Law, Katherine E.

Abstract Background This study compared the ergonomics of surgeons during deep inferior epigastric perforator (DIEP) flap surgery using either baseline equipment (loupes, headlights, and an operating microscope) or an exoscope. Plastic surgeons may be at high risk of musculoskeletal problems. Recent studies indicate that adopting an exoscope may significantly improve surgeon postures and ergonomics. Methods Postural exposures, using inertial measurement units at the neck, torso, and shoulders, were calculated in addition to the surgeons' subjective physical and cognitive workload. An ergonomic risk score on a scale of 1 (lowest) to 4 (highest) was calculated for each of the postures observed. Data from 23 bilateral DIEP flap surgeries (10 baseline and 13 exoscope) were collected. Results The neck and torso risk scores decreased significantly during abdominal flap harvest and chest dissection, while right shoulder risk scores increased during the abdominal flap harvest for exoscope DIEP flap procedures compared with. Exoscope anastomoses demonstrated higher neck, right shoulder, and left shoulder risk scores. The results from the survey for the “surgeon at abdomen” showed that the usage of exoscopes was associated with decreased performance and increased mental demand, temporal demand, and effort. However, the results from the “surgeon at chest” showed that the usage of exoscopes was associated with lower physical demand and fatigue, potentially due to differences in surgeon preference. Conclusion Our study revealed some objective evidence for the ergonomic benefits of exoscope; however, this is dependent on the tasks the surgeon is performing. Additionally, personal preferences may be an important factor to be considered in the ergonomic evaluation of the exoscope.

The goal of this study was to evaluate residents’ workload and teamwork and the correlation between their workload and teamwork subscales during deep inferior epigastric perforator (DIEP) flap surgery. Ten residents who assisted during DIEP flap procedures completed an electronic survey following each DIEP flap procedure from July 2019 to August 2020. The survey contained items from the NASA-TLX and SURG-TLX and questions to measure teamwork subscales. Across 29 surgical cases, 38 surveys were recorded. Overall, the means of workload subscales were mostly greater than 10 and less than 15 (range=020) and the means of all teamwork subscales were greater than 15 (range=0-20). Good teamwork was correlated with lower distractions (Rs= -0.36 to -0.48) and better performance (Rs=0.35 to 0.52). Also, all the teamwork subscales were highly correlated (Rs= 0.59 to 0.92). Our findings suggest that good teamwork, low distractions, and successful performance are generally observed together; however, a causative relationship could not be established based on these results.

Patient portals are websites or apps where patients can access their health information from their Electronic Health Records (EHR). This study was conducted via an online survey to identify what factors influence an EHR patient portal user to believe that the portal is a valuable part of their health care. In total 395 survey responses were included in a logistic regression model. Our results suggest that only 24.1% of our survey responders consider their EHR portals as a valuable part of their health care. Participants who are more likely to consider EHR portals as valuable were those who found EHR portals useful for information, trusted their portal; believed their portals were important in managing health, those who believed their portals were easy to use, and those who developed a habit of using their portals. This study contributes to the understanding of what factors support the perceived value of EHR portals.

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.

Deep inferior epigastric perforator (DIEP) flap is a surgical procedure using tissue harvested from the abdominal area to reconstruct the breast after a mastectomy. Primary surgical phases include the abdominal flap harvest, chest dissection, and anastomosis. In this study, inertial measurement units (IMUs) were used to measure surgeon upper body postures while performing DIEP flap procedures. Ergonomic risks of musculoskeletal disorders were evaluated using the Rapid Upper Limb Assessment (RULA) based on the postures obtained from the IMUs. Joint angles were analyzed using a one-way ANOVA. The neck and back had higher joint angles during the abdominal flap (M=32°, 17°, respectively) and chest dissection (M=31°, 18°, respectively) phases than the anastomosis phase. These high-risk postures may lead to musculoskeletal disorders. Future interventions should focus on improving the postures of the neck and back during the abdominal flap and chest dissection phases of the procedure.

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.

Objective: Surgeon workload, or human “cost” of performing a procedure, is not well understood in light of emerging surgical technologies. This pilot study quantified surgeon workload for colorectal procedures and identified patient, surgeon, and procedural factors impacting workload. Summary Background Data: Innovative technologies and procedures in surgery have generally been promoted for the advancement of patient care. The resulting surgeon workload is poorly studied with little knowledge of the contributing factors impacting workload. Methods: Surgeons completed NASA-Task Load Index (NASA-TLX) questionnaires to self-assess workload following abdominopelvic colon and rectal procedures. Corresponding patient data were retrieved from the medical record. Descriptive statistics, correlations, and ANOVA were performed to compare surgeon and patient factors, procedure type, and surgical approach on workload overall and by subscales. Results: Seven attending surgeons rated 238 surgeries, of which 218 (92%) had corresponding patient data. Surgeon experience and patient demographics had inconsistent effects on workload. A statistically significant 3-way interaction was identified among disease process, procedure type, and surgical approach on workload (F(9, 146) = 2.17, P = 0.027), but was limited to open procedures for neoplasia and inflammatory bowel disease patients. Proctectomy and colectomy procedures compared across open, laparoscopic, and robotic approaches showed significant differences in overall workload and subscales, where the robotic procedures required significantly less mental demand, physical demand, and effort, than open or laparoscopic ( P < 0.05). Conclusions: Patient characteristics, disease process, and surgical experience had inconsistent effects on surgeon workload. Major differences in workload were identified for procedure type and surgical approach, where robotic procedures required less mental demand, physical demand, and effort.

The adoptions of briefing and debriefing protocols have evolved from the Joint Commission’s initiative to improve communication and safety in the operating room. Briefing normally occurs prior to incision and is used to discuss and confirm critical information, while debriefing occurs during or after surgery. Debriefing provides a unique opportunity for individuals and teams to immediately reflect on their performance, allowing them to more easily identify errors and develop plans to improve their next performance. Studies have shown that using briefings and debriefings improve communication and teamwork. However, there is still much to learn about the value of both for surgical teams. This paper presents a robust methodology for examining and measuring the impacts of surgical team briefings and debriefings on teamwork. The methodology includes (1) audio/video recording the surgical care process, (2) prospective observations using a validated electronic data collection tool, (3) pre- and post-surgery surveys, and (4) individual surgical team member interviews. The current paper describes the methodology to obtain a robust and comprehensive data set for analyzing the impacts of briefing and debriefing on teamwork; the results of the surgeries recorded using this methodology will be presented in subsequent papers.