Gain Without Pain - Ergonomics in the Medical Workplace
Sep 03, 2013 08:59PM
By Ryan Frisch
Sanford Interventional Cardiologist Adam Stys, MD, has embraced the ergoniomic advantages of the Corindus CorPath robotic system.
Medicine can be a risky profession.
According to the CDC’s National Institute for Occupational Safety and Health, healthcare workers experience musculoskeletal disorders at a rate exceeding that of working in construction, mining and manufacturing. In addition to lifting and positioning increasingly heavy patients, many of these injuries occur as a result of being forced to spend many hours working in awkward positions. 
The problems don’t necessarily take years to develop and are not confined to older workers. A 2008 UK study of Ob/Gyn residents found that more than a quarter of them sustained some type of injury to their hands, wrists, shoulders, necks, and lower backs during the course of their training. Back problems from spending hours on their feet and from bending over are common among all types of surgeons. And a 2012 study found that office-based procedures are no easier, suggesting that “there is considerable risk of musculoskeletal injuries of physicians/surgeons performing office-based surgeries”.
Robotics in Cardiology
“We do our procedures standing, often in non-ergonomic positions, trying to focus on small movements of our fingertips while the rest of the body is frozen,” says Sanford Interventional Cardiologist Adam Stys.
Stys says the problems often start during cardiology fellowship training, where orthopedic injuries are five times more common than they are among practicing cardiologists. “Cardiology Fellows would start in June and by April everyone would be crying getting up in the morning because of back pain. Many would not even be able to complete a full rotation.”
The awkward stance is exacerbated by the fact that international cardiology procedures are performed while wearing a heavy lead apron to protect against radiation exposure. A 2006 survey of interventional cardiologists found that more than half experienced significant spine injuries by their 20th year of practice. They also have three times the number of cataracts seen in the general public and an elevated rate of left-sided brain tumors due to radiation exposure.
So it’s no surprise that Dr. Stys and his colleagues at Sanford have gladly embraced the advantages of robotic technology. With robotic assistance, the surgeon can manipulate wires and catheters from a seated position behind a radiation-safe console.
“There are so many advantages to robotics in this setting,” says Stys, who uses the technology primarily to perform balloon angioplasty and input stents. “Radiation exposure is practically zero when you are sitting behind the console shield. Orthopedic problems are reduced because you can take the lead off and sit comfortably in an armchair. And visibility is better, so eye strain is reduced, as well.”
Stys says up to 80 percent of balloon procedures and stent placements can now be done with the help of the robot, which offers advantages for patients in terms of decreased blood loss and lower infection risk. Stys says that, which the technology is not yet perfect, it is a major step in the right direction for reducing injuries among interventionalists.
Robotics in Surgery
“Once I switched to robotics, my injuries went away,” agrees gynecologic oncologist Maria Bell, MD, who developed upper back and shoulder issues after she began performing laparoscopic procedures more than 8 years ago. “Ergonomically, that was not a great transition.”
Like the Corindus CorPath robotic system used by Dr. Stys and his colleagues, the daVinci robotic-assisted surgery system that Bell now uses cradles her head, taking the pressure off of her neck and shoulders. While it makes every straightforward hysterectomies more comfortable to perform, the robot is especially appreciated during major, multi-hour procedures such as ovarian debulking.
“If you don’t have the robot, you have to position your body in such a way or use leverage to get the angle you need,” says Bell. “You have to use six times the force to grasp something and bring it out.” Robotic technology is not only making life more comfortable for doctors like Bell and Stys now, but Bell says that, by preventing injuries, the more ergonomic approach is also likely to lengthen her career.
“I absolutely believe that I will be able to operate longer because of robotics than I would have been able to otherwise,” she says. With the national numbers of surgeons approximately the same today as it was in 1993, while the patient population has steadily grown, longer surgical careers may be more important than ever. “We really need to protect our surgeon population,” says Bell.
Installing robotic systems is not the only way area hospitals are attempting to make life easier and more comfortable for physicians. Barry Degen, Administrative Director of Perioperative services at Rapid City Regional Hospital, says even lower tech improvements can make a big difference over the long haul.
“Usually, if you make people more comfortable, they do better work and are more efficient,” says Degen. Given that a large number of repetitive use injuries in all professions are blamed on computer use – and computers are becoming as common as stethoscopes in the healthcare environment – many of Regional’s ergonomic improvements focus on computer work stations. Even something as simple as putting computers with tiltable screens on adjustable-height carts and providing dual screens at dictation stations can make order input and note-taking easier and reduce eye and neck strain.
“Just like everyone else, doctors have to spend more and more time on computers,” says Degen. “Having multiple computers means that, whether they are 5.5 or 6.8, they can access a computer that can be adjusted for them. There is never a need to bend over or strain.”
The hospital has also invested in items such as new stools, including bariatric stools with lumbar support, to better accommodate doctors of all shapes and sizes. In the operating room, multiple monitors can be turned and tilted for a clear view without neck strain. In the hospital’s three integrated operating rooms, doctors can even adjust lights and other controls with voice activation. Suspending equipment from the ceiling on floating booms means no one had to maneuver around cords on the floor. And pneumatics make the high-tech beds easier to raise, lower and tilt for the best, most physician-friendly angle.
“The monitors in the OR and anesthesia machines that rotate are great,” says Regional anesthesiologist Troy Nesbit. “We can be doing procedures from any angle and can look up and see a monitor. This is especially helpful in the heart room. When there are so many screens, everyone in the room can easily see what’s going on.”
Nesbit says he also appreciates the fact that the hospital has invested in lighter-weight aluminum anesthesia carts and in chairs with adequate lumbar support. “Because you are sitting in there all day long, the back support is really important. It’s also nice not to have to move this big cart all over.”
Many technologies, such as the Glidescope, which uses a fiberoptic camera to make difficult intubations easier, have benefits for both doctors and patients. “Because you can see so much better with the Glidescope, we are able to keep the patient in one position and now have to maneuver all around. It is easier for us and more efficient.”
 “Preventing Back Injuries in Health Care Settings”, September 22nd, 2008, NIOSH Science Blog
 Hermanson, JE and Choi, SD, “Study of musculoskeletal risks of the office-based surgeries”, 2012, Work.
 Machan, L, “A web based survey of neck and back pain amongst interventional radiologists”, 2001, J Vasc Interv Radiol,