I’d like to share some upcoming educational opportunities.  

If you are still planning to attend some national conferences in the next year, look for me at the following events:

                American Healthcare Radiology Administrators—August 22-26, 2010 in Washington, CD

                                I’ll be presenting on Safe Patient Handling Programs in Diagnostic Imaging

                                http://www.ahraonline.org

                Puget Sound Human Factors & Ergonomics Society-September 15-16, 2010 in Seattle, WA 

                                I’ll be leading a half day Healthcare Ergonomics Workshop

                                  http://www.pshfes.org

               Applied Ergonomics Conference—March 21-24, 2011 in Orlando, FL 

                                This year I’m co-chair of the Roundtable and Networking Committee.  Should be some great sessions and outstanding networking events!

                                http://www.iienet2.org/ergo/conference/

To find out more about these programs, contact us at info@essentialergonomics.com

I recently came across a post from the Work Fitness and Disability Roundtable (http://educ.webility.md/wf/wfdr-join.tcl) that struck a chord with me.  Kevin Byrne, MD. MPH gave an interesting perspective on Carpal Tunnel Syndrome (CTS) that it seems is often overlooked.  In short, he stated that CTS is NOT a surgical problem.  Instead, like other cumulative trauma disorders, CTS is an ergonomic problem.  He goes on to point out that cumulative trauma disorders such as CTS are almost always preventable and reversible by making changes to the work environment, posture and/or work technique.  Sadly, however, few physicians stop to consider ergonomic intervention as part of the treatment plan.  Byrne states ““Fixing” the work environment should be a REQUIRED part of the treatment for work-related repetitive strain/stress problems, but all too frequently it is left out of the medical/surgical solution.”   Ergonomic interventions are seldom included in either the pre-operative treatment, as a means of avoiding surgery, nor as a post-operative, return-to-work consideration.  As a result, the worker often returns to the same work environment that caused their symptoms in the first place.  “Once someone has had CTS surgery, they are not “immune” to further repetitive problems. In fact, they are more prone to CTS because they now have a surgical scar exactly where the problem is located”, says Dr. Byrne.   Furthermore, the managing clinician has a unique opportunity to influence the employer to address ergonomic concerns as a preventative measure, were he/she (the physician) to prescribe ergonomic intervention for the worker. 

Byrne makes one final comment:  “Studies of conditions with multifactorial causation require huge study groups over long periods of time and with clear endpoints (diagnostic criteria). The classic studies of coronary disease, for example, had budgets of tens of millions of dollars. This kind of budget is orders of magnitude larger than any cumulative trauma disorder (CTD) study. As a result, we will never be able to tease out the relative contribution of so many individual variables in causing these conditions. We must treat empirically. Fortunately, the classic risk factors of awkward posture, static positions, excessive force, contact pressure, vibration, cold and repetition work well for practitioners experienced in evaluating CTDs in the workplace.”

How many can be done versus should be done?

This question is commonly asked and is a difficult one to answer. Unfortunately, many administrators, challenged with fiscal responsibility, are seeking to maximize the utilization of their staff and equipment, while sonographers are struggling with seemingly unmanageable work paces and an increasing risk for work related musculoskeletal disorders (WRMSDs). Department managers are stuck in the middle trying to balance the needs of their staff with the concerns of their administrators.

Here’s what we do know.

The 2000 Sonographer Benchmark Survey (SBS), conducted by the Society for Diagnostic Medical Sonography (SDMS) and SDMS Foundation, asked the question, “How many patients do you, personally, scan per day?” These were the results:

However, it’s important to note that along with these results, the SBS was an important source of information regarding musculoskeletal symptoms associated with the ultrasound profession. This same survey found that with the existing work conditions, 80% of sonographers scanning the abovementioned caseload were also reporting pain associated with their work. Twenty percent of those had been involved in career-ending injuries as a result of their injuries, and another 28.2% reported that their career had been adversely affected by their resulting musculoskeletal disorders.

The 2005 SDMS Salary Survey also included questions regarding the number of exams being done each day by sonographers and received the following responses:

Other studies that provide data related to the number of exams per day and risk for occupational injury include the Journal of the American Society for Echocardiography, which published a study by Smith, et al that indicated an increased incidence of work-related musculoskeletal pain associated with performing greater than 100 scans per month. <!–[if !supportFootnotes]–>[1]<!–[endif]–> Also the Journal of Occupational and Environmental Medicine publication citing the results of a study done by McCulloch et al that showed a direct relationship between the total number of studies done per day and the prevalence of musculoskeletal pain, as well as evidence of further increasing relationships to pain when the number of studies per day is coupled with the length of time per study. <!–[if !supportFootnotes]–>[2]<!–[endif]–>

So are these numbers valid as guidelines for patient scheduling? Probably not; it’s more complicated than that. It must be realized that the practice of sonography is as complicated as the human body itself. There are recommended practice guidelines of documentation and measurements that make up a quality examination. Therefore, to perform a comprehensive exam, which is consistent with best practices and quality patient care, a certain amount of time is necessary, and even more so if abnormalities are found. Furthermore, the ergonomics of the work environment significantly affect the sonographer’s onset of fatigue and risk for musculoskeletal disorder, and as a result, their overall productivity. Consequently, the best approach is productivity-enhancing ergonomic solutions. That is, the focus should be on reducing work stresses through improved design of equipment and work processes.

The interesting thing about pain is that it never deceives you. And yet, an individual’s personal experience is the only accurate assessment with which to quantify pain. However, regardless of the fact that each person’s perception of pain may differ, everyone responds to efforts to remove the stressors associated with their pain. So while productivity can be more directly measured, management’s efforts to increase productivity without implementing ergonomic solutions to address the worker’s pain are often perceived as malicious and defeating by the worker. However, the simple truth is that we all want to get paid at the end of the week, and since the income of both the worker and the company is directly related to productivity, ergonomics without productivity is a dead-end for all, as well as for the quality of patient care. Therefore, the only ergonomic solution of value must both relieve physical stressors and improve productivity.

So where does that leave us on the question of how many exams per day is acceptable? Well, the quick answer is that the above numbers, while helpful metrics, were also associated with a high degree of work-related injury and therefore, should not be used without addressing the ergonomic environment and work processes. Are there approaches to balancing productivity and ergonomics that create a win-win for both management and staff? Yes, but they require the vision, creative imagination, and cooperation between all parties concerned—workers, managers, ergonomists, policy makers, and policy administrators. They require a long-term commitment to cooperatively working on finding a sustainable program that supports the needs of everyone. Many things are possible when people work together. For more information on sustainable work safety and process improvement see Lean Healthcare.
Referenced articles:

<!–[if !supportFootnotes]–>[1]<!–[endif]–> Smith, A. 1997. Musculoskeletal Pain in Cardiac Ultrasonographers; Results of a Random Survey. The Journal of the American Society of Echocardiography, Vol. 10, No.4, 357-362.

<!–[if !supportFootnotes]–>[2]<!–[endif]–> McCulloch, M. 2002. Cardiovascular Sonography: The Painful Art of Scanning. Cardiac Ultrasound Today, Vol. 8, No. 5, 60-96.

³Sonographer Benchmark Study. 2000. Society of Diagnostic Medical Sonography. www.sdms.org

⁴Sonographer Salary Survey. 2005. Society of Diagnostic Medical Sonography. www.sdms.org