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A Planning Playbook for Opening a New Orthopedic ASC
The ASC market continues its rapid growth. In 2023, roughly 116 new ASCs opened in the U.S., many of which were orthopedic-specific in nature....
SHINE DOWN Avera Sacred Heart Hospital in Yankton, S.D., installed LED lights in the 6 new ORs it opened last January.No one can argue that light-emitting diodes are cooler, brighter and more energy efficient than old-school halogen bulbs. But do you know what to look for when shopping for LED lights that can make a difference in your ORs? Let's find out.
1 Illumination
Assess the color and brightness of the light, says Shayla Kuchta, ADN, resource nurse at Avera Sacred Heart Hospital. The Yankton, S.D., facility opened 6 new ORs last January and outfitted each with LED lights. What they found should come as no surprise. "LED light quality is a lot better. We're able to see deeper into cavities during open procedures," says Ms. Kuchta. "Many surgeons who used to wear surgical headlights during those types of cases no longer have to."
LED lights produce consistently bright, white illumination at color temperatures of 4,400 Kelvin, compared to the yellowish hue generated by halogen bulbs at color temperatures around 3,200K, says Lynne Ingle, RN, MHA, CNOR, a project manager with Gene Burton and Associates in Franklin, Tenn., who shares insights from her dealings with several leading light manufacturers. Color temperature readings between 4,000K and 6,000K produce more natural-looking light, says Ms. Ingle.
CONSUMER REPORTS Gather feedback from as many surgical team members as possible, and be sure to note their comments for future reference.TRIALING TIPS
Putting LEDs Through Their Paces
Here's how to run an effective light trial to ensure you pick the system that's best for your surgeons and staff.
- Bring them in house. The latest LED lights look great in exhibit halls, but those staged presentations won't reveal if they'll shine just as brightly in your ORs. Even seeing them in action at neighboring facilities isn't good enough. Avera Sacred Heart Hospital in Yankton, S.D., conducted consecutive 2-week LED light trials in its 6 new ORs earlier this year so physicians from various specialties could work under them during actual surgeries.
- Ask around. Get as many physicians as possible involved in the trial, says Lynne Ingle, RN, MHA, CNOR, a project manager with Gene Burton and Associates in Franklin, Tenn., but keep perspectives in mind when reviewing the evaluations they submit. "Will general surgeons who predominantly perform laparoscopic procedures put lights to the true test?" she asks. "Or do the opinions of physicians who perform open procedures or joint-replacement surgeries matter a little more?"
- Take notes. Differentiating various features on seemingly similar light systems can be confusing, so write down every nugget submitted by surgical team members during trials, suggests Tom Viereck, RN, Sacred Heart's director of perioperative services. "It's really nice to remind them of what they said about a particular product," he says. "That really jogs their memories when you're sitting down for a final review of the options."
- Drill deeper. Look for helpful features beyond how well lights brighten the surgical field. For example, the lights purchased by Sacred Heart dim for laparoscopic cases with the push of a button. "The view of the video monitor isn't affected, but techs can still see what they're doing," says Mr. Viereck.
"Can you adjust the beam's width to focus light directly where it's needed?" asks Ms. Ingle, RN. "Are the lightheads easy to maneuver and position in the desired spot, and do they remain there without drifting for the entire procedure?"
— Daniel Cook
2 Color rendering
Surgical lights have Color Rendering Indexes, which measure their abilities to distinguish slight variations in color. Halogen lights have high CRIs, but that's only relevant for observing pastel colors, says Ms. Ingle. You instead should look at a light's R9 value, the measurement of its impact on deep reds. The higher the R9 value, the better surgeons are able to see the true color of tissue during surgery.
Halogen lights have low R9 values because manufacturers try to filter out heat-producing infrared light, which prevents needed red light from reaching the surgical field, says Ms. Ingle. LEDs, on the other hand, don't emit infrared light, so some manufacturers are free to increase R9 values into the mid 90s.
3 Shadow control
The many light-emitting diodes embedded in lightheads means the systems adjust the output of various LED sections when obstructions such as the surgeon's head come between the path of the light and the surgical field, says Ms. Ingle. The output of LEDs behind the obstruction lessen, while the output of LEDs in other areas of the lighthead increase to compensate, producing consistent, nearly shadow-free light.
4 Heat generation
Halogen lights are veritable heat lamps. "The back of your neck gets warm, you're gowned and it gets really hot," says Tom Viereck, RN, Sacred Heart's director of perioperative services. "With the LEDs, however, there's absolutely no heat coming off, which means we don't have to keep the ORs quite as cold to keep surgeons happy." And that, says Mr. Viereck, is a patient safety plus. Warmer ORs help maintain normothermia in patients, which ultimately limits surgical site infection risks, improves wound healing, and promotes patient satisfaction and timely discharges.
Worthwhile investment
LED lights are the more expensive option, so how can you justify the additional cost? "What's more important to you?" asks Mr. Viereck. "Spending the extra money so surgeons can see better, surgeries are safer and energy costs go down, or is it worth saving a few extra bucks on the front end only to end up paying more in the long run?"
SURGEON'S ADVICE
Smart Shopping for Surgical Headlights
TOP PRIORITY Surgeons want comfortable headsets that deliver focused light to the surgical site.Mark Drzala, MD, is a big fan of LED headlights. Here's why, along with the features he says you should consider when purchasing the portable lights for your surgeons.
- Freedom of movement. Most LED headlights are battery-operated — as opposed to xenon headlights that connect to light sources through fiber-optic cables — so you can work untethered around the surgical field, says the orthopedic spine surgeon with New Jersey Spine Specialists in Summit, N.J. "Surgeons like to move freely around the OR," he says. "They don't want to waste time asking someone to constantly disconnect and reconnect the headlight. That's a real nuisance."
- Battery life and weight. Consider the size and weight of a headlight's battery pack, suggests Dr. Drzala, because some physicians with back issues might find it difficult to operate with packs belted around their waists. "At the same time, some of the battery pack belts are robust and might actually provide some back support," he points out.
Also determine how long a headlight's battery stays charged while in use. Dr. Drzala bought 2 banks of batteries, so 1 is recharging during lengthy procedures in case the batteries in his headlight's holster start to drain after the 4 hours they're expected to last. - Bright illumination. Can you narrow the headlight's aperture? And if so, does the illumination diminish when you do? Also look for uniform illumination, suggests Dr. Drzala, meaning hot spots don't appear in the center of the surgical field along with dimming along its perimeter.
Some yellow-based lights sources have an incandescent look to them, while others have a cooler, higher Kelvin rating, which renders tissue with better coloration. "Surgeons must conduct their own head-to-head trials and see which ones they like best, because no 2 LED headlights are alike," says Dr. Drzala - Comfort. Look for lightweight, comfortable headsets, although comfort is very much subjective. Surgeons might take time to adjust to the feel of a headlight, and initially think the device puts them off-balance as they lean into the surgical field. "The weight of a headset can take some getting used to," says Dr. Drzala. "But with time, you get a sense of how you have to move your head in order to effectively shine the light source onto the field."
- Longevity. The lifespan of a xenon headlight is impacted by dimming bulbs and delicate fiber-optic cables that connect to light sources. "Every time a fiber-optic strand breaks through normal wear and tear, you lose a little bit of illumination," says Dr. Drzala. So, he says, xenon bulbs dim over time, while LEDs remain as bright as new even after repeated use."A new xenon headlight and a new, high-quality LED model are equivalent," says Dr. Drzala. "But as time passes, LED headlights will better maintain their illumination and brightness."
— Daniel Cook
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