Is your workplace hazardous to your health??

I found myself on the wrong side of the ether screen earlier this year, having surgery on my left hand to release Dupuytren’s contracture, a genetic gift from my father and (maybe) generations of our Viking forebears.

Wondering how long it will take to heal – and when I’ll get some (any?) grip strength back in my hand – leads to reflection on the combination of brain and brawn necessary in the clinical practice of anesthesiology, something we don’t think much about when we’re young and fit.

Obviously, our clinical work demands intelligence. But we should ask this question: does it need to be as physically arduous as it currently is?

Would we reduce burnout, and keep clinical anesthesiologists in the workforce longer, if we devoted some of our collective brain power to making our workplaces less physically punishing and more ergonomically friendly? This is not an idle question to ask, considering that 55 percent of anesthesiologists (more than 23,000) in active practice are age 55 or older, according to AAMC data.

Yes, we can sit down at intervals during procedures, so we’re better off than many of our surgical colleagues. But when medical students think about their choice of specialty, few of them realize how much physical effort anesthesiologists expend:
• pushing non-motorized hospital beds
• trying to manage the airways of the morbidly obese
• helping to position heavy patients in lateral or prone position
• moving patients from gurney to OR table and back again.

Good luck calling for lifting help

If we ask for an orderly or hospital assistant to help with moving a large patient, we risk costly delay. Hospital administrators like nothing better than to document how much of the time these personnel might be standing idle and use that information to justify hiring fewer and fewer of them. Inflatable patient transfer devices such as the HoverMatt® exist, but how many hospitals have one for every operating room or procedure site?

Operating rooms are getting bigger and bigger as the need grows for robotic equipment and hybrid suites. As the footprint expands, so does the distance from preop area to OR to PACU or ICU.

During one recent day at work, my phone informed me that I walked on average half a mile during each of three OR turnovers – checking to see if the patient was ready in the preop area, checking to see if the room had been cleaned, checking to see if the nurses were ready, and finally bringing the patient to the OR. Yes, it was fine in terms of reaching my 10,000-step goal, but that amount of energy spent was exhausting as well as inefficient.

Unless you work in a small outpatient center, your experience may be similar. I’m sure there’s an electronic way to monitor all these parameters of readiness for surgery without going in person to see, but in an era of constrained resources, how many hospitals are willing to make that kind of investment?

Then there is the issue of cords – electric cords, ethernet cables. Unless your OR suite was built recently enough to have an intelligent design with ceiling-mounted booms that house electric outlets, anesthesia gas conduits, and USB cable receptacles, then you probably have a rat’s nest of cables, cords, and hoses behind your anesthesia machine. They may even be running across the floor and directly in your path as you try to make your way around the OR. This is particularly hazardous in radiology or cardiac catheterization suites where the lights are often dimmed. It’s a miracle more of us haven’t been injured tripping over them.

Am I strong enough to manage this airway?

I can remember despairing as a new resident, thinking that my hands would never be big or strong enough to ventilate large patients by mask. Luckily, the application of thought to the task soon proved that you don’t need to reach the mandible with your little finger to ventilate by mask – you just need to learn how to lift the chin and get a good mask seal.

Sadly, most of our physical challenges in the operating room aren’t as easy to work around. Even with a video laryngoscope, it still takes some upper body strength to intubate a 300-lb patient. There isn’t any reason why the same robotic technologies that enable us to see inside body cavities and manipulate instruments can’t be applied to making airway management more predictable, less dependent on physical strength, and safer for patients.

It’s time we stopped treating anesthesiologists and trainees as cheap labor. Hospital beds and gurneys should be motorized, and someone other than us should be pushing them. You can’t watch a patient’s airway and vital signs during transport if you’re trying to push the bed and avoid every obstacle in a crowded corridor.

We should be at every design meeting when operating suites are being built or renovated. We need to be involved with all stages of planning from the very start, making sure each anesthetizing site is uncluttered and well equipped. We need a voice in creating the workflow process that gets patients to and from the OR efficiently. We need to make sure that we get the right anesthesiologists freed up from clinical duty to attend those planning meetings as our champions.

Hospital administrators have no idea what we do, and (let’s be honest) aren’t interested in our welfare. They just want us to keep churning out the cases.

Our working conditions should not put us at constant peril of tripping over cables or injuring our backs while we tend to a morbidly obese patient. The fact that we put up with these conditions speaks to our dedication and – let’s face it – to our unwillingness to ask for help or admit weakness.

It’s time we put a stop to these abuses. As we tell our children – you must take care of your things if you want them to last. Our workplaces need to take better care of us.

(This article first appeared in the April 2022 issue of the ASA Monitor)

5 COMMENTS

mitesh patel

Karen, I totally agree. One of our hospitals here in Dallas recently discussed “allowing” anesthesiologists to roll patients into the OR unaccompanied by a nurse so that we could “save time” during turnovers. Of course, no one addressed the free labor aspect of this, or the fact that these beds are heavy. You hit this spot on.

[Reply]

Dheeraj Nagpal

You said it” Hospital administrators have no idea what we do, and (let’s be honest) aren’t interested in our welfare.”
Even the ubiquitous EMR Epic had minimal involvement of anesthesia care professionals.
Transferring patients is the least of our problems as a matter of fact I would like to take my own patients to PACU as that is the most critical time of perioperative period and the patient is not being monitored so an experienced anesthesia care team professional will ensure safety.

[Reply]

Michael Sebastian

Dr Nagpal, I too like to accompany my patients to PACU. Not quite sure why a physician, or even a nurse, needs to physically transfer to patient to the stretcher, nor push the unpowered oxcart to PACU.

[Reply]

Michael Sebastian

Karen, timely post. I was thinking about this issue recently during an all-day spine case. There were neuro-monitoring cables and my cables everywhere, crisscrossing my work area. I was stumbling around back there and at least a couple times I tripped over stuff. Happens all the time. Luckily I’ve not yet been hurt. I also love that our monitoring cables —ECG, BP, SpO2, etc —all seem to be clad in a material whose design purpose seems to be to grip tightly to any other cable in contact, making untangling them a chore. And there’s rarely any good way to coil or retract them to keep them off the floor, nor any way to bring them in from above, which would be the optimal way in older OR’s where no thought has been given to ergonomics.

I wonder if OSHA regularly inspects operating rooms. I can’t imagine the hospital wouldn’t face stiff fines for the unsafe working environment they provide for us. My dad would have been fined out of business if he’d kept his warehouses as cluttered and dangerous as the average OR.

The really exasperating thing is that no one ever asks us if they can run their cables through our work area; that right is just assumed. Same with being an unpaid patient orderly —it’s just assumed we’ll do this job without question. We are our own worst enemy at times. Would a surgeon tolerate a potentially dangerous obstruction that crossed her operative field? Would anyone insist she tolerate it? Of course not. We put up with it because, frankly, anesthesiologists are historically too timid, or have too little self-respect, to insist on being treated differently.

We anesthesiologists really have only one card to play, ultimately — refusing to provide our services in an unsafe workplace, and refusing to be unpaid orderlies and transport aides. We’ve tried being team players, “partnering” with our hospitals/systems, getting involved in committees, etc. The truth is, no one cares and it’s failed. Hospitals view us as vendors, offering a needed service to be obtained at the lowest possible cost. And it’s only going to get worse as hospitals face increasing cost and reimbursement pressures.

With demand for anesthesiologists at historic levels, we will never have more leverage to insist on what we need to do our jobs safely. We simply lack the will, whether that will is expressed through individuals rising up here or there, or more preferentially, through some kind of organized response. This is the sort of thing a union could be very helpful with.

[Reply]

Eduardo

I fully agree.
Congratulations and thanks for expressing the problems and feelings of all anesthesiologists in the world.
Again, your articles are useful and accurate.
Thanks, from Buenos Aires, Argentina.

[Reply]

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