Hallbeck, M. Susan

Objective: To examine perceived operating room (OR) ergonomics facilitators and barriers, with a focus on the interdisciplinary team. Background: Poor ergonomics causes musculoskeletal injuries affecting all OR staff with repercussions on patient care, outcomes, and sustainability. Lack of ergonomic awareness and education are risk factors. Methods: We conducted a self-administered web-based survey of OR nurses, surgeons, and anesthesiologists at a single center (n = 238). We developed a questionnaire through item generation and reduction, followed by reliability and validity testing. Results: Response rate was 53.8%. Respondents perceived that on average 80% of nurses, 70% of surgeons, and 40% of anesthesiologists experienced musculoskeletal (MSK) injuries, with no difference in professional groups’ perceptions. Guideline ergonomics interventions were rarely used (<25%) except for specialized clothing (33%), equipment repositioning (59%), and seating (37%), though perceived as beneficial by 80% to 90%. Reported barriers to optimal ergonomics were organizational/structural (lack of time, space, equipment, funding), whereas solutions were individual. Fear of unfavorable perceptions from others was a concern for 62%. Teams discussing, prioritizing, monitoring, or helping with ergonomics was indicated by <50%. Individual ergonomic adaptations were perceived as convenience by other staff. Conclusions: While structural/organizational issues are reported as barriers to ergonomics, solutions appear as individual responsibilities. Team dynamics did not prioritize nor support ergonomics. Education tools leveraging the interdisciplinary team are warranted. This work will be supplemented by interviews and live observations to build tailored educational tools for OR teams.

Burnout is a challenging issue among surgeons. Many factors have been linked to burnout, such as an inadequate work-life balance, high stress levels, and the frequency of on-call, overnight shifts. There is a lack of research on factors in surgeons’ daily lives associated with burnout. This study observed trauma surgeons with daily surveys assessing stress and fatigue over 9 days (6 day shifts, three night shifts). This study analyzes surgeons’ stress and fatigue levels. The study population was compared to the population of US critical care surgeons to ensure representativeness based on age, sex, and rates of burnout. Overnight shifts showed high stress and fatigue levels relative to off days, day shifts, the 3 days before, and the 3 days after overnight shifts. Days performing surgery were also more stressful and fatiguing than non-surgery work days and off days. Fatigue and stress levels were minimized during off days.

Ergonomic microbreaks such as the OR-Stretch can address work-related musculoskeletal pain among surgeons and potentially alleviate burnout and early retirement. Fifteen surgeons at a single institution completed two operative cases using the OR-Stretch, once using the Scheduled (every 45 min) timing strategy and once using the Self-Determined (between 30 and 60 min based on surgeon preference) strategy. Eight surgeons preferred the Scheduled timing strategy, and seven preferred Self-Determined ( p = .80). The stretch was skipped 16% of the time using the Scheduled strategy and 6% with the Self-Determined strategy ( p = .18). Personal interest, improved mental focus, and ease of remembering were cited as the most influential factors for continued usage, while the most influential factor for not continuing was forgetting to use it. Self-determined intervals for intraoperative microbreaks represent a valid and potentially preferable implementation approach. Efforts to promote long-term adoption of microbreaks should focus on reminding surgeons to use them during operations.

Cardiac sonographers are frequently exposed to ergonomic risks such as postural stress and high levels of physical exertion while performing scanning tasks, contributing to work-related pain, and discomfort among cardiac sonographers. Passive exoskeletons are a potential ergonomic intervention with the potential to mitigate some of the risks associated with scanning. This study examined the effectiveness of a passive upper body exoskeleton in reducing the levels of work-related pain, discomfort, and workload in cardiac sonographers while performing transthoracic echocardiograms (TTE). Twelve cardiac sonographers were asked to use the HAPO FRONT exoskeleton while performing TTEs during a full workday. Participants were asked to rate their body part discomfort and workload throughout the day, both with and without the exoskeleton. The exoskeleton did not significantly decrease discomfort or workload associated with performing TTEs, except for a slight reduction in the discomfort at the left hand/wrist. This result indicates that the HAPO FRONT was not effective or appropriate for use by cardiac sonographers. Future development and study of purpose-designed exoskeletons for healthcare applications may provide greater benefits to cardiac sonographers.

This study provided additional evidence to support the OR-Stretch Web- App as a potential ergonomic intervention in the operating room. Overall, the ORStretch Web-App was beneficial to surgeons’ physical performance, mental focus, and discomfort. However, improving the Web-App to be user-friendly, and developing strategies to align the microbreaks with appropriate time spots during surgeries to not interrupt surgical workflow are among the key factors that need attention. Additionally, no significant differences in the surgeons’ subjective evaluation of the Break-30 and Break-60 scheduling strategies were found. However, the data and surgeons’ feedback implied that taking microbreaks every 30 min (Break-30 condition) may not be ideal, especially during long or complicated surgical procedures.

Objective: Identify how surgical team members uniquely contribute to teamwork and adapt their teamwork skills during instances of uncertainty. Background The importance of surgical teamwork in preventing patient harm is well documented. Yet, little is known about how key roles (nurse, anesthesiologist, surgeon, and medical trainee) uniquely contribute to teamwork during instances of uncertainty, particularly when adapting to and rectifying an intraoperative adverse event (IAE). Methods: Audiovisual data of 23 laparoscopic cases from a large community teaching hospital were prospectively captured using OR Black Box. Human factors researchers retrospectively coded videos for teamwork skills (backup behavior, coordination, psychological safety, situation assessment, team decision-making, and leadership) by team role under 2 conditions of uncertainty: associated with an IAE versus no IAE. Surgeons identified IAEs. Results: In all, 1015 instances of teamwork skills were observed. Nurses adapted to IAEs by expressing more backup behavior skills (5.3× increase; 13.9 instances/hour during an IAE vs 2.2 instances/hour when no IAE) while surgeons and medical trainees expressed more psychological safety skills (surgeons: 3.6× increase; 30.0 instances/hour vs 6.6 instances/hour and trainees: 6.6× increase; 31.2 instances/hour vs 4.1 instances/hour). All roles expressed fewer situation assessment skills during an IAE versus no IAE. Conclusions: OR Black Box enabled the assessment of critically important details about how team members uniquely contribute during instances of uncertainty. Some teamwork skills were amplified, while others dampened when dealing with IAEs. The knowledge of how each role contributes to teamwork and adapts to IAEs should be used to inform the design of tailored interventions to strengthen interprofessional teamwork.

Exoskeletons are ergonomic devices that can support workers to improve performance and worker safety. This study created an apparatus that simulated a head-and-neck exoskeleton designed for surgeons to test the effects of varying tension forces on muscle activation (splenius capitis, splenius cervices, and erector spinae), body part discomfort, dexterity, cognition, and overall usability of the device. Eight participants were involved in twelve trials over two days and held static postures (looking down at 45° or 90°) for 20 minutes with 10-minute breaks between trials. Six trials utilized tension forces, which were recorded every two minutes and then averaged for each trial. A bivariate regression analysis ( on each metric vs. average tension forces demonstrated that increasing tension forces led to decreased muscle activity of the left splenius capitis, change in general body pain, change in neck discomfort, and the rate of discomfort developing, and improved usability scores.

Despite advances in medical technology, intraoperative adverse events (IAE) continue to occur in hospital’s complex systems. Current approaches to understanding and mitigating IAEs rely on retrospective data analyses to recognize the series of events leading to an IAE. This paper discusses current challenges and highlights the potential of the Operating Room Blackbox (ORBB) system use to enhance patient safety.

The neck muscle fatigue and subjective discomfort due to neck postural exposure was evaluated. Ten male participants were asked to hold one of the two static neck postural exposures for 30 minutes (one condition per day): 1) Neck flexion (N-45) where head and neck were flexed 45º relative to trunk while the participant was standing upright, and 2) Trunk flexion (T-45) where head and neck were not flexed relative to trunk, but trunk was flexed 45º. Surface electromyography was used to collect muscle activity of neck extensors. T-45 caused higher fatigue in neck extensor muscles (p=0.0229) and higher neck subjective discomfort (p=0.0088) compared to N-45, but the long-term effects of these two conditions are not clear because of the difference in the role of passive tissues. We recommend that work assessment tools consider both measures of neck postural exposure (neck flexion and trunk flexion) in their assessment tools.