Centralized OR controls are the brawn and brains behind high-tech OR suites. With the touch of a screen or a voice command, you can adjust surgical tables and lights or direct flat-screen monitors and equipment suspended from ceiling-mounted booms. As an operational benefit, centralized OR controls extend the life of equipment, which is often damaged when moved. What's more, today's "command-and-control" systems eliminate the need for perioperative nurses to manually tweak knobs and buttons. Here's how these systems work and what to consider when integrating your OR.

Getting started
The integrated OR starts with a control system, either a rack or a tower unit and wires running through the ceiling. Depending on the brand, a nurse operates the touch screen at a nurse's station outside the sterile field or a surgeon operate a touch screen with a disposable cover. Touch screens may be put in almost anywhere.

"Communications are sent from the touch screen through the wires to the control panel and from the control panel to the equipment," says Jeff Lipps, director of regulatory affairs at Conmed Integrated Systems.

If you're building a facility, incorporate the wires and wall mounts you'll need for an integrated OR into your building plan - even if you're not prepared to integrate the OR, says Joe Delligatti, director of new business development for Stryker Corporation. "New construction is a simpler process," says Harry Getz, product manager for the Karl Storz OR1. "In older facilities, there may be things in the ceiling, like lights or HVAC system, that may prohibit you from installing wiring."

You can retrofit your ORs. Oregon Health and Sci-ences University integrated its outpatient ORs because faster turnover and procedure times and convenience justified the cost, says Melody Montgomery, RN, MBA, assistant hospital director for perioperative services. A 500-square-foot OR with ceilings over 8 feet is ideal for retrofitting, but firms will work with other dimensions.

Whether you build or remodel, manufactures agree it is never too early to involve a vendor. "When the facility is designing an integrated OR, the architect has electrical requirements, other equipment in the room will have electrical requirements and the centralized OR control system has its own set of requirements," says Mr. Getz. "If you develop the design plan without one of those groups, you will have to do a change order to fix it, and those will increase the cost of the project."

"When you start to build or renovate an OR, decide whether you are going to integrate it and choose a vendor as soon as possible," says Heather Boling, director of perioperative services at Baptist Memorial Hospital in Oxford, Miss. Baptist Memorial decided to integrate its six new ORs just four months before opening, which added $20,000 in electrical and construction fees.

Key features
Efficiency and convenience are the top reasons surgeons and administrators like their integrated ORs. "We have an overhead camera in the OR routed to a screen outside the room, where our control nurse can monitor the case. So she knows when to send for the patient rather than having to call into the OR for updates," says Ms. Boling. "It may only save minutes but a minute here and there adds up." Here are four more features:

• Surgeon pre-sets. "It used to take us five or 10 minutes to bring in the equipment for a case and set it up," says Ms. Boling. "With surgeon pre-sets, all the equipment is ready with three touches of the screen."
• Image archiving. "The system automatically saves images from the procedure," says Ms. Boling. "I can't tell you how many times nurses forget to print pictures or lose them. Now they can easily access and print them out again."
• Voice activation. You don't have to control the OR from a touchscreen if you have voice activation: the surgeon speaks, the equipment responds. "An integrated OR without voice activation ... wouldn't save me as much time," says Thomas Chambers, MD, medical director and orthopedic surgeon at the Ocean Ambulatory Surgery Center in Myrtle Beach, S.C. His facility opened 19 months ago with two integrated ORs. "I can zoom the camera in and out, control the shaver and take pictures, all with voice commands." Dr. Chambers dictates operative notes while closing the patient. His transcription service is on speed dial, which is controlled by voice command. The surgeon can also use voice control to tweak the table and lights during a case.

Ken Zaszav, MD, lead surgeon at Advanced Orthopedics in Richmond, Va., says voice activation "is not worth the money." He says his facility's touchscreen controls work well without the expense of voice activation.

• Video routing and recording. Video routing lets you broadcast procedures via Internet or teleconference with another location. "It's not an everyday issue, but just the other day I had a colleague consult me on an unexpected problem, and I was able to help him handle it," says Gary Poehling, MD, chairman of orthopedics at Wake Forest University Medical School and surgeon at Wake Forest University Baptist Medical Center.

Most systems also let you capture and/or record video. "We upgraded the digital capture units to capture streaming video which our surgeons can burn onto a CD. They put the video into Power Point presentations," says Ms. Mont-gomery. Dr. Poehling puts procedures on a VHS tape: "I record the procedure and edit it as I go. I explain what is happening and include post-op instructions. Our patients are more informed of their surgery and what they can expect after it."

The price tag
An integrated OR costs about $100,000 for the basics, and can exceed $500,000 with all the bells and whistles. Here are three cost-savers:

• Build and plan. Manufactures will work within your budget. One option is to install the wiring that will let you integrate your ORs in the future, says Randall Blaum, director of marketing for ConMed Integrated Systems.
• Use what you have. "We were committed to finding a vendor who would integrate our pre-existing equipment," says Ms. Montgomery. She bought new surgical lights, but used the cameras, insuflators, shavers and cautery unit she already had. It's not always possible, though. Some older equipment simply can't be integrated. "They need an RS232 or a USB port to connect to the system. Most manufacturers began including them only two years ago," says Mr. Lipps.
• Plan smart. "We purchased the high-end router thinking we would use it to send images in real-time, but so far we haven't tried it," says Dr. Chambers. "That $36,000 was not well spent."

Try to get surgeons on the same page early. "We got a large group of surgeons together from all the specialties - ENT, orthopedics, neurology, general surgery," says Dr. Poehling. "We put together a list and talked to six companies. Only four could do what we really wanted."

Looking ahead
Centralized OR controls offer many benefits:

• more efficient work environments,
• faster turnover times,
• better equipment placement and protection,
• better use of staff,
• faster, smoother transmission of information,
• and greater marketability of your facility.

"As integration gains further acceptance, we will see integration include more patient data, robotics and image-guided systems," says Eric Elam, product manager for Stryker Medical.