Susan Hallbeck

• PhD PE CPE
• Professor and Chair at Mayo Clinic - Rochester

INTRODUCTION Work-related low back pain is highly prevalent in medical professionals. Alternative transfer techniques such as an overhead lift with a sling may reduce staff occupational hazards, but may increase risk of injury in patients with spinal cord injuries, highlighting the need for process improvement. METHODS A multidisciplinary team for...

Objective To identify gaps in nonfatal injury and illness (NII) reporting between physicians and other occupations. Methods Bureau of Labor Statistics data (2011-2019) were analyzed, comparing annualized NII incidence rates using incidence rate ratios (IRR), with physicians as the reference. Results Between 2011-2019, physicians reported signific...

Objective To examine perceived OR ergonomics facilitators and barriers, with a focus on the interdisciplinary team. Summary Background Data Poor ergonomics causes musculoskeletal injuries affecting all operating room (OR) staff with repercussions on patient care, outcomes, and sustainability. Lack of ergonomic awareness and education are risk fact...

Burnout is a challenging issue among surgeons. Many factors have been linked to burnout, such as an inadequate work-life balance, high stress levels, and the frequency of on-call, overnight shifts. There is a lack of research on factors in surgeons’ daily lives associated with burnout. This study observed trauma surgeons with daily surveys assessin...

Ergonomic microbreaks such as the OR-Stretch can address work-related musculoskeletal pain among surgeons and potentially alleviate burnout and early retirement. Fifteen surgeons at a single institution completed two operative cases using the OR-Stretch, once using the Scheduled (every 45 min) timing strategy and once using the Self-Determined (bet...

Cardiac sonographers are frequently exposed to ergonomic risks such as postural stress and high levels of physical exertion while performing scanning tasks, contributing to work-related pain, and discomfort among cardiac sonographers. Passive exoskeletons are a potential ergonomic intervention with the potential to mitigate some of the risks associ...

This study provided additional evidence to support the OR-Stretch Web- App as a potential ergonomic intervention in the operating room. Overall, the ORStretch Web-App was beneficial to surgeons’ physical performance, mental focus, and discomfort. However, improving the Web-App to be user-friendly, and developing strategies to align the microbreaks...

Objective Identify how surgical team members uniquely contribute to teamwork and adapt their teamwork skills during instances of uncertainty. Summary/Background Data The importance of surgical teamwork in preventing patient harm is well documented. Yet, little is known about how key roles (nurse, anesthesiologist, surgeon, medical trainee) uniquel...

Exoskeletons are ergonomic devices that can support workers to improve performance and worker safety. This study created an apparatus that simulated a head-and-neck exoskeleton designed for surgeons to test the effects of varying tension forces on muscle activation (splenius capitis, splenius cervices, and erector spinae), body part discomfort, dex...

Background We compared surgeons’ workload, physical discomfort, and neuromusculoskeletal disorders (NMSDs) across four surgical modalities: endoscopic, laparoscopic, open, and robot-assisted (da Vinci Surgical Systems). Methods An electronic survey was sent to the surgeons across an academic hospital system. The survey consisted of 47 questions in...

Despite advances in medical technology, intraoperative adverse events (IAE) continue to occur in hospital’s complex systems. Current approaches to understanding and mitigating IAEs rely on retrospective data analyses to recognize the series of events leading to an IAE. This paper discusses current challenges and highlights the potential of the Oper...

The neck muscle fatigue and subjective discomfort due to neck postural exposure was evaluated. Ten male participants were asked to hold one of the two static neck postural exposures for 30 minutes (one condition per day): 1) Neck flexion (N-45) where head and neck were flexed 45º relative to trunk while the participant was standing upright, and 2)...

Background: Human factors research involves the study of work system interactions, physician workload, cognitive effort, and performance. This pilot study incorporated a human factor approach and other surgery-based metrics to assess cognitive workload among plastic surgeons during elective plastic surgery breast procedures. Methods: In this pro...

This study investigated vascular surgeon workload and its association with specific procedural drivers over different procedure types. Thirteen attending vascular surgeons (two females) were emailed a survey over a 3-month period. Data from 253 surgical procedures (118 open, 85 endovascular, 18 hybrid, and 32 venous) revealed high physical and cogn...

During scanning, sonographers often assume significant awkward postures which may lead to musculoskeletal pain and disability. Two exoskeletons were tested as an ergonomic intervention by sonographers during trans-thoracic echocardiograms (TTE). Four sonographers each performed TTEs using right-and left-handed scanning techniques, with and without...

Background This study compared the ergonomics of surgeons during deep inferior epigastric perforator (DIEP) flap surgery using either baseline equipment (loupes, headlights, and an operating microscope) or an exoscope. Plastic surgeons may be at high risk of musculoskeletal problems. Recent studies indicate that adopting an exoscope may significant...

Objective To determine how postsurgical remote patient monitoring (RPM) influences readmissions and emergency visits within 30 days of discharge after operation and to understand patient and surgeon perspectives on postsurgical RPM. Patients and Methods This study was conducted at a US tertiary academic medical center between April 1, 2021, and De...

Two attending surgeons (surgeon at abdomen and surgeon at chest) and nine surgical trainees completed electronic surveys after deep inferior epigastric perforator (DIEP) flap surgical procedures. The survey included workload and teamwork subscales. The results indicated that DIEP flap surgery is a highly demanding surgical procedure both physically...

Objective: To identify change management (CM) strategies for implementing novel artificial intelligence and similar novel technologies in operating rooms and create a new CM model for future trials and applications inspired by the abovementioned strategies and established models. Methods: Key phases of technology implementation were defined, and...

Musculoskeletal disorders and intraoperative pain are prevalent among vascular surgeons which can negatively affect their surgical performance and quality of life. The effectiveness of a lower back support exoskeleton to reduce discomfort of the back, subjective fatigue, and the workload associated with performing vascular surgery was evaluated, as...

Background and aims Musculoskeletal (MSK) injuries among gastroenterologists are common. Our study describes risk factors and consequences of injury by comparing provider-specific anthropometric and objective procedural data to self-reported injury patterns. Methods A validated MSK symptom survey was sent to gastroenterologists to gauge prevalence...

The goal of this study was to quantify and compare prospective self-reported intraoperative workload and teamwork during robot-assisted radical prostatectomy (RARP) for multi-port da Vinci Xi (MP) and single-port da Vinci SP (SP) robots. The self-reported workload (surgeon and surgical team) and teamwork (surgeon) measures were collected and compar...

Objective Course content was designed and the learning outcomes assessed for an online ergonomics course for surgical residents. This course could fulfill an optional Surgical Council on Resident Education (SCORE) curriculum on Surgical Ergonomics. Design The online course included five 5-minute modules within the residents’ learning system, each...

Exoskeletons have shown significant impact at reducing the biomechanical demand on muscles during repetitive lifting and overhead tasks in non-healthcare industries. However, the benefits of exoskeletons are yet to be realized in the operating room, particularly as work-related musculoskeletal disorders continue to be a concern for surgeons. This s...

Introduction Our objective was to measure the impact of a basic microsurgery training course on trainees’ confidence and workload in performing microsurgery. Methods A prospective study of participants in an accredited 5-day microsurgery course over a 3-month period. Confidence and workload of the participants were assessed after the first and fin...

Background Surgeon workload is significant both mentally and physically and may differ by procedure type. When comparing laparoscopic surgery and open surgery, studies have reported contrasting results on the physical and mental workload assessed. Methods Wearable posture sensors and pre-/post-surgical questionnaires were employed to assess intrao...

Objective: Surgeons report higher burnout and suicidal ideation (SI) rates than the general population. This study sought to identify the prevalence and gender-specific risk factors for burnout and SI among men and women vascular surgeons to guide future interventions. Methods: In 2018, active Society for Vascular Surgery (SVS) members were surv...

Background Higher workload is associated with burnout and lower performance. Therefore, we aim to assess shift-related factors associated with higher workload on EGS, ICU, and trauma surgery services. Methods In this prospective cohort study, faculty surgeons and surgery residents completed a survey after each EGS, ICU, or trauma shift, including...

Abstract A systematic review was conducted to evaluate the relationship between occupational neck flexion angles and neck problems. The synthesized findings were used to answer three research questions: 1) Is there a positive/negative relationship between neck flexion and neck problems? 2) What is the appropriate angular threshold for neck flexion...

A systematic review was conducted to evaluate the relationship between occupational neck flexion angles and neck problems. The synthesized findings were used to answer three research questions: 1) Is there a positive/negative relationship between neck flexion and neck problems? 2) What is the appropriate angular threshold for neck flexion as a risk...

Operating room throughput variability with spinal procedures revealed task inefficiency and potential safety concerns. Using the DMAIC framework (Define, Measure, Analyze, Improve, Control), a transdisciplinary team conducted a quality improvement (QI) research project to identify and address safety concerns with prone patient positioning. The main...

The goal of this study was to evaluate residents’ workload and teamwork and the correlation between their workload and teamwork subscales during deep inferior epigastric perforator (DIEP) flap surgery. Ten residents who assisted during DIEP flap procedures completed an electronic survey following each DIEP flap procedure from July 2019 to August 20...

The main goal of this pilot study was to create, implement and evaluate a strategy for introducing exoskeletons in the operating room (OR) at a quaternary care academic hospital. The strategy consisted of operating-room-specific considerations, introducing exoskeletons to surgeons, and a post-surgery survey. Three male attending vascular surgeons p...

Objectives The contemporary medicolegal environment has been linked to procedure overuse, healthcare variation, and higher costs. For physicians accused of malpractice, there is also a personal toll. The objective of this study was to evaluate the prevalence of and risk factors for involvement in medical malpractice lawsuits among US vascular surge...

Quantifying the workload and postural demand on vascular surgeons provides valuable information on the physical and cognitive factors that predispose vascular surgeons to musculoskeletal pain and disorders. The aim of this study was to quantify the postural demand, workload, and discomfort experienced by vascular surgeons and to identify procedural...

Sustained non-neutral postures of the head/neck are related to transient neck discomfort and longer-term disorders of the neck. Periodic breaks can help but the ideal length and frequency of breaks are yet to be determined. The current study aimed to quantify the effects of three work-rest strategies on fatigue development. Participants maintained...

Introduction Successful tourniquet application increases survival rate of exsanguinating extremity hemorrhage victims. Tactile feedback during tourniquet application training should reflect human tissue properties in order to increase success in the field. This study aims to understand the mechanical properties of a human limb during tourniquet app...

Deep inferior epigastric perforator (DIEP) flap is a surgical procedure using tissue harvested from the abdominal area to reconstruct the breast after a mastectomy. Primary surgical phases include the abdominal flap harvest, chest dissection, and anastomosis. In this study, inertial measurement units (IMUs) were used to measure surgeon upper body p...

More and more breast cancer patients are turning to autologous options for reconstruction. Deep Inferior Epigastric Perforator (DIEP) flap reconstruction is considered the gold standard flap breast reconstruction procedure; however, it requires a significant number of resources, including two surgeons and microsurgical equipment. A multidisciplinar...

The Surgery Task Load Index (SURG-TLX) and National Aeronautics and Space Administration Task Load Index (NASA -TLX) are subjective workload assessment instruments. These instruments have three coinciding workload dimensions, but each has three unique dimensions. Each dimension is explained by a unique descriptor. It was hypothesized that the SURG-...

Introduction Physician burnout has been linked to medical errors, decreased patient satisfaction, and reduced career longevity. In light of the increasing prevalence of cardiovascular disease, vascular surgeon burnout presents a legitimate public health concern due to the impact on the adequacy of the vascular surgery workforce. The aims of this st...

Objectives: Work-related pain and disability have been reported in the literature among surgeons. This national survey was designed to identify the prevalence and severity of these symptoms in vascular surgeons. Methods: A survey was emailed to the 2910 members of the Society for Vascular Surgery (SVS). Physical pain was evaluated based on body...

STUDY OBJECTIVE The objectives of this study were to 1) pilot a robotic console configuration methodology to optimize ergonomic posture, 2) determine the effect of this intervention on surgeon posture and musculoskeletal discomfort. DESIGN This was an IRB-approved, prospective cohort study conducted from February 2017 to October 2017. SETTING A s...

Objective to estimate the ergonomic postural risk for musculoskeletal posture of vascular surgeons performing open and endovascular procedure types and with various adjunctive equipment using wearable inertial measurement unit (IMU) sensors. The hypothesis is that ergonomic postural risk will increase with increased physical and mental demand, as w...

Interventional radiologists are at increased risk for musculoskeletal discomfort/disorders and this has been linked to the use of radiation personal protective equipment (rPPE). This study examined the effects of rPPE on the development of fatigue of the erector spinae and trapezius muscles. Surface electromyography (EMG) was used to capture muscle...

Background Surgeons are at high risk of developing musculoskeletal disorders. Study Design This study was designed to identify risk factors and assess intraoperative physical stressors using subjective and objective measures including type of procedure and equipment used. Wearable sensors and pre- and post-surgery surveys were analysed. Results D...

Objective: To assess how staff attitudes before, during, and after implementation of a real-time location system (RTLS) that uses radio-frequency identification tags on staff and patient identification badges and on equipment affected staff's intention to use and actual use of an RTLS. Participants and methods: A series of 3 online surveys were...

Background: Breast surgery has evolved with more focus on improving cosmetic outcomes, which requires increased operative time and technical complexity. Implications of these technical advances in surgery for the surgeon are unclear, but they may increase intraoperative demands, both mentally and physically. We prospectively evaluated mental and p...

This quality improvement project's purpose was to define and provide best practices in surgical patient positioning and transfer processes with the surgical spine table to increase patient safety. Using the Define, Measure, Analyze, Improve, and Control quality improvement framework, a multidisciplinary team analyzed surveys, qualitative interviews...

Studies utilizing a systems perspective show that individual work system elements impact surgeon workload. However, limited work has shown how multiple elements together can affect perceived workload in the healthcare domain. Using NASA-Task Load Index (NASA-TLX), this study aimed to compare operating room workload across two work system factors (s...

The purpose of this panel will be to discuss current research and challenges relating to the work of first and immediate responders. The main discussion of the panel will have panelist challenge human factors researchers to consider new directions of research addressing current capability and knowledge gaps faced by the first and immediate responde...

There is a growing awareness of the physical demands of performing surgery and the need for ergonomic education and training, extending beyond the primary surgeon to other members of the surgical team who are also at risk for musculoskeletal injury. In this study, nine Surgical First Assistants received knowledge-based ergonomic education before th...

Background: Laparoendoscopic single site surgery (LESS) is feasible for more complex procedure types, but the technical challenges and learning curve posed by LESS makes traditional multi-incision laparoscopy still the preferred technique. The aims of this study were to understand the restricted mobility and positional requirements of these more co...

The use of lead vest/aprons in interventional medicine has been identified in self-report surveys as a contributing factor to the development of occupational low back pain. Controlled studies (both laboratory and field) that have explored this association have not provided a conclusive link. This review explores the knowledge and gaps surrounding t...

In laparoscopy, novel three-dimensional laparoscopic vision systems (3D LVS) without glasses (3D−) have been invented. While standard 3D LVS with glasses (3D+) have shown advantages over original two-dimensional systems, quantitative comparisons of surgical performance between 3D− and 3D+ systems are still lacking. The aim is to compare the systems...

Background: To understand how surgeon expectation of case difficulty relates to workload for colon and rectal procedures and to identify possible surgeon-perceived drivers contributing to case difficulty. Materials and methods: For 3 mo, surgeons were asked to complete a modified NASA-Task Load Index (NASA-TLX) questionnaire following each surgi...

Objective: Vascular surgeons may experience physical discomfort during open and endovascular procedures. We aimed to understand and quantify the timing, severity, and location of the pain, as well as to identify how pain correlates with other factors. Methods: An electronic survey was distributed to 1164 members of the Society for Clinical Vascu...

Introduction: Long, complex surgical procedures with non-ergonomic postures, headlights, loupe magnification, and microscope use may put craniofacial and maxillofacial surgeons at an increased risk of work-related musculoskeletal discomfort (WRMD). Identifying the prevalence and impact of WRMD may guide preventive strategies to prolong well-being,...

Background Work-related pain and discomfort experienced by surgeons is widely reported in the literature. A survey was, therefore, conducted to explore this issue among members of the European Association for Endoscopic Surgery (EAES). Methods The survey was emailed to 2980 EAES members in 2017 enquiring about their working practice, musculoskelet...

Objectives: A cuffed bag valve mask (BVM) is the most common device used by emergency medical responders to ventilate patients. The BVM can be difficult for users to seal around the patient's mouth and nose. An intraoral mask (IOM) with snorkel-like design may facilitate quicker and better ventilation particularly under austere conditions. Method...

Background: Current military recommendations include the use of tourniquets (TQ) in appropriate pediatric trauma patients. Although the utility of TQs has been well documented in adult patients, the efficacy of TQ application in pediatric patients is less clear. The current study attempted to identify physical constraints for TQ use in two simulat...

Objective: The American College of Surgeons (ACS) encourages clinicians to provide training to laypeople on tourniquet application. It is unclear whether clinicians are confident in their abilities and equipped with adequate knowledge, skills, and resources. This study aimed to determine surgical trainee knowledge and attitudes regarding tournique...

Objective Quantifying non-routine events (NREs) assists with identify underlying sociotechnical factors that could lead to adverse events. NREs are considered any event that is unusual or atypical during surgical procedures. This study aimed to use prospective observations to characterize the occurrence of non-routine events in gynecological surger...

Objective: Surgeon workload, or human "cost" of performing a procedure, is not well understood in light of emerging surgical technologies. This pilot study quantified surgeon workload for colorectal procedures and identified patient, surgeon, and procedural factors impacting workload. Summary background data: Innovative technologies and procedur...

Background Long surgical procedures with loupe magnification and microscopes may put microsurgeons at an increased risk of musculoskeletal discomfort. Identifying the prevalence and impact of work-related musculoskeletal discomfort may guide preventive strategies to prolong well-being, job satisfaction, and career duration. Methods An online 29-que...

Objective: With advancements in surgical equipment and procedures, human-system interactions in operating rooms affect surgeon workload and performance. Workload was measured across surgical specialties using surveys to identify potential predictors of high workload for future performance improvement. Summary background data: Surgical instrument...

Introduction Response to in-hospital cardiac arrest (a “code”) requires the coordinated efforts of a team of medical professionals in a high-stress, high-risk healthcare setting. This can lead to a chaotic situation. Excessive noise and confusion must be improved to deliver the most effective care. Purpose To develop a paradigm for efficient and e...

Periodic intraoperative microbreaks with calesthenic exercises performed within the sterile field improved self-reported mental focus (38%) and physical performance (57%) for 56 surgeons. Therefore, targeted stretching exercises and a web-application (web-app) leading the stretches with a reminder system were developed and piloted using user-center...

Microsurgery is considered one of the most demanding surgical techniques. In a recent American Society of Reconstructive Microsurgeons survey, respondents reported that about half their procedures lasted 8 hours or longer and 8% had tremor during their surgery. Thus, the aim of this study was to define user centered design requirements for a micros...

Background: Neuromusculoskeletal pain and fatigue have been self-reported by over 70% surgeons who perform minimally invasive surgery (MIS). These problems can become impairments impacting surgical performance, patient outcomes, and career longevity. Human factors engineering has identified microbreaks coupled with activities as a viable strategy...

Objective: The propose of this article is to develop a method for improving the accuracy of SpHb monitors, which are non-invasive hemoglobin monitoring tools, leading to better critical care protocols in trauma care. Methods: The proposed method is based on fitting smooth spline functions to SpHb measurements collected over a time window and the...

Advanced minimally invasive procedures may cause postural constraints and increased workload and stress for providers. This study compared workload and stress across surgical team roles for 48 laparoscopic cholecystectomies (4-port vs single-port) using a task load index (NASA-TLX), a procedural difficulty question, and salivary stress hormones. St...

Introduction and hypothesisWe compared musculoskeletal discomfort and postural load among surgeons in sitting and standing positions during vaginal surgery. Materials and methodsAssessment of discomfort and posture of the primary surgeons in both positions was performed at two institutions. The primary outcome was an increase in body discomfort sco...

Preoperative briefings have been proven beneficial for improving team performance in the operating room. However, there has been minimal research regarding team briefings in specific surgical domains. As part of a larger project to develop a briefing structure for gynecological surgery, the study aimed to better understand the current state of pre-...

This article reviews studies conducted "in the wild" that explore the "ironies of automation" in Robotic Assisted Surgery (RAS). Workload may be reduced for the surgeon, but increased for other team members, with postural stress relocated rather than reduced, and the introduction of a range of new challenges, for example, in the need to control mul...

BACKGROUND Surgical adverse events persist despite several decades of system-based quality improvement efforts, suggesting the need for alternative strategies. Qualitative studies suggest stress-induced negative intraoperative interpersonal dynamics might contribute to performance errors and undesirable patient outcomes. Understanding the impact of...

Musculoskeletal discomfort is common among surgeons. Surveys show that 77–100% of laparoscopic surgeons experience physical symptoms or discomfort attributed to operating, but few seek treatment. Surgeons are exposed to many risk factors for musculoskeletal discomfort and occupational injury, and surgical residents may be at additional risk given t...

Objective: To evaluate the validity of a novel inverted peg transfer (iPT) task for assessing laparoscopic skills of novices and experts and compare iPT to the regular PT (rPT) task to ensure surgical trainee acquisition of an adequate advanced laparoscopic skills level for safe laparoscopic practice in the operating room. Design: Prospective cr...