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Surgical suites morphing into boom towns

Next big target for expansion? ICUs

by Rick Dana Barlow

Attend any clinically oriented conference with a trade show for doctors and nurses and you’ll have to purposefully avoid espying nearly a dozen different vendor booths showcasing one of the latest trends in surgical suite technology today, as well as in forward-thinking intensive care units: Boom rooms.

To clinicians used to operating rooms cluttered with equipment and power cables these boom room booths resemble the home building industry’s annual "Cavalcade of Homes," where you can see how professionals organize surgical areas for maximum efficiency with eye-popping aesthetics to boot. Clutter-free floors and ample open space surround a surgical table situated underneath several articulating arms that sport high-tech equipment at the tips of their tentacles or on suspended towers.

These boom rooms, which carry more technical names like integrated surgical suites, may be a doctor’s and nurse’s dream. While only a small percentage of hospitals and other healthcare facilities are privileged to have these installed, those that are undergoing or planning future construction and renovation projects certainly have these in the mix.

Booming business

Surgical boom technology debuted in the early 1990s to much fanfare as a revolutionary answer to concerns about floor clutter, inefficient workflow and room size. "In the early ’90s, the trend from healthcare clinicians was that they wanted booms and equipment ‘out of the way’ when they didn’t need them," said Randy Tomaszewski, vice president of marketing, Skytron, Grand Rapids, MI. "Therefore, early boom floor-plan designs traditionally placed boom mounts to a far wall so that the equipment and services could be moved ‘out of the way’ when not in use."

But that created two problems, according to Tomaszewski. "First, for most procedures today the booms are ‘in use,’" he said. "They are used nearly all the time. Because many surgical procedures can be performed using minimally invasive devices these booms carry a significant amount of equipment to support endoscopic devices, including the nitrogen system, medical gases, vacuum for suction, power and communication outlets, cameras and light sources.

"Second, pushing a boom to a wall for storage requires that for its clinical use and movement to the field the arm had to be fully extended to be of any use," he continued. "Doing so creates the greatest moment load and center of gravity forces for a nurse to have to overcome when positioning the boom where needed, and mounting a boom close to a wall cuts its otherwise clinical positioning flexibility in half. Most booms can rotate up to 300 to 330 degrees at each articulation joint. Slapping them up against the wall reduces flexibility to one-half of the otherwise overall potential positioning effectiveness to cover more target areas for more procedures."

Tomaszewski called yesterday’s booms "Neanderthal giants" because they were bulky, heavy and hard to move. "These booms were either used where they hung or left there while the circulating nurse brought in a portable cart for other procedures versus trying to wrestle with these larger booms, due to size and difficulty to position [because they were] mounted in the wrong place," he said. "This only led to adding more clutter to the operating room versus less clutter and greater efficiency as the original goals intended."

John Nies, TELETOM product manager, Berchtold Corp., Charleston, SC, agreed. "In its infancy in the early ’90s the location of a boom in the O.R. was not always optimal," he said. "Since then, proper location of the boom in the O.R. has greatly improved. Many boom suppliers have adopted the use of high-tech 3-D software to allow users to see the design and functionality of their O.R., before it is built. By ‘testing’ each procedure in this virtual O.R. the customer will have a much higher level of confidence that the room will ‘work’ once it is installed and goes live."

Today’s booms are more flexible, lighter in weight and smaller in size, according to Tomaszewski, making them sleek and easy to move for any and every procedure. "Booms mounted centrally with equipment carriers, flat panels and lights provide an even greater flexibility advantage case to case and at a significant cost savings, especially when considering mounting structure costs and significantly reduces the complexity of overall room design considerations and potential pitfalls," he said. "But most important, these systems provide optimal flexibility and efficiencies in delivering illumination, video images, equipment and services exactly where surgeons and the surgical team need them…not just close or not at all."

Nies also cited ergonomics as a significant improvement to surgical booms, specifically as it pertains to movement and braking. "Surgical booms have moved away from ball bearings at the rotational joints and implemented roller bearings, which provide smoother and easier movement along with a longer life-span," he said. "Working in tandem with smoother bearings is the shift to active braking from friction braking. Moving a boom with friction brakes is similar to driving a car with the emergency brake partially on; there’s always a significant force that needs to be overcome to move the boom. With active brakes, typically electromechanical or pneumatic, a button is pressed and the brakes release, allowing smooth, easy movement." Finally, something as simple as adding handles to the back of the boom has given end users a comfortable and convenient place to grab and maneuver the equipment.

CompView Medical’s Nuboom

Brake systems in a surgical or ICU boom’s suspension represent a key improvement, concurred Walker Lambiotte, director of marketing, Stryker Communications. "In order to prevent booms from drifting away from their desired location, boom companies, such as Stryker, have combined pneumatic and friction brakes to ensure that the booms remain in their stationary locations," he said. "This type of braking incorporates air bladders in each joint that remain inflated until the brake buttons are compressed. When the brake buttons are compressed, the brakes release, allowing the nurse or doctor to easily move the booms in a controlled fashion. When the buttons are released, the air bladders inflate again, preventing the joints from moving. In the case of Stryker’s booms, each joint of the boom’s arm can be moved individually while the other remains fixed. This allows each horizontal arm to be independently controlled for precise movement."

James Norris, marketing manager, STERIS Corp., Mentor, OH, pointed to three primary changes in booms as improvements to the technology: Increased arm lengths, internal capacity and custom workplaces. "As monitoring and services equipment has become lighter, boom arms have lengthened, which has enabled head-to-foot coverage of the patient and flexibility for more types of MIS and other procedures," Norris noted. "As facilities increase their use of data platforms and connectivity, video capabilities and minimally invasive surgical equipment and control systems, boom manufacturers have enlarged the internal capacity of boom arms to provide a larger conduit for cables. Ceiling-mounted systems have facilitated the creation of customized configurations for specific settings. In the ICU, equipment management systems have been mounted in tandem for optimal coverage of the patient. In the O.R., booms have been integrated with surgical lighting to create more ergonomic and flexible rooms."

But not everyone agreed that booms have improved that much, if at all, over the years. "Very little has changed in the technology since the 1990s," said Paul White, founder and president, CompView Medical. "We’re turning that problem into an opportunity. Companies that have traditionally produced boom technology have not listened and responded to the evolving needs of their customers these last 20 years." He emphasized his company’s "regular consultation of surgeons, nurses and O.R. managers from the beginning."

Mounting differences

Historically, boom placement migrated to the ceiling from the walls as the technology progressed – at least until 2005 when CompView Medical launched its floor-mounted version to considerable fanfare among providers and curiosity by the competition.

White identified several "shortcomings" among boom technology that motivated the creation of his company’s floor-mounted unit. "The carts and ceiling-mounted booms sat on opposite ends of the spectrum and each presented issues in the areas of time and money efficiencies for O.R. managers, ergonomics for the surgeons and safety for the O.R. nurses and staff." He argued that CompView’s model addresses "safety and efficiency issues that the ceiling-mounted products do not resolve." He noted that CompView’s model "can be retrofitted into existing operating rooms, cutting the room’s downtime for installation down to three days from ceiling-mounted version’s 30 days required for ceiling reinforcements and other remodeling," and "it holds more equipment than ceiling-mounted versions and it costs less than half as much."

But don’t look for CompView to free its technology with a mobile option anytime soon. "Currently, the benefits to stationary positioning outweigh any that would be presented through its mobility," White said. "We leave the concept of mobility on the table, though, in the event that mobility or any other engineering breakthrough could lead to even greater benefit and functionality in the O.R."

Despite the apparent cost difference, some argued that ceiling-mounted units provide necessary flexibility for clinicians and equipment. "In an O.R. setting, wall or floor-mounted equipment management systems interfere with freedom of movement and restrict equipment placement," Norris said. "‘Booms,’ in their various iterations, allow for services and equipment to move easily to the necessary point of patient contact, head to foot, and allow for rooms to be used for many types of procedures since there are few restrictions on equipment placement.

"The costs for ceiling-mounted systems are a bit higher," Norris acknowledged, "but the ideal placement of services and equipment, easy access to the patient and procedural flexibility they provide can improve staff and patient safety, and O.R. efficiency and productivity, and hopefully support a better patient outcome. In critical care units, booms allow multiple caregivers to have simultaneous total access to the patient, even the patient’s head, without the infamous ‘duck and weave’ under and around the critical IVs and monitors connected to the patient. If a patient goes into crisis, ceiling-mounted equipment management systems maintain services and equipment within easy reach without impeding access, thereby improving CCU crisis management."

Because of the variety of surgical procedures performed, Tomaszewski agreed. "In large part, every hospital operating room must provide the flexibility to do any case, any procedure, based upon patient and surgical demands for that day," he said. "Floor- and wall-mounted units do not offer the flexibility, speed and set-up time efficiency advantages that booms otherwise deliver. They can only provide services positioned at fixed, non-flexible locations. If the patient and or table has to be rotated or the surgeon is working on the opposite side of the body than services are delivered from, managing services to point-of-use case-to-
case becomes cumbersome and inconsistent, creating difficult management problems. If a unit is mounted to the floor, it becomes a physical impediment and must be considered as a potential obstruction for every case and procedure depending upon what that
procedure is."

Flexibility and maneuverability of equipment should dictate how and where a boom is placed, Lambiotte noted. "A boom, ideally positioned in the O.R., makes the room configurable to many different set-ups," he said. "By placing all of the equipment that normally sits on the floor onto the equipment boom, critical equipment can be located precisely where surgeons and staff need it most."
This leads to a more adaptable and comfortable atmosphere for
performing different types of operations, he added.

Nies acknowledged that construction time for a floor-mounted boom may be lower because the ceiling doesn’t have to be opened but placement of the fixed mount has to be carefully considered. "With many different technologies, people and equipment competing for the premium O.R. floor space around the table, it becomes difficult to locate this mount without interfering with traffic flow," he said.

Iconic booms

Tomaszewski indicated he foresees boom technology migrating into non-typical surgical support locations, such as radiological cath labs set up to be on-demand open heart operating rooms and even MRI rooms, which are now considering booms and boom support. "At the same time, the industry is looking more at laminar flow and other traditional O.R. design considerations where traditional mounting locations for lighting and booms must be reconsidered," he said. It’s all about "delivering steadily smaller and compact, lighter and multifunctional systems," he continued. "Perhaps one day we will see the evolution of providing target services only with no need to deliver equipment carriers or equipment at all." In addition, wireless technology may obviate the need for MIS equipment in the future, while advancements in digital communications will boost image quality standards.

Lambiotte viewed future surgical booms as having a "greater range of motion, less invasiveness, easier adaptability to new equipment." But competition complicates that. As booms innovate more companies will need to cooperate with each other and their customers, which may prove more difficult to achieve with multiple vendors, he added.

"We see a future that includes a tighter integration between the boom, the user and the equipment that is placed on the boom," Nies said. "The ability to have a modular plug-and-play approach to the equipment on the boom, to allow for quick and easy reconfiguration for specific procedures, is a distinct possibility. Continuing to refine the design of booms for improved user interaction, through size, shape and location of the boom components is also something that is probable in the near future. As equipment becomes lighter weight the boom arms will become lighter and smaller, and as the use of fiber optic transmission of information in the O.R. becomes more widespread that will also drive a smaller, more compact boom solution."

Stryker ICU Boom

Norris predicted considerable changes – from the functional to the aesthetic. In the future, booms will be sleeker and slimmer, and will be used in most clinical areas, he said. They may incorporate ambient lighting in such areas as MIS and ICU and integrated task lighting in the O.R. Equipment management systems will be integrated into advanced O.R. control systems. Plus, he said he believes booms will be made with more advanced materials that involve non-ferrous components for MRI applications, sound-absorbing paints and antimicrobial surfaces, as well as be designed in optimal colors to promote healing. HPN

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