title: The Imperial Stress Assessment Tool (ISAT): a feasible, reliable and valid approach to measuring stress in the operating room.
abstract: BACKGROUND
  Stress can impair surgical performance and may compromise patient safety. This prospective, cross-sectional study describes the feasibility, reliability, and validity of the Imperial Stress Assessment Tool (ISAT) as an approach to measuring stress during surgery.
  
  
  METHODS
  A total of 54 procedures were observed with 11 surgeons (4 attendings, 4 senior residents and 3 junior residents) in a large university teaching hospital in London, UK. Data collection involved physiological measures of operating surgeons [heart rate (HR) and salivary cortisol] and self-report questionnaires (State Trait Anxiety Inventory, or STAI).
  
  
  RESULTS
  In all, 23 of 54 procedures were stressful, as identified by self-reporting. For stressful procedures compared to nonstressful ones, STAI was higher (mean +/- SD) 9.81 +/- 2.20 vs. 12.87 +/- 4.27, t (30.64) = 3.15 as was the HR (mean +/- SD) 79.94 +/- 8.55 vs. 93.17 +/- 14.94, t(32.57) = 3.81) (p < 0.05). Significant positive correlations were obtained between the measures indicating concurrent validity: Pearson's r = 0.47 (HR vs. STAI), 0.34 (cortisol vs. STAI), and 0.57 (HR vs. cortisol) (p < 0.05). Perfect correlation of subjective and objective measures was found for 70% of the procedures. HR and cortisol had specificities of 78% and 91% and sensitivities of 91% and 70% respectively for detecting stress during surgery.
  
  
  CONCLUSIONS
  ISAT is a nonintrusive, feasible approach that combines subjective and objective methods for measuring stress in the operating room. The ISAT may increase understanding of the effects of stress on clinical performance and outcomes, leading to improved patient care.
authors.affiliation: Department of Biosurgery and Surgical Technology, Imperial College, 10th Floor QEQM Building, Praed Street, London, W2 1NY, UK. Sonal.Arora06@imperial.ac.uk
authors.forename: Sonal
authors.initials: S
authors.lastname: Arora
authors.forename: Tanya
authors.initials: T
authors.lastname: Tierney
authors.forename: Nick
authors.initials: N
authors.lastname: Sevdalis
authors.forename: Rajesh
authors.initials: R
authors.lastname: Aggarwal
authors.forename: Debra
authors.initials: D
authors.lastname: Nestel
authors.forename: Maria
authors.initials: M
authors.lastname: Woloshynowych
authors.forename: Ara
authors.initials: A
authors.lastname: Darzi
authors.forename: Roger
authors.initials: R
authors.lastname: Kneebone
mesh_terms: D000328:Adult; D000368:Aged; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D017558:Elective Surgical Procedures / Q000523:psychology / Q000592:standards*; D005240:Feasibility Studies; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis*; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009873:Operating Rooms; D010820:Physicians / Q000523:psychology*; D010818:Practice Patterns, Physicians'; D015995:Prevalence; D011446:Prospective Studies; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D017751:Safety Management; D012463:Saliva / Q000737:chemistry*; D012680:Sensitivity and Specificity; D013315:Stress, Psychological / Q000175:diagnosis* / Q000453:epidemiology; D011795:Surveys and Questionnaires; D016526:Workload / Q000523:psychology
chemical_list: D006854:Hydrocortisone
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