Ergonomics: Impact on Ophthalmic surgery

Posted by Dr Niteen Dedhia on January 29th, 2020

The practice of ergonomics essentially comprises methods to adjust the work environment and work practices to prevent the imminent risk of injuries. The practical application of ergonomics is more important in the healthcare sector. Failure of ergonomic measures directly impacts the health of the patient and may sometimes lead to serious complications.

A team of various therapeutic professionals as well as paramedical staff provide their contribution to the surgery and the surgeons are just the part of the team. Apart from the surgeon, various factors, from small to large, affect the successful outcome.

Ophthalmic surgery is crucial as it is related to one of the most vital organs in the human body, the eyes. The team comprising the leading professionals in their respective field are important in successful surgery. Planning every minute step before surgery and perfectly executing the plans are the mainstay for positive post-surgical outcomes. It also has a positive impact on the patient’s experience.

It is during the planning and the execution stage of the plan where ergonomics comes into the picture. Ergonomics allow the practitioners, not only in the ophthalmological settings but while doing surgeries in all therapeutic areas, to maintain a calm and relaxed environment.

The ergonomics works on two aspects in the ophthalmological surgery settings. First, are the methods to reduce the surgeon’s physical and mental stress and second, the methods that significantly reduce the problems during the ocular examination or the surgery.

In a survey conducted on 697 ophthalmological professionals, 52% reported that they are suffering from upper body, neck or lower back pain. 15% of these respondents have even given up their work. The pain is not acute rather it results from the years of poor posture during surgery and ocular examination. The surgeon suffering from any of these pains cannot give his best during surgery. It is obvious that in most of the ocular examination rooms, the design is not comfortable and the surgeons have to look from various uncomfortable angles to get the correct diagnosis. Lifestyle also plays an important role in managing the pain. The surgeon should avoid uncomfortable positions, should not remain in static posture for prolong period and minimize repetitive activities.

This problem can be solved by redesigning the workplaces through ergonomics methods. These may include keeping the microscope at an angle comfortable to the eye examiner or raising the level of patient bed or chair while performing the surgery. Raising the level to the maximum limit may allow the surgeon to perform the surgery without much leaning forward.

The surgeon should also look after the mattress on which he has to move or stand the whole day. The mattress should have a thick pad to minimize the stress on the hip joints and knees. Wearing comfortable and spongy-sole shoes helps prevent the occurrence of back pain.

The surgeries when well-planned increase productivity and reduces the cost. The increased success rates of the surgery are affected by designing the surgical facility, planning, and preparation for surgery and instruments used to perform a complication-free surgery. These all factors in a perfectly aligned condition lead to smooth, fast, safe and stress-free surgical experience.

Ergonomics plays an important role in optimizing cataract surgery. The family doctor provides an appropriate preliminary diagnosis and refers the patient to the ophthalmic surgeon for further evaluation. Thorough ocular evaluation of the patient is done to determine if there is an immediate requirement of surgery or can be delayed. Other health check-ups are also done to assess the general health condition of the patient. Once it is determined that the patient requires cataract surgery, comprehensive information related to cataract surgery is provided to the patient. Informed decision-making from the part of the patient is advised before opting for surgery.

Various methods such as videos, writing or the internet are used to educate the patients. During the evaluation, the surgeon should decide which instruments other than generally used for cataract surgery can be required during the surgery. This can be evaluated through the presence of the underlying ocular condition in the patient.

Ergonomics also focuses on the schedule of the surgeon to determine his efficiency. The surgeon should perform only those number of surgeries that he can do while remaining focused and determined. It is also recommended that the surgeon should prefer to perform similar types of surgeries during the day to remain consistent. A protocol should be maintained on the day of surgery and the WHO checklist for surgery is compared to the available arrangements for surgery.

Power of the lens, the patient, type of lens to be fitted and the eye to be operated are some of the considerations that require significant attention. When the surgery is done, the paramedical staff explains the safety measures to be followed and the eye drops and their administration schedule.

The risk associated with cataract surgery is the insertion of the wrong Intraocular lens. Through ergonomics, this scenario can be completely avoidable. Fitting the wrong IOLs may lead to possible legal cases of negligence and brings a negative reputation to the center.

Various factors are responsible for inserting the wrong IOL. These include selecting wrong patients or wrong lenses, lack of training in handling the lenses, error in biometric measurement and simultaneous access to multiple records.

Measures that help in preventing or minimizing the case of wrong IOL insertion are repeated assurance of the patient, the eye to be treated and the power of the lens required. A whiteboard can also be kept in the operation theatre on which the critical information related to the patient is written.

Ergonomics is applied to remove various barriers that hinder the positive outcome in cataract surgery. These barriers include ineffective and unrealistic planning, inexperienced team, and poor pre-surgical assessment.

The surgical team should take responsibility for performing successful cataract surgery and maintain a relaxed and stress-free environment within the operating room. This will have a positive impact on the patient.

Tags: Impact on Ophthalmic surgery