Cohen, Tara

Abstract Background Poor operating room (OR) ergonomics poses risk of injury to OR staff, worsening patient outcomes and threatening workforce wellness and sustainability. How OR staff navigate ergonomic barriers in the interdisciplinary team environment was examined in this qualitative study. Methods Semi-structured, open-ended interviews of surgeons, anaesthesiologists, and OR nurses were conducted at a single institution using a sociomaterial approach with interview-to-the-double. Transcripts were coded by two independent researchers. Themes in the data were outlined using the System Engineering Initiative for Patient Safety (SEIPS) 2.0 framework. Results Five major themes were identified. First, physical environment issues creating cognitive and physical frictions, such as tripping hazards and poor room layouts. Second, influence of social positionality, with hierarchy by role and experience and social dynamics leading to a differential capacity to adjust. Third, team collaboration, with lack of interdisciplinary work and communication and high staff turnover. Fourth, burden of self-initiated workarounds, outlining conflicts between system/organizational issues and individual solutions. Fifth, institutional support, with lack of leadership engagement. Participants suggested solutions including accommodations to foster a collaborative approach to managing discomfort in the OR and new team communication tools. Conclusion Ergonomic barriers were described within the work system of the SEIPS 2.0 framework. Social positionality and differential levels of agency, as well as lack of team collaboration and misperceptions of others’ roles, were central to ergonomic challenges. Conflicts between problems lying with the system/organization and solutions being left to individuals were also central to challenges to optimal OR ergonomics.

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.

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.