At some point, a light is just a light. Or is it? Our survey of 79 OR and facility managers who recently bought new surgical lights suggests otherwise. According to our panelists, different models can perform very differently. And when it comes to selecting and installing surgical lights, many challenges can arise - including trialing them effectively, selecting lights that meet the needs of the entire surgical team, installing them correctly and ensuring good customer support. Read on as our panelists sound off about the features they find important, when they plan to upgrade and more.

Get these essential features
When picking your top contenders, these four features are essential, say our panel:

• High quality of light. The quality of light results from three basic features: Brightness, color and shadow control, and a significant majority rated all three of these factors very important. "While evaluating lights, we noticed a significant difference in terms of brightness and color," says Ruth G. May, RN, CASC, director of surgical services with the Indian Wells Valley Surgery Center in Ridgecrest, Calif. "One was more yellow and not as bright as we needed." Adds Phyllis Rozema, BS, clinical leader for outpatient surgery with Borgess Hospital in Kalamazoo, Mich.: "A lot has to do with what the surgeons are doing. The orthopedic surgeons work in a broadly lit area and are not so much concerned with shadows from their heads, but the vascular and neurosurgeons work with near pinpoint light and shadowing can be a real hindrance."
• Stability. Drift is a big annoyance during surgery; 92 percent of responders rated stability as very important. Keep in mind that instability can be a product of improper installation and may not represent a flaw in the lighting system itself.
• Adjustability. A significant majority of our panelists also rated adjustability of both the light field diameter and light intensity as very important. This flexibility is particularly important when your procedures cross numerous specialties. At the St. John's Clinic for Head & Neck Surgery in Springfield, Mo., for example, OR Manager Lynda D. Simon, RN, says the ability to focus the light on a small surgical site is key. A sufficient range of light intensity is also key; one responder noted that her new lights are actually too bright for some procedures and the intensity range doesn't satisfy all her surgeons' needs.
• Maneuverability. Three-fourths (76 percent) of managers rated maneuverability as very important, noting that the ability to place the lights where the surgeons need them and easily make adjustments during surgery is key.

Compare lights side-by-side
Several panelists strongly recommend trialing your top contenders side-by-side in the OR. This is the only way, they say, to accurately compare the lighting quality and other performance characteristics of one manufacturer's light to another's. The technical jargon in the product literature also makes it hard to undertake apples-to-apples comparisons, say several panelists, and competing needs among different surgical specialists further complicate the evaluation process.

Unfortunately, our panelists report that side-by-side comparisons can be difficult to pull off because manufacturers tend to resist providing demo lights. If you meet resistance, stick to your guns, says Ms. May. While opposition from one manufacturer and a three-month wait for the lights made this proposition difficult for her, she says her tenacity paid off. "We obtained the lights on temporary seven-foot stands, and we used them all during surgery. It became clear really fast which light we wanted," she says. "There were significant differences in terms of brightness and color 'The cooperativeness of the vendors also gave us some insight into how well we'd be supported after our purchase."

Adds Ms. Rozema: "We had to fight very hard to get our three top contenders in here at the same time, and this trial was a very big deal for us. As it turned out, opinions about light quality and even the amount of heat emitted from the lights turned out to be quite a variable, and some lights provided a better quality narrow-diameter field than others. If we evaluated each light independently in the manufacturers' showrooms rather than undertake our side-by-side trial in the OR, we wouldn't have been able to gain a real understanding of how the lights performed, or even remember the differences between models."

Be thorough
Be thorough throughout the evaluation process, say our panelists. Visit sites where the lights you're considering are in use, they advise, and look at the lights from every angle. Site visits are particularly important because the side-by-side demo, while invaluable, won't tell you how stable or maneuverable the lights are since demo lights come on temporary structures. Adds Ms. Simon: "During your site visits, look at the entire set-up, and see if the light system will fit in your suite. Turn on the lights and look for excess heat, adequate candle power and ease of changing bulbs."

In addition, recommend our panelists, evaluate features like the cost of handle covers and replacement bulbs, availability of sterile controls and ease of maintenance. Of our 25 panelists who express some dissatisfaction with their new lights, top complaints include instability/drifting, overly heavy lights, the need to change bulbs manually (no automatic back-up bulb), lack of maneuverability, too much heat output, limited range of light field diameters and expensive replacement bulbs.

Plan the installation
In our survey, several readers stress the importance of planning the installation before buying. Otherwise, unforeseen problems can arise after the new lights arrive. "Understand the installation specifications," says Deb Leib, administrator with the Susquehanna Valley Surgery Center in Harrisburg, Pa. "Our lights were much heavier than we anticipated." Adds Ms. Simon: "Make sure the bracing in the ceiling is adequate to hold the weight ' We needed special bracing to accommodate the weight."

Another reader said she didn't realize until it was too late that the suspension arm of her new light was too long. "Know how far down the light will hang," she advises. "Measure first to prevent bumping heads."

Another hospital-based panelist recommends ensuring that your plan calls for changing out all lights simultaneously, or at least ensuring a uniform sterile handle system. "It's too hard to maintain different items and have what you need when you need it," she writes.

Ensure prompt support
Before purchasing new lights, be sure you'll get prompt service should something go awry, says Kelvin G. Hanger, administrator with the Lexington-based Kentucky Surgery Center. Mr. Hanger remembers having to wait five days for someone to fix a light that shut off whenever the team positioned it a certain way. And while the team was able to work around the finicky light, the malfunction created scheduling issues and, more importantly, safety concerns. "If you have a patient on the table or a patient waiting to get into the OR, the best light in the world won't do you any good if you flick the switch and nothing happens," he says. "Even though cost and product are important, at the end of the day your lights are only as good as the support you get from the manufacturer." Mr. Hanger says prompt support is particularly important given the increased technological complexity of modern lighting systems. "Now that we have integrated lights with flat-panel monitors working off of them and wireless controls, there's a greater chance something can go wrong," he says.

Overall satisfaction high
Overall, the 79 managers we surveyed express satisfaction with their new lights, and the reason seems to be that they avoided making assumptions that would cost them later. "If you're upgrading surgical lights, don't automatically assume your physicians will like the newest model of the brand you currently use," writes one hospital-based nurse specialist. "Always trial the light source, whether in a procedural or surgical setting."

Many of our readers also suppressed the urge to put price over performance. "This is not a decision made based only on the cost of the items," says Ms. Rozema. "Listen to the end user, including surgeons and staff." And remember, price isn't everything. "Cheaper is not always better," says Jeannette Gray, RN, CNOR, nursing administrator with the Summit Surgery Center in Plano, Texas.