SLIM-DOWN CHALLENGE Space-saving equipment makes even the smallest suites seem roomier.

Signs it might be time to slim down (not you, your OR equipment). To get to the OR, you have to weave your way through a labyrinth of C-arms and towers double-parked in the hallway. Rooms feel crowded and congested, more like warehouses than surgical suites. To get to the patient on the table, you have to navigate an obstacle course of equipment, climbing over carts, hopping over cords and crawling under monitors.

"It's hard to even know where the patient is," says Lynn Razzano, RN, MSN, ONCC, a clinical nurse consultant from Boston, Mass. "It's like walking into a house that's got a hoarder living in it."

As Jay Bowers, BSN, CNOR, TNCC, clinical educator at West Virginia University Hospitals in Morgantown, W.Va., says, "There is not enough room to move around." Like many facility leaders, Mr. Bowers has discovered that one way to declutter your ORs is to furnish it with thinner, more streamlined equipment with a smaller footprint (see "Shopping for Thin OR Equipment"). This goes beyond such obvious choices as flat-screen monitors and modular surgical tables.

Mr. Bowers has noticed that other pieces of equipment have slimmed down, too, from thinner OR beds that are easier to move and maneuver, to hysteroscopy pumps that have less heft and fewer canisters to them, to liposuction and bipolar machines that don't take up as much space as they used to.

You can also downsize with multipurpose equipment like an all-in-one electrosurgical system that provides electrosurgical cutting and coagulation, bipolar functionality and vessel sealing in a single generator. "So we only have to have 1 piece of equipment instead of 3," says Mr. Bowers. Then there are video towers that go up instead of out, neatly stacking 4 or 5 pieces of equipment skyward: monitor, shaver, light source and insufflation devices. "Moving things onto towers and booms has helped tremendously," says Mr. Bowers of vertical storage.

Booms have replaced towers at Eastern Idaho Regional Medical Center in Idaho Falls, Idaho, where 7 of the 14 ORs have been retrofited for booms. "Booms are centrally located in the room, but you can still move them to wherever you need to," says Melissa Wood, BSN, RN, the OR clinical educator at Eastern Idaho Regional. She says booms are slimmer and, because they're suspended from the ceiling, don't take up additional space like a tower.

The great technological concentrate
Overcrowded ORs are almost unavoidable. As more and more increasingly complex cases continue to migrate to outpatient surgical centers, facilities must invest in more and more pieces of equipment — much of it big and bulky. "We have both the standard-size C-arm and the mini C-arm. Unfortunately, we need both to meet the needs of our surgeons," says Maureen Simpson, RN, CNOR, clinical nurse manager of the OR and PACU at the Rye (N.Y.) ASC.

Today's ORs must host many different specialties. "As our service line grows, we are needing more and more instruments in the room," says Andrea Fann, RN, the administrator of the Orthopaedic South Surgical Center in Morrow, Ga., which now performs spine and total joint procedures.

Being prepared for the "and/or situation," as Ms. Razzano calls it, means pulling extra equipment into the room in the event the surgeon has to convert the minimally invasive procedure into an open one.

There's also a real danger in having a limited amount of storage space but continuing to acquire more equipment. Not only is it unsightly and unsafe, but it could be unsterile, too. Crowded ORs can compromise your sterile field. "I'm constantly watching for contamination by equipment or cords or staff trying to get around equipment," says Carol Saxton, RN, the surgery director at Decatur County Hospital in Leon, Iowa. Another manager adds, "It's not easy for the housekeeping staff to clean under and around all that equipment."

Some facilities use a spare OR to store unneeded equipment, rolling the ortho, ENT and GYN carts out of harm's way when they're not needed. Parking towers against the OR wall helps, too.

It helps to think of pieces of OR equipment as if they were kitchen appliances, says Paula Jackson, BSN, RN, the robotics coordinator at Holston Valley Medical Center in Kingsport, Tenn. Even though there's a microwave, stove, refrigerator, blender and toaster in your kitchen, you're only using one appliance at a time. "There's a lot of people and a lot of equipment in the OR," says Ms. Jackson. "Thinking about using one thing at a time relieves anxiety."

Slim Jim ORs
Ms. Wood says her nurses have a knack for interior design, swapping out 2 tables for a table that has an upper shelf, for example, or stowing the massive neuro cart that's not needed for the next case in an empty room. "Our RNs are incredible at making the puzzle pieces fit," she says. "We try to utilize the equipment that we have and the space that we have." When buying new equipment, Ms. Wood says she insists that the new item have a smaller footprint than what it's replacing.

Footprint is becoming a purchasing consideration, right up there with price and warranty. When we asked 46 facility managers in an online survey how important a thinner profile or a smaller footprint is when making a capital equipment purchasing decision, all but 2 said it's either "very important" (29) or "somewhat important" (15).

"It is distracting and cumbersome when you feel like you have to crawl over equipment," says Ms. Razzano. "It's not safe for this type of environment where we need to work closely and the circulator needs to move all over the room."