Lights, Cameras, Action!

 Operating rooms (ORS) across the country are beginning to look like sets for a cable TV makeover program. Major hospitals are renovating, expanding, or replacing entire OR departments and the sterile processing area that supports them.

The reasons are many, but the results are the same. ORs that were built before 1990 are too small, and they do not have enough lights, equipment booms, power plugs, medical gas outlets, laminar air flow, or video cameras. The new ORs are bigger, with multiple types of lights, and multipurpose equipment booms that are covered with shelves, plugs, and medical gas outlets. Multiple types of airflow systems and video cameras with flat-panel display units are everywhere. The floors are multicolored, the walls are smooth, and power plugs are high on the walls or hanging from the ceiling.

Minimally invasive surgery, image-guided surgery, robotic surgery, and hybrid surgery all require more space, more flexibility, and more money. The days of the 400-square-foot OR that can be built at $150 per square foot have gone the way of $1 gasoline. We are now building 700+-square-foot rooms at $300 per square foot with hospitals asking for more.

New designs for surgical suites include vertical laminar flow in every room with large air returns at opposite corners of the rooms. They need combinations of large and small surgical lights with variable focus for deep penetrations or surface illumination. The room lights are still large 2 x 4 fluorescent lights, but there are also a dozen can spotlights on dimmer switches, indirect lights, and windows for ambient light.

And why do they need all this light? The light is needed for the cameras, of course! There are cameras in the OR lights, in the microscopes, and in all of the minimally invasive surgical instruments.

Flat-panel monitors are also everywhere. As the price has come down and the size has gone up, flat-panel monitors are the latest status symbol in every OR. Everywhere you look, there are monitors for patient vital signs, lab reports, mobile c-arm images, microscope images, flexible and ridge scope images, and, of course, PACS images.

Circulating nurses are now the OR producers. No longer running for supplies and dressings, they are now busy at documentation workstations controlling who sees what, where they see it, and when they see it. They have yet another flat-panel monitor just to control the other flat-panel monitors, room lights, and sound system.

Companies known for surgical instruments have become video experts. They are finding more profit in selling video systems than medical equipment. ORs are the new frontier in home theater. The medical procedures have not changed, but the rooms and the support have grown dramatically. Now, specialty rooms are built for each specialty. The video-tower equipment is coming out of the mobile carts to be attached to an overhead boom. Each boom provides a constant equipment configuration and positioning where needed.

The video-support procedures for biomedical service also have changed. The same medical equipment that was on the $80,000 rolling cart is now mounted on the $25,000 ceiling boom. But now, a 19-inch monitor has been replaced by multiple flat-panel monitors on their own ceiling support arms, wall mounts, and boom mounts. The video control system at the documentation workstation can cost up to $150,000 just to direct the video images to the correct monitor or provide picture-in-picture features to show four images on one screen. Of course, the four displays are so small that none are useful, but the capability is there, so why not sell it? One recent installation had an $8,000-per-room option to include the “room light control” to the Super OR Command Center. This was an $8,000 software module to control the room light switch from the touch panel to darken the room so the surgeon could see the flat-panel displays better.

In our ever-changing world of medical equipment service and support, as the surgeons become actors, we must become audio/video specialists. As fast as they can buy new technology, we must learn how to operate and service it. As we learn how to maintain these new sterile television studios, we will also discover where the medical vendors buy their technology. The home theater industry will be our source of great new technology. 24×7

C. Wayne Hibbs, CCE, is president of health care consulting firm Hibbs & Associates, Dallas, and a member of 24×7’s editorial advisory board.