Mini Breaks, Many Benefits

Surgeons find short breaks prove valuable in providing best care

By Mayo Clinic Staff

Sixty-second stretch breaks during surgery reduces pain and discomfort for the surgical team, helping them focus on the patient.

Perfecting a skill requires equal parts natural talent, dedication and practice. A concert violinist plays a single piece of music over and over. A major league pitcher hurls strikes across home plate until the stadium lights go out. And a surgeon spends day after day leaning over an operating table while maintaining mental focus on the patient.

For all three, this kind of physical exertion and repetition stresses the body, leaving it vulnerable to work-related injuries that, over time, can cut careers short.

In the surgeon's case, cutting that career short is a devastating personal loss, but ultimately, the health care system and patients stand to lose the most.

Surgeons are some of the most highly trained members of a hospital team, with their employers and federal funding agencies footing a steep bill — approaching $1 million in some surgical specialties — for expertise that can take at least 10 years to develop. But as surgical procedures become more complex and workloads grow, some surgeons have bowed out of the profession prematurely, citing musculoskeletal pain, burnout and concern for patient safety.

"We need to stop thinking of the surgeon as a machine," says Susan Hallbeck, Ph.D., the Robert D. and Patricia E. Kern Scientific Director for Health Care Systems Engineering Program in the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery. She notes that even on an assembly line, workers take breaks to combat fatigue and sharpen mental focus.

Dr. Hallbeck and colleague Juliane Bingener, M.D., a Mayo Clinic gastrointestinal surgeon, believe breaks in the operating room — even short ones — can provide similar benefits to the surgical team.

The doctors teamed up to lead Mayo Clinic's participation in a multicenter "microbreaks" study initiated by Adrian E. Park, M.D., a nationally recognized leader in minimally invasive surgery and chair of the Department of Surgery at Anne Arundel Medical Center in Annapolis, Maryland.

The group designed 60-second breaks during which the surgical team could perform a series of ergonomic stretches to reduce pain and discomfort. The stretches couldn't disrupt the flow of the operating room or prolong the procedure.

In all, 33 surgical teams at Mayo Clinic in Rochester, Minnesota, participated in the trial. Dr. Hallbeck surveyed participants after procedures on days without microbreaks to track their self-reported physical performance, mental focus, pain and level of fatigue. She returned on days that included microbreaks to ask the same questions.

Then at the very end of the day, she asked one last question: "Do you want to incorporate microbreaks into your operating room schedule?" Eighty-seven percent of teams said yes, and trial data showed that microbreaks had no negative impact on the length of operations, productivity or operating room workflow.

Those outcomes inspired Drs. Hallbeck and Bingener to think bigger. They are now beta-testing a web-based app that guides surgical teams through the microbreak stretches. The digital platform could eventually bring microbreaks to operating rooms at other Mayo Clinic sites and beyond.

"If we can build evidence-based tools like this to increase the physical and mental focus of the team in the operating room, it's good for the patient, and it's good for the surgeon," Dr. Bingener says.

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