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

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

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: Cable supports Height variable Imaging devices Height variable Imaging devices Flexible Keyboard/monitor imaging devices Height Adjusted Chairs Capusco chairs Adaptive Cushions Videotape Inservice Sound Ergonomics CBL Prevention MSK Occ Ther assessment Guest speaker Occ Ther assessment Lit review and inservice FY 01 FY 02 FY 03 FY04FY05FY06FY07FY08FY09FY10FY11FY12

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 a)Compliance to Ergonomic recommendations not measured b)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.