title: Video-based ergonomic analysis to evaluate thoracostomy tube placement techniques.
abstract: BACKGROUND
  Thoracostomy for relief of pneumo- or hemothorax may be performed emergently at the bedside, in the emergency department or trauma area, often in nonideal circumstances. We hypothesized that ergonomic analysis of thoracostomy techniques can identify areas for potential improvement in patient and operator safety.
  
  
  METHODS
  Interviews with Subject Matter Experts (SME) provided steps in the task of thoracostomy; 44 thoracostomies (emergent and elective) were video-recorded and reviewed by SMEs. Ergonomic analyses evaluated surgical performance techniques using video clips.
  
  
  RESULTS
  Risks to the patient and operator included instrument-tray positioning and instrument content. Analyses of video records revealed that despite SME-survey consensus, operators inconsistently followed recommended techniques.
  
  
  CONCLUSIONS
  Discrepancies between SME-recommended and observed practice are prevalent, with simple ergonomic problems impeding performance, and creating risks for patients and operators. Video-based ergonomic analysis is a rich source for identifying task performance problems and potential solutions.
authors.affiliation: Anesthesiology Research Laboratories, University of Maryland School of Medicine, 685 West Baltimore Street, MSTF Rm. 5-34, Baltimore, MD 21201, USA. jseag001@umaryland.edu
authors.forename: F Jacob
authors.initials: FJ
authors.lastname: Seagull
authors.forename: Colin F
authors.initials: CF
authors.lastname: Mackenzie
authors.forename: Yan
authors.initials: Y
authors.lastname: Xiao
authors.forename: Grant V
authors.initials: GV
authors.lastname: Bochicchio
mesh_terms: D015505:Chest Tubes; D004866:Equipment Contamination / Q000517:prevention & control; D006804:Ergonomics; D006491:Hemothorax / Q000601:surgery*; D006801:Humans; D016272:Occupational Health; D011030:Pneumothorax / Q000601:surgery*; D017751:Safety Management; D013907:Thoracostomy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D014741:Video Recording; D014950:Wounds, Penetrating / Q000209:etiology / Q000517:prevention & control