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NASA TASK LOAD INDEX –A Tool to Assess Stress level of Health-Care Providers During an Emergent Cesarean Delivery
Abstract Number: F-46
Abstract Type: Original Research
INTRODUCTION: The current survey is part of a study which aims at applying the Systems Engineering Initiative for Patient Safety (SEIPS) concept for management of human factors during emergency cesarean delivery (ECD).1,2 ECD is a timed event involving multiple health care teams and can be disorganized causing stress for all involved. The NASA Task Load Index (TLX), a subjective workload assessment tool for multiple operators has been used in health care to assess stress levels in ICU nurses.3 NASA TLX evaluates an individual’s perceived task load over 6 categories: mental demand, physical demand, perception of being rushed, degree of success with task, difficulty to complete task and level of frustration. This is the first study to assess stress levels amongst the various teams involved in an ECD using the NASA TLX.
METHOD: NASA TLX survey was emailed to our institutional Labor and Delivery nursing personnel, obstetric and anesthesia faculty and residents who participated in an ECD within the past 12 months. Gender, age range, professional role and years of experience were also collected. Associations between the participant characteristics and six measures of task load were evaluated using ANOVA. Pairwise comparisons were also evaluated with Tukey’s adjustment to control for multiple comparisons.
RESULTS: A total pf 114 personnel responded. Mental demand was significantly associated with age (p = 0.005); ages of 25-30 and > 50 reported significantly higher mental demand. Physical demand was associated with gender, age, and provider type (p = 0.016, p<0.001, and p = 0.018 respectively); females, ages of 25-30/subjects older than 50, and nurses reported significantly higher levels of physical demand. Age > 50 years reported feeling significant more rushed than 31-40 (p = 0.015). OB residents reported significantly lower levels of success relative to anesthesia fellows/faculty (p = 0.045). Perceived level of effort was not associated with participant gender, age range, provider type, or level of experience. Frustration was significantly associated with experience (p = 0.047); individuals with 5-10 years of experience felt significantly more frustration than > 10 years of experience (p = 0.027).
CONCLUSION: The results of the NASA TLX survey confirm that team interactions and tasks are stressful for providers during an ECD. We hope to use the SEIPS model, to a) define roles and responsibilities of the personnel performing the tasks; b) prioritize the tasks and identify physical environmental factors that could be sources of error and frustration; c) identify the characteristics of the tasks and organizational factors that hinder patient safety. Following implementation of the SEIPS model we hope to repeat the NASA TLX for improvement of stress levels amongst health care providers during an ECD.
1. Qual Saf Health Care 2006; 15 (Suppl 1):i50-58
2. Applied Ergonomics 45 (2014) 14-25
3. IIE Trans Health Syst Eng. 2011;1(2):131-143