Thinking of stepping into the world of OR integration? Being able to route video images anywhere in the room with the touch of a screen or a voice command is the ultimate in high-tech efficiency, but tread lightly. The installation is complex and costly — between $50,000 and $75,000 per OR, our recent reader survey found — and it can rarely be done within a typical IT infrastructure.

This month, 241 Outpatient Surgery readers weighed in on OR integration. Slightly more than half of them have integrated ORs in their facilities; the typical facility manager with integrated ORs oversees 5 of them. Integrated ORs are significantly more common in hospitals than ASCs — 58% of our hospital-based respondents have them, while only 25% of ASC-based ones do.

Many of our respondents who have integrated ORs touted the ability to adjust surgical tables and lights or direct flat-screen monitors and equipment suspended from ceiling-mounted booms — all without disrupting the sterile field. "It's wonderful to do away with towers and monitors that you have to bring into the room," says a staffer at an Indiana hospital. "The RN isn't moving all over the room and can change settings for everything in one location," says a Hawaii OR Manager.

"It increases workflow and efficiency of the OR team and promotes safety and accurate documentation," says Jason Smith, MSN, director of perioperative services at Baylor Surgical Hospital in Fort Worth, Texas.

Features and benefits

The most common feature shared by everyone's integrated ORs is the ability to route video images anywhere in the room; 90% have this and 76% find it "very useful," at least in part because it lets everyone see what the surgeon is seeing.

However, our respondents find one feature even more useful — "The ability to bring in PACs images close to the field," says Sherry Lynch, BSN, RN, MPA, director of surgical services at Aurora Medical Center in Oshkosh, Wis. Ms. Lynch says her orthopedic surgeons and podiatric surgeons use this feature the most.

Facility managers also like the systems' ability to help with room turnover. If your integrated OR can "remember" the settings for each surgeon, it enables a "quick set-up," says Pamela Richards, RN, MBA, surgery program manager at Mackenzie Health in Richmond Hill, Ontario. Sixty percent of our readers agree, calling this feature "very useful."

Video recording is also popular, in part because it lets surgeons easily share images with the patient and family post-operatively on a tablet, says Mary Leedom, MHA, assistant VP of perioperative services at Avera McKennan Hospital in Sioux Falls, S.D.

Less popular: the ability to record operating notes, videoconferencing, voice activation, OR table control and room climate control. Less than 20% of our respondents say these features are "very useful." Bringing up the rear: telestration, or the ability to electronically "draw" on images; just 11% say this feature is "very useful."

Downsides

Although most of the facility leaders who have installed integrated ORs love them, they are not perfect.

One problem is that like most high-tech devices, integrated ORs quickly become obsolete. For example, in facilities with HD monitors, many surgeons are asking for upgrades to 4K. "The surgeons always what the newest toy out there," says Penny Lobenstein, RN, assistant director of surgical services at Reedsburg (Wis.) Area Medical Center. "You have to replace [the monitors] at minimum every 5 years to keep up with current technology," says a nurse manager at a hospital in New York State.

Upgrades are not just about the expense. They can also mean "down time," says a director of surgical services at a small-town Pennsylvania hospital.

Facility leaders complain a lot about the learning curve involved. "Integrated ORs seem too complex for some people to learn," says Meredith Kopp, BSN, quality improvement coordinator at Children's Mercy in Kansas City, Mo. As a result, "we don't take full advantage of all the available options." She adds, "it can become a burden to the busy circulator — the more it controls the more the RN has to learn and control." Older nurses may have more difficulty. Many agree with our Hawaii OR manager, who says "There is a generation gap with user competency."

The systems can be bulky and unwieldy. "The hardware must be stored in the OR rather than in an IT closet, taking up additional space," says Baylor's Mr. Smith. Michael Porco, RN, a nurse educator with Concordia Hospital in Winnipeg, says with his system, "The exposed wires make it impossible to clean."

Some systems are not very reliable. The systems have gone down "many times" at a hospital in Birmingham, Ala., says a staffer there. The system occasionally "freezes up" at a center in Indianapolis, Ind., a staffer says. "It crashes and freezes often," says a staff member at a Vermont medical center. "Once we hit the 3-year mark, we started experiencing consistent issues across several of the operating rooms," says Baylor's Mr. Smith.

Shopping advice

The 51% of our respondents who have OR integration have several pieces of advice for those who have not yet taken the plunge:

• Take your time and do your homework. Baylor's Mr. Smith advises doing several demos of different systems and also trialing several different configurations of each system. Many respondents recommended including physicians, staffers and your IT department in this process. Plan to make visits to facilities that have systems installed and "see how those facilities use them," says Melinda Noble, MSN, clinical director at Methodist University Hospital in Memphis, Tenn.
• Resist the temptation to buy bells and whistles. "Most are not needed," says Steve Encardes, OR/materials manager at Surgical Specialists ASC in Ft. Walton Beach, Fla. Instead, purchase only what you need, but make sure the system is expandable, many respondents say. "Consider carefully how it will be used and don't get sold on features you won't use," says Ms. Kopp, "but be sure the system has the ability to expand later as things change."
• Who will you call for service? If you're planning to use one company for the system and another for the equipment, make sure you know who will provide maintenance if problems arise. Several of our respondents think it's best to get the hardware and software from one vendor.
• Buy the service contract. Make sure it includes updates, and factor in the total cost of the technology as you consider your budget.
• Make sure all surgeons will accept the same camera. If not, buy a system that includes universal adapter options, says an Indiana surgical services manager.

Just do it

Of the respondents who do not yet have OR integration, 1 in 3 say they are "very" or "somewhat likely" to install a system within the next 3 years. Most of their colleagues who already have the technology would advise them not to wait. "Go for it," says Maria Camilon, MSN, RN at San Diego's Shiley Eye Center. "Do it," says a Pennsylvania surgical services director. "It is worth it." OSM