AMI Core Measure Update

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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
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Disclaimers/Conflicts

• Euler None to report
• Meadows None to report
• (though both authors have purchased and used the
  products and processes discussed)

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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, 93 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 gt 24,000 Employee Health Expenses
FY2004 0.5 FTE Productivity Loss FY2004
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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.
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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

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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

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Adaptive Cushions
Height variable /Capusco Chairs Keyboard/Monitor
flex imaging devices
Portable Imaging devices for Bedside scanning
Ducer Cable Support Brace
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Objective of Study

• 10 Year Review of
• Incidence of injury
• Cost of treatments
• Productive Time lost due to Sonographer MSK
  injury
• Impact of interventions

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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 .
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Results Timeline of Interventions
          Cable supports Cable supports Cable supports Cable supports Cable supports Cable supports
          Height variable Imaging devices Height variable Imaging devices Height variable Imaging devices Height variable Imaging devices Flexible Keyboard/monitor imaging devices Flexible Keyboard/monitor imaging devices Flexible Keyboard/monitor imaging devices
      Height Adjusted Chairs Height Adjusted Chairs Height Adjusted Chairs Height Adjusted Chairs Height Adjusted Chairs Height Adjusted Chairs Capusco chairs Capusco chairs Capusco chairs
      Adaptive Cushions Adaptive Cushions Adaptive Cushions Adaptive Cushions Adaptive Cushions Adaptive Cushions Adaptive Cushions Adaptive Cushions Adaptive Cushions
      Videotape Inservice Sound Ergonomics Videotape Inservice Sound Ergonomics Videotape Inservice Sound Ergonomics Videotape Inservice Sound Ergonomics     CBL Prevention MSK CBL Prevention MSK CBL Prevention MSK
      Occ Ther assessment Occ Ther assessment Occ Ther assessment Guest speaker     Occ Ther assessment    
      Lit review and inservice Lit review and inservice              
FY01 FY02 FY03 FY04 FY05 FY06 FY07 FY08 FY09 FY10 FY11 FY12
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• 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

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Last incident of Injury occurred March 2010
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Characteristics of Results

• 60 of injuries reported from female
  sonographers
• 60 of injuries reported from sonographers gt 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.)

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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.

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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.
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