Ergonomic risks in healthcare workers in acute care; the POSTURE framework

Area of Science:

• Occupational health and safety
• Ergonomics in healthcare
• Medical procedure safety

Background:

• Healthcare workers (HCWs) in fluoroscopy-guided procedures face elevated risks of work-related musculoskeletal disorders (WMSD).
• Prolonged, maladaptive postures and lead apron burden exacerbate ergonomic challenges in surgical settings.
• Limited continuous assessment of posture risk and task-specific contributors exists.

Purpose of the Study:

• To quantify the duration of medium-to-high risk postures during fluoroscopic procedures in Interventional Cardiology and Orthopaedic Trauma.
• To identify and categorize specific tasks contributing to poor ergonomics and WMSD risk in Orthopaedic Trauma.
• To assess the prevalence of WMSD risk factors in healthcare professionals.

Main Methods:

• A mixed-methods cohort study involving 23 participants across 47 procedures (Interventional Cardiology and Orthopaedic Trauma).
• Continuous posture assessment using three inertial measurement units (IMUs) to derive real-time Rapid Upper Limb Assessment (RULA) scores (≥5 indicating medium-to-high risk).
• Qualitative video analysis of Orthopaedic Trauma procedures using the Operating Room Black Box® to identify task-related posture contributors via open and focused coding.

Main Results:

• Healthcare workers spent over 50% of procedural time in medium-to-high risk postures.
• Orthopaedic physicians exhibited the highest risk, with 38.9% of time in RULA 6+ postures.
• The novel POSTURE framework (Pressure, Operations, Sight Technology, Uneven Demographics, Reaching, Exceptions) identified role-specific ergonomic risks beyond traditional RULA scores.

Conclusions:

• A significant prevalence of high-risk postures exists among healthcare workers during fluoroscopy-dependent procedures.
• Integrating IMU-based RULA monitoring with qualitative task analysis provides a scalable approach to posture assessment.
• The POSTURE framework offers actionable insights for ergonomic interventions, policy development, and training to mitigate WMSDs in surgical environments.