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The Imperial Stress Assessment Tool (ISAT): A Feasible, Reliable and Valid Approach to Measuring Stress in the Operating Room

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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.

Conclusion

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.

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Acknowledgments

This study was funded by the BUPA Foundation. The funding bodies had no involvement in the design and conduct of the study; the collection, management, analysis, and interpretation of the data; or the preparation, review, or approval of the manuscript.

Conflict of interest statement

All authors declare that they have no conflict of interest to disclose.

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Authors and Affiliations

  1. Department of Biosurgery and Surgical Technology, Imperial College, 10th Floor QEQM Building, Praed Street, London, W2 1NY, UK

    Sonal Arora, Tanya Tierney, Nick Sevdalis, Rajesh Aggarwal, Debra Nestel, Maria Woloshynowych, Ara Darzi & Roger Kneebone

  2. Gippsland Medical School, Monash University, Clayton, VIC, 3800, Australia

    Debra Nestel

Authors
  1. Sonal Arora
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  2. Tanya Tierney
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  3. Nick Sevdalis
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  4. Rajesh Aggarwal
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  5. Debra Nestel
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  6. Maria Woloshynowych
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  7. Ara Darzi
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  8. Roger Kneebone
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Correspondence to Sonal Arora.

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Arora, S., Tierney, T., Sevdalis, N. et al. The Imperial Stress Assessment Tool (ISAT): A Feasible, Reliable and Valid Approach to Measuring Stress in the Operating Room. World J Surg 34, 1756–1763 (2010). https://doi.org/10.1007/s00268-010-0559-4

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  • DOI: https://doi.org/10.1007/s00268-010-0559-4

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