The PRIME Pilot - Photo-Based Review for Individual Mitigation of Endoscopic Injury

Introduction: Endoscopy-related injuries are common for gastroenterologists and can contribute to significant workplace and quality of life disruption. While standardized ergonomics curricula are important for prevention and education at the fellowship level, this approach may be lower yield for practicing endoscopists who have variable years of experience. We present a pilot practice improvement project to provide individualized ergonomic feedback to practicing endoscopists to decrease occupational injury. Methods: In this pilot study, seven staff gastroenterologists were evaluated by an ergonomics engineer while performing routine colonoscopy. The ergonomist identified various risk factors for injury based on repetitive maneuvers performed during colonoscopy, including the risk of tendinitis or tenosynovitis of the digits, carpal tunnel syndrome, neck discomfort, shoulder discomfort, and knee/hip/back discomfort. Photographic documentation was obtained to demonstrate potentially high-risk maneuvers by the performing endoscopist that may contribute to an increased risk of endoscopy-related injuries (Figure 1). Additionally, root causes and potential solutions were proposed by the ergonomist in an attempt to help prevent injury and mitigate risk. Participating staff were asked to rate the benefit of this feedback utilizing a 1-5 Likert scale. Results: The survey was completed by 6 endoscopists (50% (3) early career, 50% late career). Two endoscopists (34%) had endoscopy-related injuries currently or in the past. All endoscopists found the feedback “very useful” (Likert 4), and “minimally disruptive” to their work (Likert 1). Endoscopists agreed that they had room for improvement in their endoscopy-related ergonomics (50% (3) – “agree” (Likert 4; 50% (3) – “strongly agree” (Likert 5)). The majority of endoscopists thought that this activity should be performed on a more formal, organized basis for interested endoscopists in the division (16% (1) – “neutral” (Likert 3; 34% (2) – “agree” (Likert 4); 50% (3) – “strongly agree” (Likert scale 5)). Conclusion: The results of this pilot study support implementation of consistent individualized evaluation and feedback sessions from an experienced ergonomist for endoscopists at a practice level. Future investigation will be performed to demonstrate the benefits of a more formal evaluation by an ergonomist for endoscopists in different stages in their career, and the impact on occupational injury prevention.Figure 1.: Representative Images of Different Endoscopists Taken During Ergonomics Evaluation.