Operating room safety and ergonomics should create a safe space for all
It’s time for surgeons to speak up about what a pain their specialty can be.
Operating room safety and ergonomics are an area of intense interest—interest that is focused almost exclusively on patient safety. Surgeons and other OR staff are rarely part of the discussion.
“What gets forgotten is the occupational health and safety side, surgeon and staff safety,” said Kristin Chrouser, MD, MPH, associate professor of urology at the University of Michigan in Ann Arbor. “Instruments and equipment are often designed with just the patient in mind, leaving the user—the surgeon—as an afterthought. We have surgeons who are being injured by that lack of attention and retiring early because they have had ergonomic problems with instruments and devices in the OR.”
Dr. Chrouser will deliver a State-of-the-Art Lecture on "Ergonomics and Safety in the Operating Room" 10:55-11:10 a.m. today in the Stars at Night Ballroom.
Maximizing patient safety in the OR is important but is not an excuse to endanger surgeons and other staff through poor environment, equipment or instrument design.
Kristin Chrouser, MD, MPH
Surgeons bear some of the responsibility, Dr. Chrouser said. Traditional surgical culture has long been to take physical discomfort in stride without complaint.
“If it hurts, well, that’s just part of the job,” she explained. “You spend your entire residency learning to ignore all the signals your body sends you during a surgery. You’re tired, hungry, need the bathroom; you learn that’s part of the grind. If you get into an awkward or painful position using an instrument or a device, ignore it. Learning to ignore your own symptoms is dysfunctional, yet it is part of our training. The OR is not designed to facilitate surgeon safety, but simple adjustments can help optimize postures.”
Poor ergonomic instrument and device design is a known issue, Dr. Chrouser added, and a tough problem to address. Most open and laparoscopic surgical instruments were designed in the 1980s to 1990s or earlier.
“The distribution of male and female surgeons has changed significantly since then,” she said. “We have a much different range of hand sizes, strength and flexibility in the OR than there used to be.”
Industry also bears responsibility. Instruments and equipment are too often designed by engineers who make assumptions regarding the physical abilities and handedness of the end-user. Beta testing is often a reward for more senior surgeons who are more representative of earlier generations of practitioners than the current workforce. The Society of Surgical Ergonomics and other groups advise more physically diverse representation in both instrument design and beta testing to minimize ergonomic issues.
Surgeons need to talk openly about what a pain their specialty can be.
“We need to hear from senior surgeons who are well respected and willing to say publicly, ‘This happened to me, and I had to have physical therapy or carpal tunnel release or change my practice,’” Dr. Chrouser said. “No one has seriously tried to optimize ergonomics in the OR because people aren’t speaking up. Surgeons aren’t complaining. It’s time to be honest about the realities we face at work to bring positive change to the OR, and also to benefit patients. We can’t use our hard-won surgical skills to benefit others if our careers are altered or cut short by work-related injury.”
