Human Factors Approach to Assess Physician Workload in Elective Plastic Surgery Breast Procedures.

[BACKGROUND] Human factors research involves the study of work system interactions, physician workload, cognitive effort, and performance. This pilot study incorporated a human factor approach and other surgery-based metrics to assess cognitive workload among plastic surgeons during elective plastic surgery breast procedures.

[METHODS] In this prospective study of plastic surgery breast procedures over a 3-month period, surgeon and patient demographics and procedural details were collected. The lead surgeon assessed each procedure using a validated workload questionnaire (National Aeronautics and Space Administration Task Load Index [NASA-TLX]) that included 6 subscales (ie, mental, physical, temporal demand, performance, effort, and frustration), a question on distraction, and their expectation of procedural difficulty.

[RESULTS] Fifty-seven cases were included in this study. Surgical duration had a positive correlation with increased mental demand ( < .001), physical demand ( < .001), and degree of distractions ( < .001). Free flap reconstruction, breast reduction, and transgender mastectomy had the highest average mental, physical demands, and perceived effort. Bilateral cases had significantly higher workload than unilateral ones ( = .002). NASA-TLX scores between immediate and delayed reconstructions were comparable, but delayed cases had higher degree of distractions ( = .04). There was a strong correlation between degree of distractions and increased mental workload 0.68; < .001), increased physical demand ( = 0.61; < .001), and increased temporal demand ( 0.78; < .001). More difficult procedures were associated with greater procedural duration than those rated as difficult as expected or less difficult than expected ( = .02).

[CONCLUSIONS] These preliminary data demonstrated multiple factors that may influence and govern perceived physician workload and may provide insight for targeted quality improvement to plan procedures safely and effectively.