Lindén, Anna

More and more breast cancer patients are turning to autologous options for reconstruction. Deep Inferior Epigastric Perforator (DIEP) flap reconstruction is considered the gold standard flap breast reconstruction procedure; however, it requires a significant number of resources, including two surgeons and microsurgical equipment. A multidisciplinary group was tasked with reducing operative time of DIEP flap procedures by 25% so that complex surgeries can become more routine and accessible to patients. Using participatory ergonomics, members of the operative team were engaged to identify interventions. Following implementation, 22 DIEP flap cases were evaluated using workload surveys and patient outcomes to determine the success of the interventions. DIEP flap surgical durations were reduced by 25% on average (M=12.9 hours, SD=5.7 to M=9.7 hours, SD=1.4). When cases lasted longer than 9 hours, surgeons reported 31% more physical demand and 78% more fatigue than cases that were 9 hours or less. Survey results linked positive team characteristics to reduced frustrations and distractions.

Studies utilizing a systems perspective show that individual work system elements impact surgeon workload. However, limited work has shown how multiple elements together can affect perceived workload in the healthcare domain. Using NASA-Task Load Index (NASA-TLX), this study aimed to compare operating room workload across two work system factors (surgical specialty and case number of the day) using a large set of self-reported surgeon workload data. Thirty-two surgeons completed 545 workload surveys across a three month period. Surgeons reported significant differences in composite workload scores across the surgical specialties (F(7,544)=3.622, p=0.001). Significant interactions were identified between surgical specialty and case number for composite workload, F(20,534)=1.72, p=0.027. While such findings are promising, future work is needed across multiple institutions to establish baseline workload values across specialties with different patient characteristics and work systems.

There is a growing awareness of the physical demands of performing surgery and the need for ergonomic education and training, extending beyond the primary surgeon to other members of the surgical team who are also at risk for musculoskeletal injury. In this study, nine Surgical First Assistants received knowledge-based ergonomic education before their body postures were evaluated using inertial measurement units in an anatomy training lab setting and again in the operating room (OR). Five of those trainees comprised the intervention group, receiving a personalized report detailing their level of ergonomic risk, while the other four did not receive this individual feedback. The intervention group significantly improved their neck and left arm posture during the anatomy lab training with carryover into the OR, indicating some retention of ergonomic concepts, while the control group did not. The integration of wearable technology and individualized feedback into traditional educational settings helped trainees learn about their own behaviors and practice strategies for reducing risks in the OR with greater retention compared to knowledge-based education alone.

The aim of this study was twofold—(1) to compare the current ED staffing workload alert system to clinicians’ perceptions of workload in the ED, and (2) to examine the potential impact of a multi-faceted, systems-level intervention on clinicians’ perceptions of workload. Constant flow of patients into the Emergency Departments (ED) regularly increases the workload of clinicians and can compromise the quality of care delivery and patient safety. An automatic staffing workload alert system was created and implemented in response to an observed shift in patient volume to the overnight hours at one academic quaternary care center. Surveys addressing workload and interruptions were administered to ED clinicians, pre-and post-intervention implementation. Output from the staffing workload alert system was recorded for each clinician shift. Clinicians’ perceptions of workload were able to predict swing shift activations, χ 2 (6) = 14.14, p = 0.028. Only the performance subscale significantly correlated with swing shift activations, p=0.006. A Kruskal-Wallis H test found perceived interruptions changed following systems-level changes, χ 2 (1) = 7.195, p = 0.007. Utilizing subjective measure of clinicians’ workload validated an objective, automated staffing workload alert system that determined if swing shift activations are necessary.

Clinicians have anecdotally indicated that interruptions increase following trauma activations in the emergency department (ED), yet it is unknown whether interruptions change following the end of a trauma case. This study aimed to examine the interruption characteristics of clinicians that participate in trauma activations before and after activations using the SEIPS model. Observers shadowed ED clinicians across entire shifts and logged interruptions that affected clinicians in a tablet PC-based tool. Interruption characteristics captured included duration, nature, location, and task priority. Trauma activations lasting more than five minutes were also recorded. Only interruptions occurring within one-hour of trauma activations were included in the analysis. Chi-square analyses identified significant associations between SEIPS-categorized interruptions and the interruption priority, p < 0.01, and between the SEIPS-categorized interruptions and the interruption location, p = 0.01, pre- and post-trauma activations. Identifying these associations revealed key opportunities to reduce unnecessary interruptions in the ED.