Elimination of Sonographer Musculoskeletal Injury in a Hospital-Based Cardiovascular Sonography Laboratory Following Implementation of Ergonomic Guidelines

The sonography literature states that as many as 80% of sonographers report scanning in pain. Our organization suffered lost time and high expense in an outbreak of injuries in 2004, prompting an aggressive campaign to address musculoskeletal (MSK) and repetitive motion injuries.

The objective of this study was to measure the incidence, cost of treatment, and time lost as a result of sonographer MSK injury and quantify the impact of interventions.

Organizational records for all sonographers in echo/vascular laboratories from October 2000 to September 2011 were reviewed. Data from Employee Health Services detailed the type of injury, cost of treatment, and hours of limited work. Payroll data provided total hours worked, and data from the picture archiving and communication system (PACS) provided procedure counts. Incidence, cost, lost hours, hours worked, and procedure volumes were compared with interventions performed.

Procedure volume over the 10-year period gradually increased (Figure 1a), whereas sonographer productive hours remained nearly the same (Figure 1b). Sonographer injuries were low (one per year) until 2004 (Figure 2a), when four injuries resulted in $22,000 of treatment cost (Figure 2b) and 191 hours of lost time (Figure 2c). Interventions following ergonomic guidelines began in 2004 and extend until the present day (Tables 1 and 2), including required annual education, ergonomic chairs/arm support devices, and flexible monitors/keyboards on imaging devices. Significant decreases in cost of treatment and lost hours occurred immediately. The rate of reported injury gradually dropped, with only one injury reported between October 2008 and September 2012.

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Figure 1.

(a) Total exams performed requiring sonographer imaging (excludes transesophageal echocardiography, intracardiac echocardiography, surgical procedures). (b) Total productive hours worked (echo lab and vascular lab).

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Figure 2.

(a) Total number of incidents reported by sonographer (echo and vascular lab). (b) Total cost from diagnosis (DX)/treatment of sonographer injury (echo and vascular lab). (c) Total work hours restricted/absent due to sonographer injury (echo and vascular lab).

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Table 1.

Interventions as Recommended in Ergonomic Guidelines

Interventions	Description
Literature review and in-service	Group review/discussion of recommendations in the sonography literature
Occupational therapy assessment	Site visit by Employee Health and Occupational Therapy for audit and recommendations
Guest speaker	Regional presentation by a national leader in ergonomics
Videotape in-service	Ergonomic Guidelines for Sonographers (Sound Ergonomics, Inc, Kenmore, Washington) and annual review by all staff
CBL prevention	Computer-based learning (CBL)—ergonomics/injury prevention review included in employee annual safety education
Adaptive cushion	Arm/hand support cushions (Sound Ergonomics, Inc) available in all rooms
Height-adjust chairs	Variable seat height (24–38 inches) and back support
Capusco chairs	Variable height with back/arm support (Sound Ergonomics, Inc)
Height-variable imaging device	Height-variable keyboard (Sequoia C512; Siemens Healthcare, Malvern, Pennsylvania)
Keyboard/monitor flex imaging devices	Variable position keyboard/monitors (Philips iE33; Philips Healthcare, Andover, Massachusetts)
Cable supports	Cable support brace (Sound Ergonomics, Inc)

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Table 2.

Timeline of Interventions

FY01	FY02	FY03	FY04	FY05	FY06	FY07	FY08	FY09	FY10	FY11	FY12
					Height-variable imaging devices	Height-variable imaging devices	Height-variable imaging devices	Height-variable imaging devices	Keyboard/monitor flex imaging devices	Keyboard/monitor flex imaging devices	Keyboard/monitor flex 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 in-service a	Videotape in-service a	Videotape in-service a	Videotape in-service a			CBL prevention MSK	CBL prevention MSK	CBL prevention MSK
			Occupational therapy assessment	Occupational therapy assessment	Occupational therapy assessment	Guest speaker			Occupational therapy assessment
			Literature review and in-service	Literature review and in-service

CBL, computer-based learning; FY, fiscal year; MSK, musculoskeletal.

a

Videotape from Sound Ergonomics, Inc (Kenmore, Washington).

In conclusion, the implementation of ergonomic guidelines eliminates sonographer MSK injury, decreasing organizational cost and lost productive hours.