Human Factors Approach to Assess Physician Workload in Elective Plastic Surgery Breast Procedures.

Background: Human factors research involves the study of work system interactions, physician workload, cognitive effort, and performance. This pilot study incorporated a human factor approach and other surgery-based metrics to assess cognitive workload among plastic surgeons during elective plastic surgery breast procedures.

Methods: In this prospective study of plastic surgery breast procedures over a 3-month period, surgeon and patient demographics and procedural details were collected.

Relating clustered noise data to hospital patient satisfaction.

Hospital noise can be problematic for both patients and staff and consistently is rated poorly on national patient satisfaction surveys. A surge of research in the last two decades highlights the challenges of healthcare acoustic environments. However, existing research commonly relies on conventional noise metrics such as equivalent sound pressure level, which may be insufficient to fully characterize the fluctuating and complex nature of the hospital acoustic environments experienced by occupants.

Listening campaigns: engaging clinicians to assess system factors contributing to burnout.

Background: Even prior to the pandemic, many US physicians experienced burnout affecting patient care quality, safety and experience. Institutions often focus on personal resilience instead of system-level issues. Our leaders developed a novel process to identify and prioritise key system-related solutions and work to mitigate factors that negatively impact clinician well-being through a structured listening campaign.

An assessment of information needs and workflows for emergency service providers and caregivers of children with medical complexity.

Background: The goal of Project Austin, an initiative to improve emergency care for rural children who are medically complex (CMC), is to provide an Emergency Information Form (EIF) to their parents/caregivers, to local Emergency Medical Services, and Emergency Departments. EIFs are standard forms recommended by the American Academy of Pediatrics that provide pre-planned rapid response instructions, including medical conditions, medications, and care recommendations, for emergency providers. Our objective is to describe the workflows and perceived utility of the provided emergency information forms (EIFs) in the acute medical management of CMC.

Course Design and Learning Outcomes of a Practical Online Ergonomics Course for Surgical Residents.

Objective: Course content was designed and the learning outcomes assessed for an online ergonomics course for surgical residents. This course could fulfill an optional Surgical Council on Resident Education (SCORE) curriculum on Surgical Ergonomics.

Design: The online course included five 5-minute modules within the residents' learning system, each ending with an ungraded knowledge question, and a final 5-question multiple-choice retention quiz that allowed infinite attempts.

Microsurgical skills training course and impact on trainee confidence and workload.

Introduction: Our objective was to measure the impact of a basic microsurgery training course on trainees' confidence and workload in performing microsurgery.

Methods: A prospective study of participants in an accredited 5-day microsurgery course over a 3-month period. The confidence and workload of the participants were assessed after the first and final day.

Mechanical Assessment of Tissue Properties During Tourniquet Application.

Introduction: Successful tourniquet application increases survival rate of exsanguinating extremity hemorrhage victims. Tactile feedback during tourniquet application training should reflect human tissue properties in order to increase success in the field. This study aims to understand the mechanical properties of a human limb during tourniquet application.

Ergonomic Robotic Console Configuration in Gynecologic Surgery: An Interventional Study.

Study Objective: The objectives of this study were to (1) pilot a robotic console configuration methodology to optimize ergonomic posture, and (2) determine the effect of this intervention on surgeon posture and musculoskeletal discomfort.

Design: This was an institutional review board-approved prospective cohort study conducted from February 2017 to October 2017.

Setting: A single tertiary care midwestern academic medical center.

Intraprocedural ergonomics of vascular surgeons.

Objective: The objective of this study was to estimate the ergonomic postural risk (EPR) for musculoskeletal posture of vascular surgeons performing open and endovascular procedure types and with various adjunctive equipment using wearable inertial measurement unit (IMU) sensors. The hypothesis was that EPR will increase with increased physical and mental demand as well as with procedural complexity.

Methods: A prospective, observational study was conducted at a large, quaternary academic hospital located at two sites.

Impact of Procedure Type, Case Duration, and Adjunctive Equipment on Surgeon Intraoperative Musculoskeletal Discomfort.

Background: Surgeons are at high risk of developing musculoskeletal disorders.

Study Design: This study was designed to identify risk factors and assess intraoperative physical stressors using subjective and objective measures, including type of procedure and equipment used. Wearable sensors and pre- and postoperation surveys were analyzed.

Measuring Ergonomic Risk in Operating Surgeons by Using Wearable Technology.

This case series study examines the ergonomic risk of surgery using wearable sensor inertial measurement units to monitor the ergonomics of surgeons at work.

Defining Best Practices for Patient Safety in Positioning and Transferring Patients With the Surgical Spine Table.

This quality improvement project's purpose was to define and provide best practices in surgical patient positioning and transfer processes with the surgical spine table to increase patient safety. Using the Define, Measure, Analyze, Improve, and Control quality improvement framework, a multidisciplinary team analyzed surveys, qualitative interviews, ergonomics, near-miss sentinel events and skin integrity data to standardize this process. Results reinforced the need to develop and standardize the process of patient positioning and transfer from cart to table.

Workload Differentiates Breast Surgical Procedures: NSM Associated with Higher Workload Demand than SSM.

Background: Breast surgery has evolved with more focus on improving cosmetic outcomes, which requires increased operative time and technical complexity. Implications of these technical advances in surgery for the surgeon are unclear, but they may increase intraoperative demands, both mentally and physically. We prospectively evaluated mental and physical demand across breast surgery procedures, and compared surgeon ergonomic risk between nipple-sparing (NSM) and skin-sparing mastectomy (SSM) using subjective and objective measures.

Surgeon Workload in Colorectal Surgery: Perceived Drivers of Procedural Difficulty.

Background: To understand how surgeon expectation of case difficulty relates to workload for colon and rectal procedures and to identify possible surgeon-perceived drivers contributing to case difficulty.

Materials And Methods: For 3 mo, surgeons were asked to complete a modified NASA-Task Load Index (NASA-TLX) questionnaire following each surgical case. Questions included items on distractions, fatigue, procedural difficulty, and expectation plus the validated NASA-TLX items.

Sweating the Little Things: Tourniquet Application Efficacy in Two Models of Pediatric Limb Circumference.

Background: Current military recommendations include the use of tourniquets (TQ) in appropriate pediatric trauma patients. Although the utility of TQs has been well documented in adult patients, the efficacy of TQ application in pediatric patients is less clear. The current study attempted to identify physical constraints for TQ use in two simulated pediatric limb models.

Crossover Assessment of Intraoral and Cuffed Ventilation by Emergency Responders.

Objectives: A cuffed bag valve mask (BVM) is the most common device used by emergency medical responders to ventilate patients. The BVM can be difficult for users to seal around the patient's mouth and nose. An intraoral mask (IOM) with snorkel-like design may facilitate quicker and better ventilation particularly under austere conditions.

Preliminary Investigation of Civilian Clinician Perspectives & Just-in-Time Guidance for Tourniquet Use to "Stop the Bleed".

Objective: The American College of Surgeons (ACS) encourages clinicians to provide training to laypeople on tourniquet application. It is unclear whether clinicians are confident in their abilities and equipped with adequate knowledge, skills, and resources. This study aimed to determine surgical trainee knowledge and attitudes regarding tourniquet application and compare the effectiveness of instructions.

NASA-Task Load Index Differentiates Surgical Approach: Opportunities for Improvement in Colon and Rectal Surgery.

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.

NASA-TLX Assessment of Surgeon Workload Variation Across Specialties.

Objective: With advancements in surgical equipment and procedures, human-system interactions in operating rooms affect surgeon workload and performance. Workload was measured across surgical specialties using surveys to identify potential predictors of high workload for future performance improvement.

Summary Background Data: Surgical instrumentation and technique advancements have implications for surgeon workload and human-systems interactions.

Evidence-based intraoperative microbreak activities for reducing musculoskeletal injuries in the operating room.

Background: Neuromusculoskeletal pain and fatigue have been self-reported by over 70% surgeons who perform minimally invasive surgery (MIS). These problems can become impairments impacting surgical performance, patient outcomes, and career longevity. Human factors engineering has identified microbreaks coupled with activities as a viable strategy to counteract known physical, cognitive, and environmental stressors as well as mitigate neuromusculoskeletal (NMS) problems for workers in office and manufacturing domains.

Surgical team workload comparison for 4-port and single-port laparoscopic cholecystectomy procedures.

Advanced minimally invasive procedures may cause postural constraints and increased workload and stress for providers. This study compared workload and stress across surgical team roles for 48 laparoscopic cholecystectomies (4-port vs single-port) using a task load index (NASA-TLX), a procedural difficulty question, and salivary stress hormones. Statistical analyses were performed based on the presence intra-cluster correlation within team roles, at α=0.

"The Jackson Table Is a Pain in the…": A Qualitative Study of Providers' Perception Toward a Spinal Surgery Table.

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.

Validation of a Novel Inverted Peg Transfer Task: Advancing Beyond the Regular Peg Transfer Task for Surgical Simulation-Based Assessment.

Objective: To evaluate the validity of a novel inverted peg transfer (iPT) task for assessing laparoscopic skills of novices and experts and compare iPT to the regular PT (rPT) task to ensure surgical trainee acquisition of an adequate advanced laparoscopic skills level for safe laparoscopic practice in the operating room.

Design: Prospective crossover study.

Setting: Multidisciplinary simulation center and motion analysis laboratory, Mayo Clinic.

Kinematic and ergonomic assessment of laparoendoscopic single-site surgical instruments during simulator training tasks.

While laparoendoscopic single-site surgery (LESS) appears to be feasible and safe, instrument triangulation, tissue handling, and other bimanual tasks are difficult even for experienced surgeons. Novel technologies emerged to overcome LESS' procedural and ergonomic difficulties of "tunnel vision" and "instrument clashing." Surgeon kinematics, self-reported workload and upper body discomfort were used to compare straight, bent and two articulating instruments while performing two basic surgical tasks in a LESS simulator.