The Imperial Stress Assessment Tool (ISAT): A feasible, reliable and valid approach to measuring stress in the Operating Room

Arora, S., Tierney, T., Sevdalis, N., Aggarwal, R., Woloshynowych, M., Nestel, D., Darzi, A. and Kneebone, R. 2010. The Imperial Stress Assessment Tool (ISAT): A feasible, reliable and valid approach to measuring stress in the Operating Room. World Journal of Surgery. 34, pp. 1756-1763. https://doi.org/10.1007/s00268-010-0559-4

TitleThe Imperial Stress Assessment Tool (ISAT): A feasible, reliable and valid approach to measuring stress in the Operating Room
TypeJournal article
AuthorsArora, S., Tierney, T., Sevdalis, N., Aggarwal, R., Woloshynowych, M., Nestel, D., Darzi, A. and Kneebone, R.
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.

JournalWorld Journal of Surgery
Journal citation34, pp. 1756-1763
ISSN1432-2323
0364-2313
Year2010
PublisherSpringer
Digital Object Identifier (DOI)https://doi.org/10.1007/s00268-010-0559-4
PubMed ID20393847
Web address (URL)https://link.springer.com/article/10.1007/s00268-010-0559-4
Publication dates
Published15 Apr 2010

Related outputs

Obesity, oxidative DNA damage and vitamin D as predictors of genomic instability in children and adolescents
Usman, M., Woloshynowych, M., Britto, J.C., Bilkevic, I., Glassar, B., Chapman, S., Ford-Adams, M.E., Desai, A., Bain, M., Tewfik, I. and Volpi, E. 2021. Obesity, oxidative DNA damage and vitamin D as predictors of genomic instability in children and adolescents. International Journal of Obesity. 45, p. 2095–2107. https://doi.org/10.1038/s41366-021-00879-2

Food and Mood: Exploring the determinants of food choices and the effects of food consumption on mood among women in Inner London.
Leeds, J., Keith, R. and Woloshynowych, M. 2020. Food and Mood: Exploring the determinants of food choices and the effects of food consumption on mood among women in Inner London. World Nutrition. 11 (1), pp. 68-96. https://doi.org/10.26596/wn.202011168-96

Work conditions, mental workload, and patient care quality: a multisource study in the emergency department.
Weigl, M., Müller, A., Holland, S., Wedel, S. and Woloshynowych, M. 2016. Work conditions, mental workload, and patient care quality: a multisource study in the emergency department. BMJ Quality and Safety. 25, pp. 499-508. https://doi.org/10.1136/bmjqs-2014-003744

A multicentre observational study to evaluate a new tool to assess emergency physicians' non-technical skills
Flowerdew, L., Gaunt, A., Spedding, J., Bhargava, A., Brown, R., Vincent, C. and Woloshynowych, M. 2013. A multicentre observational study to evaluate a new tool to assess emergency physicians' non-technical skills. Emergency Medicine Journal. 30 (6), pp. 437-443. https://doi.org/10.1136/emermed-2012-201237

Teams under pressure in the emergency department: an interview study
Flowerdew, L., Brown, R., Vincent, C. and Woloshynowych, M. 2012. Teams under pressure in the emergency department: an interview study. Emergency Medicine Journal. 29 e2. https://doi.org/10.1136/emermed-2011-200084

Identifying Nontechnical Skills Associated With Safety in the Emergency Department: A Scoping Review of the Literature
Flowerdew, L., Brown, R., Vincent, C. and Woloshynowych, M. 2012. Identifying Nontechnical Skills Associated With Safety in the Emergency Department: A Scoping Review of the Literature. Annals of Emergency Medicine. 59 (5), pp. 386-395. https://doi.org/10.1016/j.annemergmed.2011.11.021

Development and Validation of a Tool to Assess Emergency Physicians' Nontechnical Skills
Flowerdew, L., Brown, R., Vincent, C. and Woloshynowych, M. 2012. Development and Validation of a Tool to Assess Emergency Physicians' Nontechnical Skills. Annals of Emergency Medicine. 59 (5), pp. 376-385. https://doi.org/10.1016/j.annemergmed.2011.11.022

The ABC of Handover: Impact on shift handover in the Emergency Department
Farhan, M., Brown, R., Vincent, C. and Woloshynowych, M. 2012. The ABC of Handover: Impact on shift handover in the Emergency Department. Emergency Medicine Journal. 19, pp. 947-953. https://doi.org/10.1136/emermed-2011-200201

The ABC of handover: a qualitative study to develop a new tool for handover in the emergency department.
Farhan, M., Brown, R., Woloshynowych, M. and Vincent, C. 2012. The ABC of handover: a qualitative study to develop a new tool for handover in the emergency department. Emergency Medicine Journal. 29, pp. 941-946. https://doi.org/10.1136/emermed-2011-200199

Patient safety factors in children dying in a paediatric intensive care unit (PICU): a case notes review study
Monroe, K., Wang, D., Vincent, C., Woloshynowych, M., Neale, G. and Inwald, D.P. 2011. Patient safety factors in children dying in a paediatric intensive care unit (PICU): a case notes review study. BMJ Quality and Safety. 20, pp. 863-868. https://doi.org/10.1136/bmjqs.2010.048504

Stress Management Training for Surgeons - a randomised controlled intervention study
Wetzel, C.M., George, A., Hanna, G.B., Athanasiou, T., Black, S.A., Kneebone, R.L., Nestel, D. and Woloshynowych, M. 2011. Stress Management Training for Surgeons - a randomised controlled intervention study. Annals of Surgery. 253 (3), pp. 488-494. https://doi.org/10.1097/SLA.0b013e318209a594

Factors compromising safety in surgery: stressful events in the operating room
Arora, S., Hull, L., Tierney, T., Nestel, D., Woloshynowych, M., Darzi, A. and Kneebone, R. 2010. Factors compromising safety in surgery: stressful events in the operating room. The American Journal of Surgery. 199 (1), pp. P60-65. https://doi.org/10.1016/j.amjsurg.2009.07.036

The impact of stress on surgical performance: A systematic review of the literature
Arora, S., Sevdalis, N., Nestel, D., Woloshynowych, M., Darzi, A and Kneebone, R 2010. The impact of stress on surgical performance: A systematic review of the literature. Surgery. 147 (3), pp. 318-330. https://doi.org/10.1016/j.surg.2009.10.007

Reflective analysis of safety research in the hospital accident & emergency departments
Wears, R.L., Woloshynowych, M., Brown, R. and Vincent, C.A. 2010. Reflective analysis of safety research in the hospital accident & emergency departments. Applied Ergonomics. 41 (5), pp. 659-700. https://doi.org/10.1016/j.apergo.2009.12.006

The effect of stress and coping on surgical performance during simulations
Wetzel, C.M., Black, S.A., Hanna, G.B., Athanasiou, T., Kneebone, R.L., Nestel, D., Wolfe, J.H.N. and Woloshynowych, M. 2010. The effect of stress and coping on surgical performance during simulations . Annals of Surgery. 251 (1), pp. 171-176. https://doi.org/10.1097/SLA.0b013e3181b3b2be

Managing Intra-operative stress: What do surgeons want from a crisis training programme?
Arora, S., Sevdalis, N., Nestel, D., Tierney, T., Woloshynowych, M. and Kneebone, R. 2009. Managing Intra-operative stress: What do surgeons want from a crisis training programme? The American Journal of Surgery. 197 (4), pp. 537-543. https://doi.org/10.1016/j.amjsurg.2008.02.009

The Care Homes Use of Medicines Study: prevalence, causes and potential harm of medication errors in care homes for older people
Barber, N.D., Alldred, D.P., Raynor, D.K., Dickinson, R., Garfield, S., Jesson, B., Lim, R., Savage, I., Standage, C., Buckle, P., Carpenter, J., Franklin, B., Woloshynowych, M. and Zermansky, A.G. 2009. The Care Homes Use of Medicines Study: prevalence, causes and potential harm of medication errors in care homes for older people. BMJ Quality and Safety. 18, pp. 341-346. https://doi.org/10.1136/qshc.2009.034231

Methodological variability in detecting prescribing errors when evaluating computerised physician order entry
Dean Franklin, B., Birch, S., Savage, I., Wong, I., Woloshynowych, M., Jacklin, A. and Barber, N. 2009. Methodological variability in detecting prescribing errors when evaluating computerised physician order entry. Pharmacoepidemiology and Drug Safety. 18 (11), pp. 992-999. https://doi.org/10.1002/pds.1811

Continuity of care 2006: what have we learned since 2000 and what are policy imperatives now?
Freeman, G., Woloshynowych, M., Baker, R., Boulton, M., Guthrie, B., Car, J., Haggerty, J. and Tarrant, C. 2007. Continuity of care 2006: what have we learned since 2000 and what are policy imperatives now? NCCSDO.

Communication Patterns in a UK Emergency Department
Woloshynowych, M., Davis, R., Brown, R. and Vincent, C. 2007. Communication Patterns in a UK Emergency Department. Annals of Emergency Medicine. 50 (4), pp. 407-413. https://doi.org/10.1016/j.annemergmed.2007.08.001

Patient safety and iatrogenesis
Woloshynowych, M. and Vincent, C. 2007. Patient safety and iatrogenesis. in: Ayers, S., Baum, A., McManus, C., Newman, S, Wallston, K., Weinman, J. and West, R. (ed.) Cambridge Handbook of Psychology, Health and Medicine. 2nd edition Cambridge University Press.

Incident reporting in one UK accident and emergency department
Tighe, C.M., Woloshynowych, M., Brown, R., Wears, B. and Vincent, C. 2006. Incident reporting in one UK accident and emergency department. Accident and Emergency Nursing. 14 (1), pp. 27-37. https://doi.org/10.1016/j.aaen.2005.10.001

The effects of stress on surgical performance.
Wetzel, C. M., Kneebone, R., Woloshynowych, M., Nestel, D., Moorthy, K., Kidd, J. and Darzi, A. 2006. The effects of stress on surgical performance. The American Journal of Surgery. 191 (1), pp. 5-10. https://doi.org/10.1016/j.amjsurg.2005.08.034

Techniques used in the investigation and analysis of critical incidents in healthcare
Rogers, S, Taylor-Adams, S. and Woloshynowych, M. 2006. Techniques used in the investigation and analysis of critical incidents in healthcare. in: Walshe, K. and Boaden, R. (ed.) Patient Safety: Research into Practice Maidenhead, UK Open University Press. pp. 130-143

The investigation and analysis of critical incidents and adverse events in healthcare
Woloshynowych, M., Rogers, S., Taylor-Adams, S. and Vincent, C. 2005. The investigation and analysis of critical incidents and adverse events in healthcare. Health Technology Assessment. 9 (19). https://doi.org/10.3310/hta9190

Error Reduction in Medicine: Final report to the Nuffield Trust
Lyons, M., Woloshynowych, M., Adams, S. and Vincent, C. 2004. Error Reduction in Medicine: Final report to the Nuffield Trust. Nuffield Trust.

Retrospective case record review: a blunt instrument that needs sharpening
Neale, G. and Woloshynowych, M. 2003. Retrospective case record review: a blunt instrument that needs sharpening. BMJ Quality and Safety. 12 (1), pp. 2-3. https://doi.org/10.1136/qhc.12.1.2

Exploring the causes of adverse events in British NHS hospital practice.
Neale, G., Woloshynowych, M. and Vincent, C. 2001. Exploring the causes of adverse events in British NHS hospital practice. Journal of the Royal Society of Medicine. 94, pp. 322-220. https://doi.org/10.1177/014107680109400702

Adverse events in British hospitals: preliminary retrospective record review
Vincent, C., Neale, G. and Woloshynowych, M. 2001. Adverse events in British hospitals: preliminary retrospective record review. BMJ. 322, pp. 517-519. https://doi.org/10.1136/bmj.322.7285.517

Immediate Recovery of Psychomotor Function After Patient-Administered Nitrous Oxide/Oxygen Inhalation for Colonoscopy
Trojan, J., Saunders, B.P., Woloshynowych, M., Debinsky, H.S. and Williams, C.B. 1997. Immediate Recovery of Psychomotor Function After Patient-Administered Nitrous Oxide/Oxygen Inhalation for Colonoscopy. Endoscopy. 29 (1), pp. 17-22. https://doi.org/10.1055/s-2007-1004055

The Patient Requests Form: a way of measuring what patients want from their general practitioner.
Valori, R., Woloshynowych, M., Bellenger, N., Aluvihare, V. and Salmon, P. 1996. The Patient Requests Form: a way of measuring what patients want from their general practitioner. Journal of Psychosomatic Research. 40 (1), pp. 87-94. https://doi.org/10.1016/0022-3999(95)00548-X

The measurement of beliefs about physical symptoms in English general practice patients
Salmon, P., Woloshynowych, M. and Valori, R. 1996. The measurement of beliefs about physical symptoms in English general practice patients. Social Science & Medicine. 42 (11), pp. 1561-1567. https://doi.org/10.1016/0277-9536(95)00263-4

Psychological aspects of gastrointestinal endoscopy: a review
Woloshynowych, M., Oakley, D.A., Saunders, B.P. and Williams, C.B. 1996. Psychological aspects of gastrointestinal endoscopy: a review. Endoscopy. 28 (9), pp. 763-767. https://doi.org/10.1055/s-2007-1005602

Permalink - https://westminsterresearch.westminster.ac.uk/item/w6v7w/the-imperial-stress-assessment-tool-isat-a-feasible-reliable-and-valid-approach-to-measuring-stress-in-the-operating-room


Share this

Usage statistics

28 total views
0 total downloads
These values cover views and downloads from WestminsterResearch and are for the period from September 2nd 2018, when this repository was created.