Preventing Sonographer Musculoskeletal Injury: Ergonomic Guidelines Implementation Study

1. Elimination of Sonographer Musculoskeletal Injury in a Hospital Based Cardio-Vascular Ultrasound Lab Following Implementation of Ergonomic Guidelines Edward Euler, RDCS Valerie Meadows, RDCS Memorial Medical Center, Springfield, IL

2. Disclaimers/Conflicts: • Euler – None to report • Meadows – None to report • (though both authors have purchased and used the products and processes discussed)

3. Background: • SDMS • Society of Diagnostic Medical Sonography. Sonography Benchmark Survey. 2000. “More than 80% of sonographers are scanning in pain and 20% of these professionals eventually experience a career-ending injury.” • JCAHO • Preventing Occupational Injury among Diagnostic Medical Sonographers. JCAHO, Environment of Care News, March 2006, 9:3 • OSHA • Preventing Work Related Musculoskeletal Diseases in Sonographers, CDC/National Institute for Occupational Safety and Health, Pub No. 2006-148, Sept 2006 • IAC-Echo/IAC-Vascular • 2010 ICAEL Standards for Accreditation in Adult Echocardiography Testing, 2.1.1 • ICAVL Standards for Accreditation in Non-Invasive vascular testing, 3.1.1 • Local Experience: • > $24,000 Employee Health Expenses FY2004 • 0.5 FTE Productivity Loss FY2004

4. Sources for Guidelines Industry Standards for the Prevention of Work-Related Musculoskeletal Disorders in Sonography: Consensus Conference on Work-Related Musculoskeletal Disorders in Sonography Journal of Diagnostic Medical Sonography, September/October 2003; 19: 281-282. Industry Standards for the Prevention of Work-Related Musculoskeletal Disorders in Sonography Journal of Diagnostic Medical Sonography, September/October 2003; 19: 283-286. Marylou Muir, Paul Hrynkow, Robert Chase, Dianne Boyce, and Daria Mclean The Nature, Cause, and Extent of Occupational Musculoskeletal Injuries among Sonographers: Recommendations for Treatment and Prevention Journal of Diagnostic Medical Sonography, September/October 2004; 20: 317-325.

5. Ergonomic Guidelines: • Policies and Procedures for Prevention of Work Related Musculoskeletal • Disorders in Sonographers: • Provide adequate work space • Position monitor / keyboard • Proper use of adjustable exam chairs / tables • Vary postures throughout day / sit or stand • Alternate the scanning hand / vary the grip used • Minimize awkward / extreme postures • Increase tissue tolerances through exercise and adequate rest • Schedule different types of exams in a work day • Limit the number of portable exams • Consider a maximum number or exams per day • Annual training and reassessment

6. Actions/Interventions: • Required: • Annual Computer Based Learning (CBL) Module on Ergonomics and Injury Prevention • Sonographer Reporting of on the job injury or persistent pain with scanning to Employee Health Services • Adherence to ICAEL/ICAVL Standards and Guidelines • Lab Culture Shift: • Topic Included in Dept Meetings • Literature Reviews during QI/Case Reviews • Occupational Therapy assessments • Guest Speakers (National and Local) • Recommended:

7. Adaptive Cushions: Height variable /Capusco Chairs: Keyboard/Monitor flex imaging devices: Portable Imaging devices for Bedside scanning: Ducer Cable Support Brace:

8. Objective of Study: • 10 Year Review of: • Incidence of injury • Cost of treatments • Productive Time lost due to Sonographer MSK injury • Impact of interventions

9. Methods: • Review of Employee Health records: • Type of Injury • Cost of Treatment • Hours of limited work or unavailable for work • Review of Payroll records: • Total of Productive Hours worked Echo and Vascular Cost centers (including callback and overtime) • Department Records (Cardiology PACS, Siemens/Syngo): • Annual Procedure Volumes • Exclusions: • Non – MSK injuries (cuts, falls) • Temporary/Agency Employees Incidence, Cost, Lost hours, Hours worked and Procedure Volumes were compared to Timeline of Actions/Interventions .

10. Results: Timeline of Interventions:

11. Echo Procedures: • Adult Echo • Pediatric Echo • TEE • Stress • Interventional • Vascular Procedures: • Carotid • Abd/Mesenteric/Renal • Upper/Lower Venous • Upper /Lower/Graft Arterial • Upper/ Lower Arterial Doppler • Venous Reflux • Interventional

12. Last incident of Injury occurred March 2010

13. Characteristics of Results: • 60% of injuries reported from female sonographers • 60% of injuries reported from sonographers > 20 years • in the field • 100% of injuries reported from single hand scanners • (scan with only left or only right hands) • Decrease in incidence despite conversion to inpatient • scanning at bedside (Echo = 100%, Vasc = 50%.)

14. Study Limitations: • Individual Sonographers not evaluated • Compliance to Ergonomic recommendations not measured • Limited Long term follow-up • Cardiac and Vascular Ultrasound only • Reviews only Reported Injuries • Statistical Significance of Variability not evaluated.

15. Conclusions: Shared Accountability (Sonographer Compliance to Guidelines and Organizational Support with Tools) with Required Annual Re-Education contributes to Laboratory Culture of Awareness and Prevention. Implementation of Ergonomic Guidelines eliminates Sonographer MSK Injury decreasing organizational cost and lost productive hours.