Errors and complications that derive from poor ergonomics in the OR
During surgery, unexpected patient complications can arise due to underlying disease, but that is not the only risk for the patient.
Errors and complications more commonly arise from poor ergonomics in the operating room. Inadequately designed medical instruments account for half of the 1.3 million unintentional patient injuries in hospitals in the United States every year, the U.S. Food and Drug Administration estimates.
"Medical devices are vital to the surgical procedure, but many do not adhere to basic ergonomics,"
Peter F. Nichol, MD, Ph.D., FACS, assistant professor, section chief of pediatrics, department of surgery, University of Wisconsin School of Medicine and Public Health, Madison, told the American College of Surgeon's Bulletin.
"[The] undersupply of surgeons adds to the stress of the OR environment and may reduce the quality of care,"
Nichol added. "It is an industrial truth that the more stress you put on human beings, the more mistakes they make."
How does ergonomics affect patient care?
The proper position of a patient and surgical equipment allows surgeons to accurately view the operating field and asses the patient's condition throughout the surgery. However, when a surgeon is standing, looking down at the patient, it strains their neck. If the surgeon is in pain or needs to look away, an error may occur, or they could miss something.
Operating room set up can also pose a risk to both doctors and patients. With the rise of robotic and laparoscopic surgery, OR's look like a maze of tubes and cords. These tubes and wires can cause numerous hazards such as tripping for staff and have resulted in staff injury and patients going back into the OR. Adding ceiling or floor outlets and minimizing or eliminating unnecessary tubes and cords in the OR can help mitigate these risks.
Besides injury, for staff, the labyrinth of cords can also result in mix-ups. According to the Occupational Safety Health Administration (OSHA) of the U.S. Department of Labor, it is "not uncommon" for surgical staff to attach the wrong cable to the wrong machine during surgery.
In July 2018, the Food and Drug Administration ("FDA") sited an issue where hospital staff attempted the use of green bags and masks after delivery of a preterm baby. All of the device's connections came apart, and the green bag disconnected. The device was not able to be put back together, but luckily, there was no harm to the baby.
To date, various equipment requires a foot pedal to operate and is placed under the OR table. The risk of stepping on the wrong foot pedal, which results in activating the wrong equipment, is a real issue, creating confusion and safety hazards for both the patient and staff.
Only 11% of surgeons surveyed in 2017 by the American College of Surgeons responded that their hospital system had a program to protect them from ergonomic injuries.
What are the potential hazards of poor ergonomics?
OR staff typically stand in static, awkward postures for hours at a time during surgical procedures. Prolonged standing causes muscle fatigue and the pooling of blood in the staff's lower extremities. Additionally, the hard surface of the OR floor, coupled with prolonged standing, contributes to trauma and pain to the feet. Awkward postures resulting from the lengthy-standing, trunk flexion, neck flexion, and arms held higher than the optimal working height further add to physician fatigue and distraction.
OSHA flagged these issues as real concerns and offered several possible solutions. Adjusting the surgical vision field via height-adjustable work tables and surfaces to allow staff to sit on stools, offering surgeons well-cushioned soles in their shoes, providing a footrest bar, and using anti-fatigue mats are a few recommendations.
How has poor ergonomics affected real patients and doctors?
There are countless examples of the detrimental effects the current environment in an OR can have on physicians. The Journal of American College of Surgeons collected a survey from 127 surgeons. These surgeons most commonly reported symptoms of fatigue, discomfort, stiffness, and back pain. Twenty-seven percent of surgeons said these were the result of an occupational injury.
Vascular surgeon Rashad Choudry, who works at Einstein Healthcare Network, has thrown his back out 13 times due to the massive lead garments he wears during operations, according to The Philadephia Inquirer.
Urologist Daniel Eun, who works at Temple University Hospital, suffers from tennis elbow, rotator cuff problems and has had surgery for carpal tunnel syndrome.
As for patients, the FDA cited a situation where, at the end of the transcatheter aortic valve replacement ("TAVR") procedure, the ProGlide device had what the doctor called a "missed deployment." During the procedure, the ProGlide got stuck inside the patient. To remove the ProGlide, the surgeon needed to perform a small cut down; fortunately, no long term harm came to the patient.
In the case of bipolar electrocautery, foot pedals frequently need repositioning by the OR staff, requiring them to get on the floor and exposing them to blood pathogens. This also creates a delay in time to cauterization, leading to increased blood loss and longer OR time.
These are just a few examples of real surgeons who are suffering and have fear for their future if the field of dynamics is not improved. Instruments that are hard to use and not intuitive, directly impact the doctor's overall health and increase the risk to patients.
Using instruments that are designed with ergonomics in mind can help save surgeons and doctors while simultaneously improving the safety of the staff and, ultimately, the patient.
Actively introducing ergonomic improvements into the OR is everyone’s responsibility.