Ready for a 4K Upgrade?

What's not to like about 4K ultra-high-definition surgical monitors? At 4 times the resolution of high definition, the picture quality is out of this world. If you're thinking about upgrading to 4K monitors in your ORs, where do you start and what should you expect? We spoke to a few facility leaders who've recently added 4K, and they shared some advice based on their experiences.

• Look beyond the screen. Simply getting a 4K monitor doesn't necessarily mean you're going to be viewing 4K. The entire video chain, from cameras on scopes to image processing boxes, must be native 4K. "Be careful with the vendors and how 4K is marketed," advises Robert Eisenberg, ?RN, MBA, administrative director of ambulatory surgery, integration and planning at WellSpan Health in York, Pa. "Some vendors will say they have 4K systems, but what that may mean is they use software to upscale an image to 4K. It's not true 4K."

Many surgical 4K systems do a lot more than just display clear, crisp images and video in the OR. You can take video of the procedure, download images from other parts of the hospital like radiology and view it on a monitor during a procedure, or upload video and images to surgeons' offices for use during clinic visits.

"We can put various images on different monitors," explains Mr. Eisenberg, who bought systems for 4 ORs in his system's new surgery center in Hanover, Pa. Each OR has 5 4K monitors — 3 mounted on booms, another on top of the arthroscopy tower and a large screen mounted on a wall.

"If the surgeon wants to see a patient's X-ray and MRI, take a picture using a C-arm and capture an image from the arthroscopy tower, they can put all those images on different monitors around the patient while doing surgery in real time."

• Try before you buy. The facilities we spoke with trialed products from 2 to 4 vendors, with surgeons using each for weeks at a time. "We evaluated 3 vendors," says Mr. Eisenberg. "I wouldn't recommend going beyond that. It just gets overwhelming and too hard to achieve consensus in decision making."

When Brandon Thompson, administrator at Tidewater Orthopedics in Hampton, Va., began working at the facility a few years back, he decided upgrades were needed — including moving from HD to 4K. He looked at 3 vendors, and brought in 2 for trialing. The surgeons overwhelmingly chose the system with the best picture quality.

Don Bucher, CMRP, assistant director of materials management at Oswego (N.Y.) Hospital, bought 4K systems for the facility's 4 main ORs in 2018; each OR has 2 31-inch monitors placed on either side of the operating table, giving the entire surgical team the ability to view the procedure. "You need to have great communication not just with your surgeons, but with the nurses and scrubs techs, too, because you're not in there for every case," he says. "Not only did I have the doctors fill out evaluation sheets, I had the staff do it, too. Their input to me was just as good."

Beyond picture quality, administrators also stress ease of use in terms of setting up the imaging technology between cases as a key factor to evaluate on behalf of surgeons and staff.

• Consider the case mix. Surgeons of different disciplines might prefer different systems. Marshall Medical Center (MMC) Health System trialed 4K systems with its OB/GYN, orthopedic and general surgeons, among other disciplines. "Finding one that satisfied all the needs and requirements of each of the different types of surgeons was our big goal," says Sherry Jones, RN, CNOR, director of surgical services at MMC North in Guntersville, Ala.

Easier said than done. The ortho surgeons were comfortable with a particular type of system and the company they'd always worked with, but the images that system provided were too dark for the general surgeons. Eventually, a consensus was reached. "The wider color gamut, detail and brightness worked for all of them," says Ms. Jones.

Mr. Eisenberg advises meeting with your surgeons to better understand the types of cases they do now, the cases they want to do in the future, and what system capabilities would be valuable to them. Then contact vendors that have the video equipment that meets those needs. "For orthopedic surgeons, who work looking at various shades of white, it's about picture quality and ease of use," says Mr. Eisenberg. "In general surgery, more colors of anatomy are involved, so the enhanced picture quality is even more important."

• Calculate the cost benefit. 4K is still much more expensive than HD, so you need to make the numbers work at your facility before you move forward. At Tidewater Orthopedics, the purchase price was $111,000 for 2 monitors and towers, but Mr. Thompson didn't encounter pushback about the cost at the facility, a 50-50 joint venture between a physicians group and a local hospital.

"The surgeons didn't need convincing," he says. "And the hospital was on board with the fact that we wanted to be the first in the market to [add 4K], so we could stay ahead of everybody else."

On the whole, 4K isn't a moneymaker per se for Tidewater, but it's improved working conditions and efficiency for surgeons and staff, which is beneficial in softer ways. "I wouldn't say 4K has necessarily improved outcomes, but it's helped us save a little bit of time on cases because the surgeons aren't having to strain to see things," says Mr. Thompson. "If you want to be able to provide quality pictures and image clarity for your surgeons, 4K is the right way to go."

Baptist Health's ambulatory campuses in Fleming Island and Amelia Island, Fla., have new high-tech surgery centers with 4K technology in their ORs and endoscopy suites. Darin Roark, vice president of Baptist Health's ambulatory campuses, says the technology was well worth the expense because it provides better outcomes for patients and is popular with surgeons.

"Providing superior visual images is paramount because it allows the surgeons to get a better view of what they're operating on," he says. "We've had no complaints, and get compliments every day from the surgeons about the quality of images that helps make their jobs easier."

Still — crunch the numbers. "Some less expensive offerings make better sense for some surgery centers," says Mr. Eisenberg. Do you have competition in the community, and would 4K make you better than them? Look at the acquisition costs, but also look at the cost of ownership. With your given case mix, how much is it really going to cost to acquire and use this equipment for each case?

Mr. Bucher says his hospital's 4K systems have paid for themselves many times over thanks to the added efficiency in which surgeons can operate. "They don't have to squint [to see anatomical details]," he explains. "The visual color and the identification of parts of the anatomy are much clearer now, which saves time in the OR."

Keep in mind that 4K can help you differentiate yourself in your market — not just to consumers, but perhaps more importantly, to referring physicians. "One of the things we considered was whether 4K could give us a competitive advantage in our market," says Mr. Eisenberg. That didn't involve marketing to consumers, though, but rather to the center's referral sources "to let them know their patients will be cared for in a place that's invested in the latest and greatest technology." OSM