By John Palmer
This article first appeared September 4, 2018 on PSQH.com.
It’s no secret that America’s healthcare workers are in danger of injuries sustained from improperly lifting and moving the patients they tend to every day in U.S. hospitals. And if workers can’t safely move patients, it places the patients at risk as well.
According to Occupational Safety and Health Administration (OSHA) statistics, worker injuries from slips, trips, and falls are one of the agency’s biggest concerns, especially in hospitals. Injury and illness rates in healthcare, at 5.2 cases for every 100 workers, continue to be above the national average, which is 3.5 cases per 100.
In 2011, U.S. hospitals recorded 253,700 work-related injuries and illnesses, or 6.8 injuries and illnesses for every 100 full-time employees. This is almost twice the rate for private industry as a whole.
Despite this, says OSHA, hospitals still are not employing enough assistive devices to help move patients, and that's a major reason why healthcare workers have one of the highest rates of occupational musculoskeletal injuries in the U.S. A recent study found that such devices can help cut down on these injuries and improve patient care at the same time.
The National Institute for Occupational Safety and Health reports that there are 75 lifting-related injuries for every 10,000 full-time hospital workers, and 107 injuries for every 10,000 workers at nursing homes and residential facilities. Hospital rates are nearly twice the national average for all industries, and nursing home rates are nearly three times as high.
The problem has gotten so bad that OSHA was forced to create an entire website devoted to lifting injuries in hospitals and to solutions that facilities can employ, including training tips and advice. However, OSHA still does not have any published mandate or standards related to reducing patient-handling injuries, just a recommendation that hospitals take steps to reduce them.
Aging Patients Need Assistance
Now look at this issue from the patient's perspective. U.S. residents are getting older, and with that their mobility will become compromised. The number of people older than 65 in the United States is expected to grow significantly in the next 10 years. Consider the following:
- One out of every eight U.S. residents is age 65 or older. One in four will be in that age group by 2030.
- U.S. residents over the age of 85 are the fastest-growing segment of the population. Projected figures show them increasing from 3.3 million to 18.9 million—one in 20 people—by 2050.
- People are living longer. The average life span today is 75 years compared to 47 years in 1900 and is projected to rise to 85 years by 2050.
According to a May 2016 study by Guy Fragala, PhD, PE, CSP, CSPHP, senior advisor for ergonomics at the Patient Safety Center of Inquiry in Tampa, Florida, 36.5% of U.S. adults are obese, and one out of five U.S. adults have a disability, which means they will likely wind up on a physician's exam table at some point in their lives. So will we all, but for individuals with mobility challenges, these exam tables can be major contributors to the injury statistics we've just discussed. (Fragala's study was sponsored by Midmark Corporation, an Ohio-based provider of medical, dental, and veterinary equipment and technologies, including exam tables and chairs.)
"In ambulatory care settings, assisting patients on and off of examination tables happens with each patient visit all day long," Fragala says. "The risks associated with these types of movement are similar to those associated with a bed-to-chair or chair-to-bed type transfer, one of the most difficult and high-risk activities for caregivers to perform because of the potential strain on a caregiver's shoulders, back, and neck. Even something as seemingly insignificant as extending a hand to help a patient ascend a fixed-height table can quickly become dangerous for caregivers if the patient stumbles."
By some estimates, populations in nursing homes and long-term care facilities will double in the not-so-far future, and this increase will require forethought and investment in equipment to help move patients safely and securely.
According to some reports, hospitals are trying to do their best by utilizing new technologies and installing patient lifts. However, many nurses and caregivers still prefer to lift and move patients themselves. The problem, of course, is that if they don't lift properly, or if the patient shifts during the process, it could cause the caregiver or the patient to be injured.
There is some controversy around when lift devices should be deployed. Some research says nurses and other caregivers should not lift more than 35 pounds without an assistive device. The American Nurses Association has advocated for hospitals to deploy equipment and adopt protocols so that no staffer ever moves a patient without device assistance. But most caregivers balk at these recommendations, noting that they regularly move children and adults of average weight without help.
Some hospitals in healthcare systems such as Kaiser Permanente and the Veterans Health Administration have begun to install overhead lifts in their facilities that consist of a motorized hoist that can lift a patient into the air while the patient is secured in a sling. An overhead rail system allows nurses to move patients around the room or between rooms.
Some models designed for obese patients have two motors and can lift as much as 1,000 pounds. They can be pricey, though. Permanent overhead lifts cost an average of $16,000 per room to install. In contrast, mobile devices cost an average of $6,000. A few mobile devices can service an entire hospital if workers take the time to find and use them, according to statistics from the ECRI Institute.
OSHA says that these devices are cost-effective and that the benefits far outweigh the costs, adding that the initial capital investment in policies and equipment can be recovered within two to five years. Consider the following benefits OSHA says can be enjoyed by facilities that use lift–assist equipment:
- Reduced injuries
- Decreases in lost time and workers' compensation claims
- Increased productivity
- Higher quality of work life and worker satisfaction
- Increased staff retention
- Better patient care and satisfaction
Some hospitals have success stories with this equipment. For instance, St. Joseph's/Candler Health System in Savannah, Georgia, installed ceiling lifts in 38 patient rooms in the critical care department, the 330-bed St. Joseph's Hospital and 384-bed Candler Hospital, where a troubling 78 patient-handling injuries per year occurred. St. Joseph's is the state's oldest continuously operating healthcare facility; Candler is the second oldest in the nation.
In 2011, the hospital installed the ceiling lifts along with a staff training program; within a year, with the program only partially in place, the number of annual injuries dropped to 37. That number has been maintained since.
Assistance in the Ambulatory Setting
Overhead lifts aren't the only devices that can help prevent patient and caregiver injury. Fragala says that patients can benefit from adjustable equipment such as height-adjustable examination chairs and tables. His study found that with adjustable chairs, the level of exertion required by a patient needing a minimal assist was reduced by 72%, the level of difficulty getting into the chair was reduced by 64%, and the feeling of safety improved by 42%.
"These reported results indicate that when a height-adjustable examination chair is provided to assist a patient who requires even a little bit of help to mount the chair, the process of getting up onto the examination chair is made much easier and requires less exertion," he says.
That's good, Fragala notes, because if a patient can't get onto an exam table or chair, the physician may be unable to examine the patient properly. That can have cascading effects—the patient might be misdiagnosed because the physician can't collect sufficient information, or the patient might miss the benefit of early detection of a serious condition.
"By providing accessible examination chairs, physicians improve the quality of care available to people with disabilities and activity limitations," he says. "In addition, the use of an accessible exam table may also reduce the frequency and time required in using a lift team, lift equipment, and/or providing transfer assistance from staff."
As ambulatory care settings expand throughout the healthcare delivery system, he says there will be pressure to reduce healthcare costs through shortened length of stay, meaning activity in these settings will only increase.
"It is likely that greater volumes of patients with high dependency levels, who require assistance with movement and mobility, will be seeking the services provided in ambulatory care settings," Fragala says.
"As new ambulatory clinics are built and renovations are done to existing clinics, the benefits of height-adjustable examination tables should be recognized, and those making decisions on furnishings need to understand how height-adjustable examination tables can add to the quality of care provided."
It is part of Fragala's professional mission to be an advocate for equipment such as height-adjustable chairs and tables, which he says go a long way to reducing the risk of physical strain for both patients and providers.
Traditionally, he says examination tables have a height of about 33 inches. "Consider this height of 33 inches versus the height of a common chair seat, which is approximately 18 inches," he says. "That's nearly twice as high, making it all the more difficult for a patient with mobility limitations."
Fragala says when an examination table or diagnostic chair is high and not adjustable, wheelchair users and people with other activity limitations (especially elderly or obese populations) may need to be lifted or assisted. Even a patient who is relatively independent might encounter difficulty when attempting to get up onto a surface 33 inches high. This is where the possibility of injury rears its head.
Beyond facilitating access, he says adjustable-height equipment also enables healthcare providers to position the equipment at a comfortable height, letting the caregiver assume a better posture while conducting an examination or procedure and again enhancing the quality of care.
"The federal agency providing leadership and guidance for accessible design, the U.S. Access Board, recommends an exam chair with a low, uncompressed seat height of 17 to 19 inches," says Fragala.