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Challenges and Opportunities of Ergonomics Research in the Operating Room from an Individual Researcher’s Perspective
Event Type
Oral Presentations
TimeWednesday, April 1412:50pm - 1:10pm EDT
LocationHospital Environments
DescriptionTopic: This presentation discusses the challenges and opportunities of conducting ergonomics research in the sterile Operating Room from the author’s perspective and using realistic examples.
Application: This presentation is meant to raise awareness for ergonomics research conducted in the operating room (OR) and its unique characteristics to fellow researchers who are interested in conducting research in the OR in the future. It can also serve as a discussion point among fellow researchers who have worked or currently work in the OR. Additionally, this presentation invites interested clinical staff to a view from the researchers’ perspective.
Background: Teamwork in the OR has been studied extensively in the recent two decades. Many of these studies support that effective OR teamwork and communication improve patient safety and quality of care. It was found that briefings and debriefings are a good method for improving teamwork and communication in the OR. And improved teamwork and communication may be associated with improved patient outcomes (Wahr et al., 2013; Hicks, Rosen and Hobson, 2014)

Perception of teamwork has been studied among different roles of OR staff. For example, one study has shown significant discrepancies in perceptions of teamwork in the operating room: physicians perceive teamwork of others as good, yet nurses perceive teamwork as mediocre (Makary, 2005). Past study has also found that distractions, although sometime inevitable in the OR, can harm surgical teamwork and consequently compromise quality of patient care and patient safety (Wahr, 2013)

However, few studies have explored the potentially modified team dynamics when research is in session parallel to regular OR activities. Researchers may interact with clinical staff before, after or during surgery for brief or sustained periods of time. However, it is questionable how researchers fit or do not fit into the overall OR teamwork.

Such ambiguity can become problematic as the success of the research depends heavily on clinical staff (research subject) buy-in; development of situation awareness (SA) in short periods of time may be difficult if researchers are not included in OR staff briefing and debriefings. Lack of SA from the researchers may negatively affect regular or emergent OR activities, create sources of distractions for clinical staff’s teamwork (Mcllvaine, 2007). Such disturbance in clinical staff’s teamwork may in turn harm their buy-in of the research contents.

In such situations, researchers may feel isolation and lack of sense of legitimacy at the sidelines of clinical staff’s teamwork, despite the purpose of the research being promotional to the wellbeing of the OR staff or to the quality of patient care delivery.

The author has identified several potential ways to improve the ergonomics researcher’s research experience and outcome in the OR:
(1) Learn who and what roles will be in the OR on data collection day, as well as the basic flow of the surgical procedure before going in the OR from an experienced researcher and/or the OR staff; this knowledge can help researchers gain and maintain general SA during data collection.
(2) Try to gain permission from the surgical team so that one research team member participate in relevant OR briefings and debriefings so that s/he can share relevant information to the research team. This teammember also communicate research plans to the surgical team when necessary. Such efforts may help both researchers and OR staff gain case-relevant SA during data collection.
(3) Create a data collection checklist and use it throughout data collection. Consider incorporating items such as equipment preparation, data uploading and storage to the checklist, even if they may not take place on the same day or at the same location of data collection. Surgical safety checklists are said to improve teamwork and communication in the OR (Russ et al., 2013); surgical research may benefit from its own checklist.
(4) If possible, assign two researchers who know each other’s workstyle well to work together at data collection; more than two may overcrowd the OR; yet one researcher may not be able to carry out research tasks with the desireable speed when time stress is high (i.e. placing motion sensors on surgeons before they scrub in and administering an oral survey in the meantime). The two researchers will also be able to cover one another during breaks on a long data collection day.
(5) Seize the opportunity to advocate for ergonomics research (Caple, 2007; Dul et al., 2011; Carayon, 2013). Staff from inside or outside of the OR that one is collecting data at may become curious about the research one is conducting. If time and situation are appropriate, make an elevator speech about the current research.

Overview of Presentation: After demonstrating several of the above-mentioned challenges that the researchers may face in the OR using realistic ergonomics research examples, potential opportunities to address these challenges will be suggested.

Reference:
Caple, D. C. (2007). Ergonomics-future directions. Journal of human ergology, 36(2), 31-36.

Carayon, P. (2013). Human factors and ergonomics in health care and patient safety.

Dul, J., Bruder, R., Buckle, P., Carayon, P., Falzon, P., Marras, W. S., ... & van der Doelen, B. (2012). A strategy for human factors/ergonomics: developing the discipline and profession. Ergonomics, 55(4), 377-395.

Hicks, C. W., Rosen, M., Hobson, D. B., Ko, C., & Wick, E. C. (2014). Improving safety and quality of care with enhanced teamwork through operating room briefings. JAMA surgery, 149(8), 863-868.

Makary, M. A., Sexton, J. B., Freischlag, J. A., Holzmueller, C. G., Millman, E. A., Rowen, L., & Pronovost, P. J. (2006). Operating room teamwork among physicians and nurses: teamwork in the eye of the beholder. Journal of the American College of Surgeons, 202(5), 746-752.
McIlvaine, W. B. (2007, September). Situational awareness in the operating room: a primer for the anesthesiologist. In Seminars in Anesthesia, Perioperative Medicine and Pain (Vol. 26, No. 3, pp. 167-172). WB Saunders.

Russ, S., Rout, S., Sevdalis, N., Moorthy, K., Darzi, A., & Vincent, C. (2013). Do safety checklists improve teamwork and communication in the operating room? A systematic review. Annals of surgery, 258(6), 856-871.

Wahr, J. A., Prager, R. L., Abernathy III, J. H., Martinez, E. A., Salas, E., Seifert, P. C., ... & Nussmeier, N. A. (2013). Patient safety in the cardiac operating room: human factors and teamwork: a scientific statement from the American Heart Association. Circulation, 128(10), 1139-1169.
Author
Senior Health Services Analyst