Hallbeck, M. Susan

Researchers at a large Midwest Tertiary Care Hospital have developed a remote monitoring system that supports 24-hour real-time physiological monitoring of multiple noncritical care patients from a central remote display station. The system’s potential to revolutionize the healthcare industry has encouraged future plans to expand the operation. However, all of the system’s characteristics and how those characteristics interact to affect qualities of interest such as worker efficiency, fatigue, and patient care have not been fully explored. A mixed-methods ethnographic approach was used to identify and more comprehensively understand characteristics of the remote monitoring systems currently in place. Analyses described three remote monitoring paradigms, emphasizing elements of communication that were perceived to impact patient care. These efforts are the first steps in continued analyses of remote monitoring systems and are important in the identification of key system elements intended to construct a fundamental remote monitoring model.

Medical care providers recognize nonadjustable examination tables in clinics as a barrier to comprehensively and safely providing routine healthcare for disabled, elderly and obese patients. The aim of this study was to understand how the availability of the adjustable examination table may affect the medical care provider’s perception of the quality of care provided to patients who need physical assistance. Fifty providers answered questionnaires to report their perceptions of two different examination tables’ usability. The first one is a mid-century industrial designed table and the other adjustable and ADA compliant, as used in a community health clinic. Before implementation of the new adjustable examination table, 34 medical care providers provided feedback on their experiences with nonadjustable examination tables. A second survey was administered approximately six months after implementation of the new adjustable examination tables to 16 medical care providers (with 2 indicating participation in the prior-to-implementation survey) for their feedback on experiences with the new adjustable examination tables. Providers reported significantly (p<0.05) more comfort in getting typical patients (27%), bariatric patients (50%), and geriatric patients (30%) into a sitting position when they used the adjustable examination table compared to the nonadjustable examination table. Providers considered the adjustable examination tables to have a more ideal width (60%) and length (64%) to accommodate a wider variety of patients than the nonadjustable examination tables. Providers also considered the adjustable table (33%) easier to use and preferable to the nonadjustable table. This research showed how the adjustable examination table improves healthcare provider experience to provide access to healthcare for patients with disabilities with better ergonomics and greater safety for both patients and providers.

Abstract Background Surgical performance, provider health, and patient safety can be compromised when workload demands exceed individual capability on the surgical team. The purpose of this study is to quantify and compare intraoperative workload among surgical team members. Methods Observations were conducted for an entire surgical day for 33 participating surgeons and their surgical team at one medical institution. Workload (mental, physical, case complexity, distractions, and case difficulty) was measured for each surgical team member using questions from validated questionnaires. Statistical analyses were performed with a mixed effects model. Results A total of 192 surgical team members participated in 78 operative cases, and 344 questionnaires were collected. Procedures with high surgeon mental and physical workload included endovascular and gastric surgeries, respectively. Ratings did not differ significantly among surgeons and residents, but scrub nurses physical demand ratings were 14–22 (out of 100) points lower than the surgeons, residents, and surgical assistants. Residents reported the highest mental workload, averaging 19–24 points higher than surgical assistants, scrub nurses, and circulating nurses. Mental and physical demands exceeded 50 points 28–45 % of the time for surgeons and residents. Workload did not differ between minimally invasive and open techniques. Conclusion The workload questionnaires are an effective tool for quantifying intraoperative workload across the surgical team to ensure mental and physical demands do not exceed thresholds where performance may decrease and injury risk increase. This tool has the potential to measure the safety of current procedures and drive design of workload interventions.

Workload experienced by health care workers continues to be a challenge to define and quantify. The purpose of the current study is to present descriptive data on the application of sociometers in an emergency care environment during simulated hand-off scenarios and discuss their potential and limitations for quantifying individual’s workload in health care settings. Sociometer devices, worn by nine actors, collected body movement, interactions, and speech data during four simulated hand-off scenarios in the emergency department wards. Results found that sociometers distinguished body movement differences between sitting, standing, lying, and walking individuals. Interactions quantified by the devices were limited by obstructions, distance, and angles between the sociometer devices. The data collected by these devices show promise in providing human factors researchers a tool for quantifying the dynamic exposures experienced by health care workers over time.

Surgical trainees undergo demanding training to achieve high surgical task proficiency. Abounding clinical and educational responsibilities mandate efficient and effective training. This research measured resident workload during laparoscopic skills training to identify excessive workload and how workload impacted task performance. Twenty-eight surgical trainees performed a standardized surgical training task and completed a workload questionnaire while observers measured physiological stress, posture risk assessment, and task performance. Participants self-reported mental demands, physical demands, temporal demands, performance, effort, and frustration. Effort (12±4) and frustration (12±5) were the highest subscales while physical demand (8±4) was the lowest. All participants were observed performing the task in at-risk postures, with 21% exhibiting risk levels requiring immediate intervention. Physical demand was associated with posture risk assessment scores (p<0.05). Mental demand was positively (R 2 =0.20, p<0.05) and frustration was negatively (R 2 =0.18, p<0.05) associated with skin conductance range. A point increase in physical demand was associated with a six second increase in performance time (β=6.0, p=0.01). These results support the fact that human factors and ergonomic tools can be used to relate surgical skills performance with workload, stress, and posture risks.

Laparoendoscopic single site surgery (LESS) can provide potential patient benefits beyond conventional laparoscopy (CL). However, LESS further exacerbates current ergonomic disadvantages of CL. LESS practices to compensate for the constraints include intracorporeal crossing of instruments (UL) for improved manipulation of instrumentation and extracorporeal crossing of hands (PL) for illusion mitigation. Preliminary results from this study involving 12 medical students (7 males) performing a simulated surgical task found statistical difference between CL, PL, and UL for physical demand (P<0.001), task complexity (P=0.002) and performance times (P<0.001) with no difference for mental demand (P=0.106). These initial findings show that the PL technique cannot currently compensate for the limitations of LESS to make UL more similar to CL. Further research is needed to determine if PL or another LESS compensatory practice can allow surgeons to more effectively perform procedures with a single port and therefore ensure patients reap its benefits.

Objective The aim of this study was to define health care providers’ perceptions toward prone patient positioning for spine surgery using the Jackson Table, which has not been hitherto explored. Methods We analyzed open-ended questionnaire data and interviews conducted with the spine surgical team regarding the current process of spinal positioning/repositioning using the Jackson Table. Participants were asked to provide an open-ended explanation as to whether they think the current process of spinal positioning/repositioning is safe for the staff or patients. Follow-up qualitative interviews were conducted with 11 of the participants to gain an in-depth understanding of the challenges and safety issues related to prone patient positioning. Results Data analysis resulted in 6 main categories: general challenges with patient positioning, role-specific challenges, challenges with the Jackson Table and the “sandwich” mechanism, safety concerns for patients, safety concerns for the medical staff, and recommendations for best practices. Conclusions This study is relevant to everyday practice for spinal surgical team members and advances our understanding of how surgical teams qualitatively view the current process of patient positioning for spinal surgery. Providers recommended best practices for using the Jackson Table, which can be achieved through standardized practice for transfer of patients, educational tools, and checklists for equipment before patient transfer and positioning. This research has identified several important practice opportunities for improving provider and patient safety in spine surgery.

This study shows what employees in the Environment, Health and Safety (EHS) area within private Brazilian companies think about the relationship between ergonomic risks and Homogeneous Exposure Groups (HEG). Thirty-seven professionals from different market segments answered a questionnaire via Google Docs. The results show that 75.6% of the companies sampled use HEG in order to map occupational risks. Within those companies, 54% include ergonomic risks in their HEG, which has negative consequences to both employees and employers in these companies.