Hi everyone, good evening. The American Society of Gastrointestinal Endoscopy welcomes you to this evening's presentation. Tonight's webinar, Safeguarding the Endoscopy Suite, Ergonomic Strategies for Enhancing Safety and Reducing Injury in Healthcare, is sponsored by Olympus Corporation of Americas. My name is Ryan LaRosa, and I am ASGE staff who will facilitate and moderate tonight's webinar and discussion. Before we start, here are a few housekeeping items. There will be a question and answer session at the close of the presentations. Questions can be submitted anytime using the Q&A icon at the bottom of your screen. Please do not use the chat box to submit questions. Please note that this is a learning event, is being recorded and posted on GILeap, ASGE's learning management platform, in about approximately one week after tonight. You have ongoing access to the recording in GILeap as part of your registration. Our speaker tonight is Tamara James, an ergonomist on faculty at Duke University Health System in North Carolina and a paid consultant of Olympus Corporation of the Americas. At this time, I'd like to turn the webinar over to Tamara to share her thoughts on ergonomics for clinical gastroenterology. Good evening, everyone. Thank you so much for joining me. I'm an industrial engineer and also human factors engineer slash ergonomist, and I've been doing this type of work for over 30 years. Most of the work that I've done has been primarily in health care. I'm really passionate about identifying and reducing injury risk in these environments, especially within health care, and I'm excited to share some of that knowledge with you this evening. My goals for this webinar are to answer three questions for you. What is ergonomics? Why is it important to you and to your profession, and what is it that you can do to prevent endoscopic-related injuries, or ERIs as we call them? Let's start with some basics. What is ergonomics? What we do as ergonomists is we like to look at the abilities and the limitations that people have within specific environments, and then we like to try to maximize efficiency and quality by trying to match jobs and environments to workers. That way, we can make sure that workers are not trying to adapt or contort to different environments. We start by looking at the human abilities and their limitations, and then we look at the tasks, the tools, and the environments. It's always better to do this proactively rather than reactively. Another way of looking at this, there's really two different types of ergonomics, microergonomics, which kind of looks at the individual and is a more reactive approach. An example of this might be when a gastroenterologist is experiencing pain, and an evaluation might be requested to determine what are the appropriate interventions for that gastroenterologist to reduce that pain or discomfort. That would be an example of microergonomics. Microergonomics looks more at the organizational level, and it's a lot more proactive in nature. An example of the macro approach or macroergonomics might be when an ergonomics program or policies are implemented within an organization. These are just sort of shows you the spectrum between micro and macroergonomics. This is a diagram that, again, just kind of shows you another way of thinking about ergonomics. Fitting organizations to individuals would be the macro approach, and then the micro approach would be fitting tasks to individuals. Very different approach. Again, the micro focuses on tasks, whereas the macro focuses on organizations, fitting those organizations to individuals. This evening, I'm going to touch briefly on organizational or macroergonomics, but I really want to spend most of the time where my primary focus is going to be on microergonomics. Those are the things that can happen more quickly to prevent or reduce pain and discomfort. These are things that you might have some more immediate control over. When I was doing some research for this webinar, I was looking at some studies, and I came across this one. It's actually a survey that was done, and I found this very interesting, actually, because there's already a strong awareness among your profession, and it's recognized already that it's important to you. There are a number of various ergonomic surveys. This particular one, which was published in 2022, was sponsored by ACG, and it surveyed 455 respondents. Over 95% of you and your colleagues felt that ergonomics and endoscopy is somewhat or very important to them in their practice, or to you in your practice. So I think that's pretty significant, the fact that there's already this strong awareness of ergonomics, and you do feel that it's important. So awareness is high, but I think that there's still a need for some better education and training in endoscopy. At least that's been my experience in the providers that I've worked with. This study in 2021 found that there was an intervention that was given to endoscopists. They were actually given individualized wellness programs that included exercises and postural recommendations. And what was interesting is that post-implementation, the researchers found that there was a 63% decrease in pain sites, and that's very, very significant. So just by having that little bit of information about better posture and what kind of exercises that you can do to help made such a huge difference in this study. Similarly in 2020, this was a study that looked at the use of ergonomics training to reduce pain for GI fellows. This is actually a photo of some of our GI fellows at Duke. And so they implemented some basic ergonomic concepts for the fellows. But also included postural awareness and stretches similar to the previous study that I mentioned. And they actually found in this particular study that there was 100% decrease in discomfort. And that's huge. So this is something, this is the type of program that's very easy to implement. And you can see the results are very significant and can't be overlooked. So we know a little bit now about what ergonomics is, and we know that it does help. We can do some things to help reduce discomfort, but why is it so important for you in gastroenterology? It's because the rates of injuries are so incredibly high for your profession. You literally tick all the boxes here. The work that you do is highly repetitive. And when you combine that, that repetition with high force, such as when you're inserting and torquing an insertion tube, and you're using awkward posture, as I see a lot when I'm doing evaluations of folks in your profession, and you're performing these tasks and holding these postures for prolonged periods of time. And so when you start combining all those things, that's when you get into trouble. Because like I said, you do tick all the boxes. So there was some research that was published in 2011 and 2015. And what they found, what the researchers found, and those references are at the bottom of the screen here. What the researchers found was that musculoskeletal health was even more challenged. So you're challenged already, but you're even more challenged when cases exceed 20 per week. And I know a lot of you work or perform more than 20 cases a week, because I've seen that, and I've encountered that with some of the folks that I've worked with. So more than 20, you know, more of a challenge when your cases exceed 20 per week, and or if you are performing cases more than 16 hours per week. So either of those, or both of those together, are creating an even greater risk for injury. Now that said, it gets worse. You combine these things, these risk factors, with aging, which we're all doing, and stress, and working under pressure, and your musculoskeletal health can be dramatically decreased over time. And that's what this graphic emphasizes here. So there was a study that was just published in April of last year, and they looked at some previous surveys of endoscopists, and found that endoscopic related injuries, or ERIs as I mentioned, we call them, were occurring in between 14 to 97% of respondents. I mean, this just flabbergasted me, 97%. So my question to you is, if you don't have healthy providers, who's going to perform these procedures? So you can see it's just a real problem. The researchers in this study found that the most frequent pain sites were the neck, the back, and the shoulder. They also found that gender, age, years of experience, and procedure volume that I mentioned earlier were the most common risk factors. Another survey that was done of endoscopists in 2008, this was quite a while ago, found that only about 10% of endoscopists were working with no pain. Again, that's just crazy, 10%. The other 90% are working in pain. And about half of those were working in severe pain, that's what I've highlighted in yellow here. Severe pain, nearly half of the workers working in severe pain. I mean, I just cannot even imagine this. And I would argue that this can't be sustained. I mean, again, this is a little bit older study, 2008. So I hope they've been able to improve things for this group of endoscopists that were surveyed. I mean, that's just crazy. So have you ever wondered, I was curious, if you've ever wondered how you compare with other medical providers? There was a survey in 2021, which was actually done in Pakistan, which found that more than 95% of endoscopists had sustained an ergonomic-related injury. So again, very few people that didn't have an injury, only 5% that didn't. So that's a very small amount. And when they compared that to non-endoscopists, there were only 54% that had sustained an ergonomic-related injury. So again, that's quite significant, quite a difference. So almost twice as many injuries occurring with an endoscopist as non-endoscopists. Similarly, about a decade earlier, in 2011, there were nearly three times as many endoscopists having hand and wrist pain in this particular study. And what they found was that, what I think was really interesting about this particular study is that of the non-endoscopists that were experiencing these hand and wrist pain problems, 33% of them went ahead and made some changes to their work environment to improve things. So that's good. About a third of them did. Whereas for the endoscopists, again, that were having hand and wrist pain, only about 12% of them made some changes. So again, I'm wondering if having some greater education, even better awareness of what things you can do within the work environment to improve things and reduce injuries, if that would make a difference. So there have been numerous studies that have highlighted the problem. But the question is, how can we affect some change? How can we make improvements? How can we make this better for your profession? Change is difficult, I know. And I get the argument all the time that ergonomic interventions are too expensive to implement. But you can make a business case. And it should be part of a strategic safety policy or program for an organization. It needs to be incorporated into the goals and objectives of the organization. It needs to be done at a much, much higher level than you would expect. But most organizations, part of the problem is, getting back to the cost issue, most organizations use a standard ROI or return on investment approach to justify ergonomic related expenses. And what happens is when you use that approach, the ROI approach, it's just not great. It's not a good way of evaluating ergonomics interventions. So I believe a cost-benefit analysis or a CBA approach instead of an ROI approach is what should be used. Basically, the cost-benefit analysis looks at all costs and all benefits associated with an expense. And I'll show you an example in just a moment. But basically, the thing to remember is that good ergonomics is really good economics. The two really do go hand in hand. So I'll demonstrate a little bit about that here. So this is just a study or an example, basically, of some of the benefits that you could or should be using in a cost-benefit analysis. Things like absenteeism, presenteeism, quality, productivity, customer satisfaction, and staff retention, so important. So there's been some studies that have looked at this, and I'll just talk about them briefly. In 1997, researchers looked at absenteeism costs, and they calculated this for nurses at a private hospital. What the researchers found was that even really small improvements in ergonomics totally justified the expenditures, and it justified them really quickly. So just looking at, again, the cost of absenteeism versus the cost of implementing an intervention is just one of those areas that needs to be included in an analysis. In 2009, researchers were implementing ergonomic interventions, and they found that that reduced absenteeism and workers' compensation as well as the absenteeism, increased productivity as well as customer satisfaction. They also found that quality was improved and staff retention was improved. That's a lot of benefits from just looking, just, you know, an ergonomic intervention. So these are just examples, again, and, again, you need to really consider all of the benefits, not just injury reduction as a benefit. You need to really look at all of them. In 2017, I thought this was a very interesting study. They looked at, the researchers looked at sustainability of the workforce, and they found that it was threatened, the sustainability was threatened due to poor work environments. And so they used an ergonomics approach, which they said or they argued in their research that that could really help with employee retention. So, and we know employer staff retention is really, really important because of the shortage of healthcare workers. It's very critical right now. And that shortage is projected to continue for at least the next 10 years. So it's really important we try to get a better handle on this. The other problem is we know that some healthcare workers actually leave or retire early, and this is due to musculoskeletal pain. So, again, another reason to include this in an analysis. Other costs that need to be included in a cost-benefit analysis and really cannot be overlooked at all is employee satisfaction as well as patient safety. This is an article that came out in 2012, and back then we were starting to see more articles about pressure from increased volume and how that impacts procedure quality. This study was actually conducted among ASGE members, and they found that more than 92% of respondents indicated pressures for increased demand for services from, sorry, the pressures were from increased demand for services. It was also from rising overhead and shrinking reimbursement rates. The physicians, as a result, started postponing, aborting, or reducing the length of colonoscopies. So you can see how the pressures from these things were actually impacting the colonoscopies themselves and affecting patient safety. So we know that employee satisfaction and patient safety are critical factors in these cost benefit calculations. So I do want to just mention, if you are interested in learning more about the business case for ergonomics, there's a book that just came out published by ACG. It's called Ergonomics for Endoscopy, and it has an entire chapter, which I co-wrote, on this topic. And it's got a wealth of other information in it as well. If you're interested, just feel free to contact me, or you can look for it. I think you can actually get it on Amazon. So now, on to the third and final question. What can you personally do to prevent injuries? So this diagram may look familiar to you, because it was actually first published in 2019 by Drs. Shurgill and McQuaid. This is a diagram of a hierarchy of controls for interventions to prevent endoscopic-related injuries. What they show is that the most effective interventions, and that's those that are highlighted here in the blue and the green, are things like facility design improvements and changes to equipment and changes to the design of that equipment. And we know that these things do eliminate risk, and they are the best type of control. But we also know that these types of things take a lot longer to implement. So that's, again, why it's important to try to educate organizations about the business case, and that can hopefully bring about these higher-level improvements a lot more quickly. Many engineering controls, and those are highlighted in yellow, it's fortunate that you can actually implement some of these things, and they are very effective still. Some examples might be if you were adding an adjustable monitor to an endoscopy suite or adjustable bed. Those are things that are a little bit easier to do, easier to implement, and they are still very effective. And I just want to mention, too, that in a few moments I'm going to be sharing with you a short video, and this is a video of me conducting an ergonomic evaluation in an endoscopy suite. And I'll be demonstrating some of these interventions, so you'll get to see kind of the things that I look to do when I go into these places and do an evaluation. The last ones there, the ones that are the red and the orange, are improvements that are not quite as effective. Those are things like taking micro-breaks and giving ergonomics training, posture awareness, those kinds of things. They are immediate, and they are very easy to implement and very inexpensive to implement. And they are helpful, as I mentioned earlier. We saw in that one study, you know, 100% reduction in pain. But the problem is that they are at the very bottom of that inverted triangle. They are the least effective type of intervention. And the reason why is because these types of programs, like training and so forth, they really do tend to fade over time. They're not permanent changes. The permanent changes are the ones that you see highlighted in the blue and the green in this triangle. So, we can take some time to educate and implement ergonomics programs at an organizational level. In this next video, you'll see me conducting an ergonomic evaluation in an endoscopy suite. And in this video, I'm going to be demonstrating for you a few interventions to a provider. So, you'll actually be able to see how I interact with the provider and what some of the things are that I do recommend. And again, these are, it's because at the higher level, the organizational level, it's going to be hard to do these things. It does take time. But we can actually do some things that are more immediate to help you. And that's what's going to be demonstrated in this video. Hi, I'm Tamara James, an ergonomist on faculty at Duke University Health System in North Carolina. I'd like to show you a few things to help reduce your risk of injury before, during, and after a procedure. Before the procedure begins, check the patient bed height as well as the position of the patient lying on the bed. Ideally, the bed should be adjusted so you can perform precision tasks a little higher than elbow height, tasks requiring minimal force at elbow height, and those requiring moderate force slightly below elbow height. Reaching should also be minimized. Keep in mind, you can always move the position of the bed if needed to achieve neutral postures. There's no reason a bed has to be placed square in the room. So experiment with this to achieve the best posture. A riser can be used to elevate your height if needed. Risers can also be used to elevate one foot at a time during longer procedures to reduce low back strain. Consider using an anti-fatigue mat or anti-fatigue insoles. These reduce discomfort or fatigue you may experience from standing during a long procedure. Check the monitors to make sure you can use a neutral head posture while working. That means your head should be balanced on your shoulders with no flexion, extension, or rotation. Some workstations include an adjustable arm, which allows you to adjust the monitor to the appropriate position relative to your patient, the bed height, and your own height. There are also rolling monitor stands in various heights with tilt and swivel functionalities. Throughout the procedure, try to stay aware of your posture, listen to your body, and make adjustments, changing posture as needed to maintain neutral. For additional guidance, ask a colleague to video you while working to analyze your own posture, much like a golfer analyzes a swing. It's also helpful to take micro-breaks. A short break every 30 minutes may help to reduce fatigue and discomfort, and can be done without increasing procedure time. These short breaks may also improve performance and mental focus. A good rule of thumb is to do the opposite of what you've been doing. One example would be to use the right hand for the controller periodically to give the left thumb a break, or rest the controller on the bed now and then to reduce prolonged gripping. Make sure you choose the right equipment to promote neutral postures and minimize fatigue. There are endoscopes available with lightweight control sections and ergonomic features. These may help improve your operability and may allow you to experience less fatigue during high-volume caseloads and lengthy procedures. After every procedure, check the computer workstation where you type post-procedure notes for proper setup. The top of the monitor should be at about eye level and an arm's length away, with the keyboard and mouse at about elbow height. The chair should provide good back support and allow you to place both feet flat on the floor. You and your team should take time to stretch and rest before the next patient. It's important to build time into the schedule for this. Breaks help minimize fatigue and can reduce risk of injury. And finally, education is key. Programs to improve ergonomics awareness are critical to preventing injury. One example is the surgical ergonomics program at Duke University Health System. They've had great success by providing training and postural awareness to all incoming surgical residents. Also be sure to work with your schedulers to make sure lengthy and difficult procedures are balanced with shorter, less difficult procedures. This can have a huge impact on minimizing fatigue, which can lead to injury. All right, so I'd like to just summarize with three key points that I hope you take away from this webinar. First is that ergonomics needs to be taken seriously and it's important for your health as well as that of your patient. Secondly, when decision makers are analyzing ergonomics interventions, they need to consider all benefits, not just the cost of injuries. They need to look at everything and that's utilizing a cost-benefit approach. And lastly, I just want you to know it may take time to educate and implement organizational ergonomics programs per se, but in the meantime, you can focus on immediate interventions, some of which were highlighted in that video, as well as the video that you're going to see next. So I want to thank you for your time. And with that, I'm going to turn the presentation over to Ryan. Thank you, Tamara. Our second and final video tonight shares how using Olympus products and technologies helps reduce your risk of ERIs. Hi, I'm Heather Fosberg. I'm a senior product manager of gastroscopes and duodenoscopes at Olympus. Neutral posture, appropriate monitor and bed height, and microbreaks are essential to reducing the number of endoscopic-related injuries sustained by gastroenterologists. But you also need to consider the equipment you use throughout a procedure. Olympus offers several products and technologies that may help you experience less fatigue and pain and avoid potential injury every time you scope. The ErgoGrip control section of Olympus's Evus X1 scope is designed to improve user comfort and scope handling. It weighs 10% less than Olympus's previous generation scope control section, and its easy-to-reach angulation control knobs and switches accommodate users with small hands. These features may help improve your operability and may allow you to experience less fatigue during high-volume caseloads and lengthy procedures. The EndoCuff vision device attaches to the distal end of the colonoscope and maximizes visualization by flattening mucosal folds while helping to improve scope control. Designed to increase an endoscopist's adenoma detection rate, the EndoCuff vision device collapses into the body to minimize intubation force and insertion resistance. It also allows for controlled withdrawal. ScopeGuide technology is exclusive to Olympus and provides a real-time 3D image of the position and configuration of the colonoscope during a procedure. It is designed to help physicians recognize loops as they form, potentially decreasing insertion time and lessening patient discomfort. Passive Insertion Technology, or RIT. It combines three proprietary Olympus technologies – passive bending, high-force transmission, and variable stiffness – to improve ease of insertion and operator control, which may help to minimize patient discomfort and enhance procedure efficiency. Passive bending helps an endoscopist move their colonoscope through acute bends in the colon, potentially decreasing patient discomfort and speeding insertion to the cecum. High-force transmission provides an endoscopist with improved operator control when pushing or twisting the colonoscope. The scope reacts more sensitively and is easy to maneuver within the colon. Variable stiffness allows an endoscopist to incrementally change the flexibility of their colonoscope by manipulating a flexibility adjustment ring. It can be changed on a case-by-case basis to meet the anatomical needs of each patient and the handling preferences of the endoscopist. Learn more about the ergonomic benefits of these Olympus products and technologies by visiting medical.olympusamerica.com. All right. At this time, Tamara and I will address some questions received from the audience. As a reminder, please, if you have any questions, please submit them through the Q&A icon at the bottom of your screen as it's much easier to use in the chat box. So, I'll start off with a couple of questions we have here. I would say, so, Tamara, as a fellow or a newly practicing physician, how do you recommend they ask about purchasing ergonomic equipment, an anti-fatigue mat or a stepstool? I mean, those are pretty low-cost items. I wouldn't think that that would be a hard thing to justify, but you could see if there's like a safety department, you know, within the organization, a lot of times, you know, they'll be your advocates and can help you, you know, with these kind of recommendations. But it is important to also determine who are the decision makers, you know, is it a purchasing department or is it a manager? I mean, is it a facility manager? I mean, who makes the decisions about purchasing those types of things? And then trying to work with those individuals or that individual, but definitely get trying to find out if there is a safety department or someone that can, you know, advocate for you and for the fact that that is a safer thing to have in the endoscopic suites. Okay. And see, moving on here, we have another one. From the recent video we watched here, are there any specific stretches you recommend or specific areas of the body that should be stretched maybe during or like post-procedure? So in general, I usually recommend that you do the opposite. So if you've been, you know, bending forward a lot during a procedure, then you need to do something that allows you to bend back a little bit. You know, if your hand or wrist is turned or bent in a certain way, then you need to stretch it the opposite way. So always doing the opposite. If you've been standing a lot, then you need to sit down for a bit. So just think along those lines. I do have to say that in that book that I mentioned earlier, that there's a whole section in there on stretches and exercises that are specific to endoscopy. And so again, that's something you might want to consider as a reference guide. Moving on for our next question here. So it looks like they're asking about an ergonomics assessment for themselves or maybe some folks on their care team at their facility. Does Olympus make any resources available or is that something that you guys can help facilitate if they're looking for an ergonomics assessment? I'm not sure about Olympics. That's maybe... Olympus. Sorry. Excuse me. Yeah. Sorry. Go ahead. Yeah. I mean, you know, that's something maybe Heather or Jessica can address. But I mean, I've done some of those evaluations in the past for providers, you know, within as well as outside of Duke. And I think another place that you could go to for assistance is your physical therapy department. PTs are great at looking at what you do and how you work and the posture that you use. And so sometimes you can utilize them as resources. Again, a safety department or if there's an employee health within your organization, employee health is another place that you can maybe get some help with those resources to do an evaluation. All right. I'm not seeing any other questions here right at this moment. So I think that might be it for us there on that. I'll give a couple more seconds there. Okay. I think that may have been our last question there. So Tamara, do you have any final thoughts or anything else you'd like to mention? I don't believe so. Okay. Well, thank everybody for joining us today, especially our speaker Tamara James. We hope this information is helpful to you and your practice. As a reminder, you can access this recording of this webinar by logging in on GILeap. Thank you again for everyone's participation. And this concludes our webinar for tonight. And I hope everyone has a great evening.

ergonomics

endoscopy

musculoskeletal injuries

microergonomics

macroergonomics

healthcare

Olympus Corporation