SAFE PATIENT HANDLING Stretcher chairs transport and support patients from admission to discharge on a single surface.

Surgery requires multiple patient transfers from surface to surface along the perioperative path. In the traditional patient-handling model, caregivers must move patients 3 times:

• Upon arrival in the OR, you transfer the patient from a stretcher onto the OR table.
• After surgery, you transfer the patient back to the stretcher.
• At some point in recovery, you transfer the patient to a recliner.

All that lifting and moving not only takes time, but also increases the risk of staff injuries and patient falls. Stretcher-chairs do away with your transfer problems. They let you wheel patients from admission to discharge on a single surface that morphs from chair to transport stretcher to OR table to recovery recliner. With the push of a button on a motorized model, you can raise and lower the machine's back, legs and height, taking patients from supine to upright and every sitting and lying position in between, even Trendelenburg.

Stretcher-chairs start at around $5,000, but they can go up to $20,000, depending on the system and any added features. To make sure yours doesn't end up in storage, here are 3 key features to consider.

1 Weight and width
The surgical managers we talked to say that the chair's weight limit and width can make or break the chair's effectiveness. "You really need to check the weight limit," says Barbara Getlan, RN, BSN, administrator of the Dulaney Eye Institute in Towson, Md. "Some of them are designed for use only in smaller patients, so which one you purchase can really depend on your patients' weight."

Some managers regret that some of their convertible tables go unused because they have too low of a weight limit for regular use. "The model I have has a weight limit of 325 pounds," says JoAnne Looker, RN, CNOR, clinical director of the Winchester (Va.) Eye Surgery Center. "When I have a patient heavier than that, I have to put them on a regular stretcher without hydraulics."

Many new models come with upper weight limits of 400 to 500 pounds, and bariatric models have a maximum weight limit of 1,000 pounds. The best way to determine the right weight limit for your facility is to look at your patient demographics and specialties, says Ms. Looker. For freestanding ASCs performing elective procedures on relatively healthy patients, or those with strict BMI cut-offs, a chair with a 300- to 500-pound weight limit may suffice. For those doing procedures where BMI can greatly fluctuate, including in eye or cosmetic procedures, it can pay to look into models that handle heavier patients, says Ms. Getlan. For facilities that have a consistently heavier patient demographic — or a spread-out floor plan — you may turn to models that have auto-drive, a feature that manufacturers tout as making it possible for a single nurse to move a 500-pound patient from one room to the next with a push of a button.

You also want to look at the width of the stretcher-chair's mattress to ensure that it's wide enough to easily place patients and position their arms, while being small enough to navigate in and out of your ORs, says Cindy Beauvais, RN, BSN, MBA, CAPA, clinical director of the Georgia Eye Institute Surgery Center in Savannah. "With the way the population is getting larger, the chairs are sometimes too narrow or short," she says. "It's harder for bigger patients to get comfortable." While most standard chairs come with 24-inch widths, some manufacturers say they can upgrade the width to 28 inches or more for an added price.

2 How do you operate the chair?
Another decision you'll need to make is whether you'll go with manual chairs that use hand cranks and levers to position patients, or those that are electrically controlled or run off batteries. Battery-powered chairs make positioning patients for surgery easier, as they allow for fine-tuned adjustments and require little effort from your staffers. "They're very easy for the staff to control the movement," says Ms. Getlan. "For patients, it's good, too, because the movement between positions is smooth rather than sharp."

Ms. Looker notes that battery-powered chairs make it easy for geriatric patients to get in and out. "You can put them in a sitting position, have the patient sit down and then recline it back," she says. "You don't have to pull a handle or pump it to make it go back down or up."

Some models come with 2 batteries: While one's in use, the other's recharging. If you're considering a battery-operated model, look at both the maintenance requirements and battery life, says Ms. Looker. "Batteries on my chairs last the whole day," she says. "We charge them overnight. But if you're pushing these things in and out of the OR, you probably won't want to take time to plug and unplug them throughout the day."

Jeannine Arcuri, BSN, administrator of the Cleveland Eye and Laser Surgery Center in Fairview Park, Ohio, says her center stocks both a battery-operated version and a conventional hand-crank one to give nurses more options. Overall, they provide the same basic functions, she says, but the battery-operated tables require a bit more upkeep. "The only downfall: If a battery goes down, you might have to charge it in the middle of the case," she says.

In addition to charging and stocking backup batteries, don't forget that you'll also have to replace them regularly. "You'll have to continue to purchase batteries for the life of the stretcher-chair," says Ms. Arcuri, who installs fresh batteries every 2 years.

EASY POSITIONING Simply press a button on battery-operated stretcher tables to comfortably move patients.

3 Positioning and headpieces
Surgeons who sit or use microscopes regularly, like ophthalmologists, will be concerned with the height of the chair and the headpiece's movement, say managers. The chair will likely need to have specific height requirements to give the surgeon adequate legroom, says Ms. Getlan. The surgeon may also need a special or removable headpiece, or a wider range of positioning options, to get the surgical site access he needs. You'll find more chairs with adjustable heights and articulating headpieces that can tilt and move several degrees to get the perfect position. "Test if the headpiece is one that your physicians like," says Ms. Arcuri. "Our chair had to have a headpiece that could detach when needed, and it had to make our patients' faces accessible in a temporal or superior approach."

If the chair will be your go-to for moving patients from admission to discharge for a wide range of surgeries, you may want to look for a model that offers more options, like a steeper Trendelenburg position. But if it's being used for something simpler, then an option with fewer bells and whistles can be sufficient. Ms. Getlan notes that her old center used the chairs primarily for patients in recovery. "I recommend them to other centers for use simply to transport the patient from the OR table to PACU," she says. "It lets you move the patient slowly, which is a great option if you're dealing with nausea."

Try before you buy
Ask vendors to bring in the chairs for you to trial for a few days or even a week, says Ms. Beauvais. Let staff wheel them around and practice using them. Ask them to evaluate their ease of use, if patients can sit comfortably in them and if they can easily maneuver in and out of the OR. Get your physicians' input, too. Did they like the size, shape and positioning? Did the headpiece articulate to their liking? Did it sit too low or too high? OSM