Surgical headlights are expensive and last for quite a long time. So when you do set out to purchase new headlights for your facility, it's important to make a decision that pleases the business office and the surgeons on whose foreheads the lights will shine for years to come.

The best way to do this is to organize a headlight trial of as many headlights as feasible. At the University of Kentucky, where I'm chair of the physician advisory committee for the Center for Advanced Surgery, we ran a headlight trial a few years ago to coincide with the opening of the medical center's eight-OR surgery center. I worked with the nurse clinical coordinator to organize the trial that lasted three months before we made our final decision to purchase 18 headlights for about $42,000.

Having the latest technology and efficient service were important factors for us. At the time, we weren't happy with the service we were getting from our existing headlight vendor. Calls for service and replacement cords were not returned. Neither were requests to trial new products.

We did our preliminary research for the trial by walking the showroom floor at the annual meeting of the American Academy of Otolaryngology. Afterward, we contacted three manufacturers and asked them to deliver two or three sets of loaner headlights for the trial. Our institution's policy is to ask the vendors to supply the loaners free of charge and to pay for shipping, both ways.

When you start a trial, pay attention to when and how you receive the loaner headlights. It's a good indicator of the kind of customer service you may receive if you purchase the products. Note how long it takes to send the headlights and how they arrive at your facility. Are the loaners overnighted or shipped by a slower, cheaper method? Does a representative deliver the loaners in person? If so, find out how far the rep must travel. Ideally, you'd like to work with a company that has a rep in your area.

Corral the surgeons
Once the loaner headlights arrive, make sure that all the surgeons know that you're conducting a trial. Some surgeons love to try out new stuff, others don't. So you may need to give a nudge here and there. Focus on one product at a time and make it as easy as possible for the physicians to offer feedback. We created a review sheet with questions that physicians answered on a scale of 1 to 5, such as:

• Is the headlight comfortable?
• Is it bright enough?
• Is there a focus ring and does it work well for your procedures?
• Would you prefer a corded or a battery-operated system?

During the trial period for each headlight, we handed the physician the simple evaluation form to fill out after the procedure or at the end of the day. Physicians returned their responses to the nurse clinical coordinator. Again, some physicians needed reminders to fill out the sheets.

How well do they work?
You can do a quick check of a headlight by putting it on your head and looking inside a person's mouth. Is the light focused and does it let you see detail in the back of the throat? Or you can try looking at your thumbs, side-by-side, at the distance you usually operate (focal length).

The surgeon should try out the headlight in the lighting conditions found in different OR settings. For example, an ENT surgeon works with his head about two feet away from the patient. General surgeons usually work with all the OR lights on while other surgeons may work in a darkened OR.

Most importantly, a headlight should have enough illumination to let the surgeon see the surgical site. When the light's not bright enough, it becomes a patient safety issue.

But there's more to consider than just brightness. The light should be focused and not create glare, which can make it hard to see the color and topography of tissue. To avoid creating shadows, the luminaire should be positioned coaxial with the surgeon's vision. You should be able to draw an imaginary line directly in front of the bridge of the nose that bisects the luminaire and the pupils as the surgeon looks down during surgery.

For many of our physicians, brightness and comfort were the most important aspects of a headlight. The top of the head should bear more of the weight of the headlight. If a surgeon is wrapping gauze around his head before he dons the headlights, there's a good chance that the headlight isn't comfortable. How the system is designed to keep the fiber-optic cable out of the way is another issue that concerns some physicians, since the cable can roll to the side or, worse, in front of the headlight to become a distraction.

Once everyone has had a chance to try out each headlight and make comments, you should be able to narrow the choice down to one or two lights. In our case, it was obvious which one was the favorite. When you're ready to make your decision, meet with the people who'll be wearing and ordering the headlamps. Ask if anyone feels strongly about one headlight. Discuss the cost, warranty and service. If there's similar interest in both headlights, buy the cheaper one if the warranty and service options are comparable.

Life after the trial
Once you purchase your headlights, it's time to start living with your decision. Standardizing will save you money. As new surgeons enter your facility, avoid making exceptions that would require you to purchase a different headlight.

Over the years, as the headlights start to wear and break, you'll have to do a cost analysis to determine when it's no longer a good financial decision to have the lights repaired.

Eventually, the process starts all over again, and you're holding another trial. But this time you're wiser, because you've been through it all before.