients.

"Ensure that you talk to each of your surgeons individually," he says, "letting them know that if they do not give their input on this important item, it could affect their surgical satisfaction in the future."

Seek second opinions
Ideally, manufacturers should be forthright about the benefits and drawbacks of installing HD systems in your OR. It's fair to say, however, that vendors also have some skin in this game.

Seeking out third parties should help inform your ultimate decision, says Jeffrey McKune, BBA, MHA, administrative director of planning and decision support at Phelps County Regional Medical Center in Rolla, Mo.

Mr. McKune was director of the ambulatory surgery unit at PCRMC in 2007, when HD video systems were installed in the center's OR suite. At that time, high-definition video was fairly new to surgery centers, which left PCRMC with a dearth of facilities to seek out for advice, he says. In 2011, surgery centers don't have that excuse.

"Today, I would contact vendors and consultants, and I would ask for at least 5 references for integrations [each vendor] had performed over the past 2 years," says Mr. McKune. "I would then contact each of those references to find out what worked well for them, how adaptable and technically savvy the integrator was, and what issues they have experienced since the integration was completed."

Administrators can call other centers for input as well, asking for names of specialists in different specialties, so physicians can ask them what they think of their systems, adds Mr. Katz.

"A GI surgeon talking to a GI surgeon is going to ask the right questions," he says. "As an administrator, I could talk to a GI surgeon at another center, but I'm not going to know what he's talking about. I want our surgeons to talk to the people actually using the systems every day."

Look at logistics
The average OR is filled with countless wires and cables that connect all of the vital equipment that helps your surgical staff do their jobs.

HD systems, of course, add more wires and cables to that mix. The logistics of syncing video inputs and outputs, cabling and connecting video signals, and laying out your OR can't be overlooked.

These were issues for PCRMC when the center implemented high-def systems in its 2 endoscopy rooms, 2 pain procedure rooms and 3 ORs in 2007. "Our early conceptual designs for our ORs were focused on using boom technology, and having much of the equipment hanging from the ceiling rather than sitting on carts or towers," says Mr. McKune.

"That is a great concept, but if you are talking about running several different video signals down a boom arm to a high-definition monitor, the arm itself needs to be large enough to handle all that cable and still allow for movement without kinking or stressing the cable from repetitive repositioning of the boom arms," he notes.

"Don't underestimate the amount of cable that will have to be run, and what that would mean in terms of the diameter of boom arms or other areas where the cables would be run," adds Mr. McKune. "The ceiling over the OR can become a spidery morass of cables pretty quickly."

It doesn't have to, however. Give plenty of forethought to how to best utilize the layout of your OR suite, and insist that your integrator provide a detailed schematic of the entire installation, he says.

"We used signal converters to convert between different video signals and connector types," explains Mr. McKune. "It did require that we run enough different cables that we could connect to whatever we needed. And a touch panel allowed us to select a video input and then route it to 1 of 2 high-def monitors.

"We are blessed to have a good design and some very functional ORs. Everything worked out fine," says Mr. McKune. But, he adds, "I would give these issues much more attention in any future implementation. And I would start with the architectural design for the areas around and above the ORs."

Better visualization for better outcomes
When it comes to integrating HD into an established operating or procedure room, keep in mind that your hi-def digital image processor is the backbone of the system, says Craig Reeves, administrator of Saint Luke's G.I. Diagnostics in Kansas City, Mo. This unit provides illumination for the image as well as an enhancement technology that lets GI physicians, for example, observe subtle irregularities of mucosal patterns, vessel structures and contrasting color changes. Monitors are a key piece of the puzzle, too. They must be able to receive the HD signal and produce an image of superior HD quality, says Mr. Reeves. This image increases efficiency and productivity by letting the physician identify abnormalities quicker and document changes that otherwise might have gone unnoticed.

HD endoscopes have been ergonomically designed for control and comfort. Graduated stiffness and zoom capabilities are added features that increase both efficiency and productivity in the endoscopic setting, says Mr. Reeves, noting you can customize buttons on the scopes to perform functions required by the physician. Pentax Medical's I-scan and Olympus America's Narrow Band Imaging enhance certain mucosal or vascular irregularities and produce the greatest contrast between vessels and surrounding mucosa, says Mr. Reeves. "This helps the physician determine the margins of abnormal tissue and where the best area would be for sampling (biopsies)," he says.

The trend toward wireless
High-def cables and wires tangling up your OR won't likely be as great an issue in coming years, as more wireless HD systems come to market. The trend toward wireless only figures to continue, says Mr. Katz.

Indeed, administrators should understand and anticipate the direction in which the technology is headed. "The questions for administrators become, 'What type of wireless technology is on the horizon?'" says Mr. Katz. "And 'What will be the difference in cost to upgrade from a wired system to a wireless one?'"

The vendor you choose should be able to answer these questions, and keep you apprised of software and technology updates, as well as potential issues with your particular system, says Mr. DeConciliis.

"[The supplier] should have representatives there at the start to troubleshoot and perform in-services, for example," he says.

A written service contract is recommended, and your contract should include a repair/replace clause, "because the equipment will break down, and you don't want to be strapped with constant repair bills," he cautions.

HD instrument personnel and technicians should also be trained to sufficiently clean the equipment and periodically check for defects, he says, noting that some companies offer training courses on the care of their HD equipment.

High-def technology is always evolving and improving, which means even clearer images and increased capabilities for your surgeons. It also means your doctors will always be tempted by the bells and whistles of the newest — and not necessarily proven — HD system. As an administrator, take every opportunity to reiterate to your surgeons that the HD system they help select the first time out is for the long haul — so choose wisely.

"You don't want your surgeons to be influenced by a colleague at another facility, or by a product rep who will try to sell them on the latest and greatest," says Mr. DeConciliis. "And if you tell your doctors up front that you expect their commitment to the system, you can remind them about your agreement later on."