In 2004 my healthcare system opened up a three-floor addition to a wing to give us a total of 16 ORs. Our goal was to create the most high-tech, state-of-the-art-facility in the area. We wanted to improve not only patient care, but also patient and staff safety and OR turnaround times, while enhancing our community partnerships. Booms figured prominently in helping us meet those objectives.

It was hard to come up with a bottom-line figure to justify the costs of our booms, especially since there's so much more to consider than the initial investment. If we became more efficient, we could increase our caseload, but it would take a systemwide commitment to make our booms a success. We had to ask some tough questions:

• Would the boom technology give us the improved flexibility in our ORs that we needed?
• Could our IT infrastructure support added electronics?
• How would we ensure infection control with a ceiling-mounted frame?
• Would our public relations department be able to market this new technology?

How we evaluated booms
The construction project took almost five years from start to finish. We started by sending a clinical team to facilities throughout the country that already used booms to observe how well the systems worked and to talk to the users about the systems' benefits and challenges. Our team evaluated each boom on the same baseline requirements, such as how bulky it was, how easy it was to raise and lower and how easily it moved, and developed objective templates to rate the systems at each level. After the team weighed and prioritized the categories, it had an objective way of determining which of the booms they'd seen would be the best for our facility's needs. We even developed a checklist, which we've reproduced here for your use (see "Boom Technology Evaluation" on page 74).

Our future goals were particularly important since we were looking at booms five years before we planned to use them. At the rate technology changes, we had to figure out how we wanted the system to function based on a combination of what was available then and by attempting to judge what would be available in the next few years.

Some other aspects we had to consider during the purchasing and installation process were how their functionality would fit into our philosophy of care and work flow. Our basic philosophy regarding equipment had to change because in order to use booms in every OR suite, we had to increase our inventory, ensure all of our equipment was electronically compatible and determine if the equipment would physically fit on the boom. We couldn't move equipment between suites or have only one model of any piece of equipment any longer.

To make our booms as efficient as possible, save time and labor, decrease our turnaround times and allow each suite to get the most efficiency possible, we had the equipment permanently mounted on the booms. The resulting cost was almost equivalent to the cost of the booms themselves.

The planning team
We knew that after the booms were installed there'd be a considerable learning curve for staff and physicians. They'd not only have to learn and adjust to boom technology, but also change their routines. Rather than wait, we got a jumpstart on this problem by having our staff prepare for the changes as soon as we selected our boom system, which was four years before it was actually installed.

There were going to be many changes to our perioperative workflow, so we designated focus groups that worked with consultants to identify the present processes and how the booms would affect them, map out workflow algorithms and spider diagrams, and build mock-up rooms. Each group included task forces for specialty groups such as staff members, physicians, end users and patients to help gather input at each stage of the process. The design team reported to the staff regularly, posted plans, invited staff members and physicians to design meetings, and encouraged feedback.

We made an anesthesiologist a permanent member of the design team because without staff and physician agreement, the project's success would have been in dire jeopardy.

Our director of strategic planning worked with OR management to determine "future volume benefits" and together we wrote a case statement to justify boom technology. It essentially became our best guesstimate, since we were the first in the area to incorporate boom technology, but it proved to be correct. Our volume increased by more than 300 cases.

Although we had the luxury of building an entirely new wing for this project, we also had to remodel three OR suites to accommodate booms. So during two years these 40-year-old OR suites were being used while we were adding equipment and anesthesia booms to them. This meant we were in for some OR downtime, creative scheduling and off-hour construction, and during all of this we needed to implement an ongoing infection control risk assessment.

Incorporating boom technology into old OR suites takes a great deal of design consideration, and it may not always be feasible if rooms aren't expandable or structurally sound (see "New Booms in Old Rooms" below). Booms should provide a sense of openness in the suite because they eliminate the need for equipment to be stored throughout the room, but you need to assess the ceiling support and proper superstructures to make this a reality. You'll need to hire a structural engineer to be sure that your room can handle the weight.

Assessing the type and acuity of surgical cases is also an important part of the decision-making process. It's easier to justify boom technology for higher-acuity than lower-acuity cases. Nevertheless, boom technology has advanced to accommodate each acuity level.

If you're seeking a unit that can adapt to any case, the buzzword is "acuity adaptable," because booms can range from simple systems holding a few pieces of equipment to complex ones that offer complete medical integration.

In our expansion wing we installed the simple versions in two minor rooms, while the other 14 rooms have all the bells and whistles. The remodeled site has three moderately-equipped booms. The types of cases, volumes and acuity levels helped us determine what level of boom to place: minor rooms got simple booms with two shelves; major rooms at our trauma and cardiac center site housed two large equipment booms with multiple shelves and video technology; the smaller OR site housed one large equipment boom with three shelves and video technology.

Our volumes have increased, our patients, staff and physician satisfaction rates have improved, and our ability to hire staff and woo surgeons has been a positive aspect of building out the OR department with boom technology. An often overlooked advantage of using booms in all the OR suites is that it let us standardize the rooms, which research has shown improves workflow and decreases errors.