Transitions are the name of the game in ambulatory surgery. From pre-op bays to the OR table to recovery and discharge, patients are on the move and in varying positions throughout the perioperative process. Convertible stretchers that serve not only as patient beds and transport equipment, but also as surgical tables and even reclining chairs can make these transitions more efficient, safer and more comfortable, as the administrators whose facilities use them will attest.

A minute here, a minute there
The most noticeable improvement that stretcherchair tables have on surgical workflow is the amount of time and energy they can save your staff in handling patients. Take eye surgery patients, for example. Many surgery centers walk them to and from the OR, but patients' mobility and stability issues — particularly considering age and anesthesia — can make this dicey. "With stretcher chairs, you sit them once and they're good to go from pre-op to the OR to PACU," says June Jackson, COA, administrator at the Advanced Eye Surgery Center in North Dartmouth, Mass. "It's much more efficient than walking the patient."

This efficiency translates to fast turnovers. Stretcher tables can shave at least 5 minutes off every case, says Ben Jones, administrator of the Jones Eye Clinic in Sioux City, Iowa. "All those minutes add up," he says. By adding a portable patient monitor (on the stretcher's side rail or on an IV pole) to the mix, he notes, patients can travel smoothly through the process without having to be unhooked and then reconnected for vital signs at each stop.

Economy of space
Rush University Medical Center in Chicago recently purchased 40 stretcher tables for use in a soon-to-be-completed new building. Chief among the advantages they'll bring to the setting is an economy of space, says Kim Humbarger, RN, BSN, CNML, who directs the center's ambulatory surgery post-anesthesia/recovery unit.

While the center's outpatient department has traditionally used stretchers for patient transport to and from the OR, then recliners for recovery, the new building's patient rooms and bays are differently sized. So a piece of equipment that does the job of a stretcher and a recliner will eliminate the need to have both in the room or bay, and provide more working space in the area, says Ms. Humbarger. It will also prevent a backup of unused stretchers (removed from recovering patients' bays) along corridor walls.

Another advantage: When stretcher-chair tables are on the move, they're easier for staff to handle, says Jill Lingren, COA, CST, surgical coordinator for the Jones Eye Clinic. "When you roll these chairs, it's much easier to steer than a stretcher," she says, on account of their smaller base and greater turning radius than traditional stretchers. They also solve a staffing problem for busy facilities, as they can be propelled and maneuvered by a single employee.

Ms. Jackson adds that the availability of push-button controls for pre-programmed and programmable positions make the sitting to lying and back again conversion quick and easy for staff. "It's remote-control operation and smooth motion, not the jerky movement of pumping a pedal with your foot," she describes. If you choose a model with sturdy, wear-resistant upholstery, turnover is a breeze as well. "You can just wipe it down with your germicidal cleaner, and it won't degrade," says Ms. Jackson.

A safer system
"Every time you have to move a patient, there is risk," says Ms. Lingren. "By only having to move the patient one time, by taking them through pre-op, the OR, PACU, all in the same chair, it's safer for them."

Why risk a fall by asking a groggy patient to climb a footstool onto a stretcher or to take a shaky step down from one? This patient safety aspect also saves time. "How long does it take after cataract surgery to ask them, 'How do you feel? I'm going to sit you up. How are you feeling now?'" says Ms. Lingren.

There are also safety benefits for the nurses and techs who are usually charged with patient handling and transfer, says Mr. Jones, since there's less heavy lifting — and consequently a reduced risk of musculoskeletal lifting injuries — ?when patients stay on a single platform throughout the perioperative process. Plus, Ms. Jackson notes, "it's higher off the ground than a recliner, so there's an ergonomic advantage for nurses. They can take blood pressure and vitals, administer eyedrops, without bending over and without backaches. Our staff can get through high-volume days with less fatigue."

Your patients may be more ergonomically positioned and more comfortable as well, given some convertible stretchers' increased articulation capabilities. "We used to use all kinds of pillows, towels and blankets to position patients on a flat cart," says Ms. Lingren. "Now we can articulate separate sections of the stretcher individually."

"Patients are pretty excited about them," says Ms. Jackson, whose ASC highlights its use of stretcher tables among the patient information on its website. "They sit down, we give them a warm blanket, and they relax, knowing that everything's taken care of. One less thing to worry about during their time here."

Criteria for choosing
As with any equipment purchase, an on-site trial of the available stretcher table options is essential in selecting the one that works best for your surgeries and patients. While Ms. Jackson's staff took turns lying on stretchers and pushing each other down hallways, there were aspects beyond transport to consider. "Did the surgeons' legs fit under the headrest when it was reclined?" she asked. "Did the microscope fit around the table?" With a 500-lb. weight capacity, it could also accommodate larger-than-average patients.

"Surgeons wanted rock-solid stability," says Mr. Jones. "How stable was the platform for the patient? That was our strictest filter. Any movement was a dealbreaker."

Ms. Humbarger recalls the influence that side rails had over her purchasing decision. One stretcher model featured rails along the upper half of the bed, but not along the lower half. "That could have compromised patient safety," she says. Another had rails along its full length, but as a result was only able to tilt, not convert into a sitting position. "What we need for outpatient surgery is a transition from lying to sitting to standing," she says. A stretcher with a divided side rail, however, fit the bill, even though the bottom rail had to be purchased as an additional option.

According to their users, stretcher tables are easy to maintain. Just plug in their rechargeable batteries at the end of each day. At Ms. Jackson's center, the only buyer's regret is not acquiring more. "You have to purchase enough to handle the turnover of all the patients you see in a day," she says. "We have 5 chairs, and sometimes that's not enough."