The Clinical Services Journal examines a system designed to help reduce the ergonomic risks and improve the workflow efficiencies associated with routine patient transportation.
Transporting patients in hospital beds is a common patient handling task that may pose significant ergonomic risks1,2,3,4 for the caregiver, including nurses, porters and other transport team members.
Use of powered transport devices can have a positive impact on the safety and efficiency of a facilities work environments.5 As a result, ergonomic risk and the potential for caregiver injuries may be reduced by the decrease in push forces and eliminating the need for lateral transfers from the bed onto trolleys for patient transport.
This article discusses the known physical impact of routine bed transportation, and the resulting push/pull forces experienced by caregivers, along with suggestions for decreasing the amount of work required from users by incorporating new technologies. Factors that impact push forces on caregivers are also discussed and transportation technologies reviewed.
The challenges of patient transport
Transporting patients around the hospital can potentially present a strain on staff, patients, and resources.6 The following factors can contribute to the challenge of routinely moving patients quickly and safely from point A to point B:
- Some beds and mobile devices are often heavy and difficult to manoeuvre
- Patient weight is generally increasing,7,8,9 making the bed even heavier to push
- Hospital environments can sometimes be challenging with steep inclines, soft/carpeted flooring, small rooms, lifts and narrow or long corridors
- Caregivers can benefit from ergonomic solutions that reduce the potential for injury during patient transportation
- Beds and trolleys are often transported long distances between departments
- Because of these challenges, powered drives or transport assistance is becoming an increasingly common requirement.
The ergonomics of patient transportation
Routinely pushing and pulling excessive loads (patients and bed) on a repeated basis, can constitute a high ergonomic risk, as can any repeated task or motion that negatively impacts the musculoskeletal system due to excessive stress or force.10
The spine is subject to extensive mechanical stress from both compressive and shear forces,11 but it has a greater tolerance for compressive forces than shear. Shear force tolerance in spinal discs is nearly one-third less than compressive force tolerance.12
Examples of compressive forces on the spine are lifting heavy objects and lifting lighter weight objects for long periods of time. Shear forces come from both lateral and anterior/posterior movements of the spine, and are an outcome from twisting, turning, bending, reaching, and awkward postures. Awkward postures are due to various factors such as available space, equipment used, number of caregivers handling the patient, and caregiver anthropometry.13
Reducing shear forces on the spine, ie: minimising or eliminating ergonomic risks, while transporting patients is critical. To reduce the excessive ergonomic effort and push forces when transporting patients, adaptations have been made to some beds by adding powered drive features and fifth wheels. Independent battery-powered bed pushing devices have also been designed to assist in bed transportation.
Manual transportation tasks
Many factors impact ergonomic risk while caregivers are manually transporting beds without powered assistance. When these factors are addressed, these forces are greatly reduced and the risk of caregiver injury can be reduced.
Increases in the shear forces to the spine during bed transportation are attributable to the following key factors:
- When a patient must be laterally transferred onto a trolley to be transported to another area and there is insufficient space, room furniture must often be moved, putting caregivers at risk
- Flooring material is a critical factor related to push forces. The lower the resistance, the easier to move the object and the less work it takes
- The combined weight of the patient and the bed impacts on the push forces as it is the total load that must overcome inertia for movement to occur. When all else is equal, the heavier the load, the greater the push forces required to initiate the move and sustain it
- Castor design, condition, size, diameter, and condition will affect the ease of moving a patient bed
- Inadequate space and clearances when performing activities such as pushing hospitals beds makes challenging tasks even more difficult and increases the risk of caregiver injury. Pushing beds is impacted by space allowances and clearances in hallways. For instance, if there is inadequate room to turn into a patient room, push forces are elevated. Doorway widths also impact the ease in which beds are moved in and out of an area. It is essential to have adequate room clearances for safely maneuvering beds.
Push forces are impacted by the above factors. When they become excessive and exceed the maximum allowable forces found in the Manual Handling Operations Regulations,14 the recommendations are to mechanise the activity and reduce the risk to the lowest level so far as is reasonably practicable.
Patient transportation technology
Interdepartmental transfers between clinical environments are increasing as patient acuity in hospitalised patients rises. Observation at a facility in the US, found that a patient was moved, on average, 2.4 times during their stay. Nurses at the site spent over 1700 hours each month on transporting patients and activities related to this task, resulting in less time to care for patients.16 Bed transportation technologies may help facilitate a reduction in the time spent transporting patients and, in doing so, may improve staff efficiencies by eliminating the need for lateral transfers from the bed onto trolleys for patient transport.
To reduce the excessive ergonomic effort and risk of injury when transporting patients, adaptations have been made to standard beds adding steering assistance with non-powered 5th wheel powered assistance. Each system has its benefits and challenges. Such technologies, especially beds with integrated powered drive features, are available and are frequently used with relatively high cost beds for critical and bariatric care. However, few medical/surgical units, although they have frequent ‘road trips’, have beds with this powered technology.
Steering assistance features such as a non-powered 5th wheel design are perceived to improve caregiver productivity during patient transportation tasks within a patient room and when moving down a corridor.17
Separate powered bed movers can be adapted and used with various beds, but they can increase waiting time as they are seldom in place/available when needed.They also increase the length of the bed, requiring additional space to manoeuvre (lifts, small rooms). They are relatively expensive, often with one bed mover allocated per 30-50 beds, and they need to be used by specially trained personnel.
Powered drives, are used to facilitate the movement of hospital beds. Wiggermann (2017) conducted a study that measured hand forces on 10 caregivers while they moved a bariatric bed manually and while using a powered drive. The powered drive decreased peak forces between 38% (while manoeuvring into a lift) and 94% (while going down a ramp). The powered drive also reduced stopping distance by 55%. During straight-line pushing, the average hand forces did not vary between bed designs but when manoeuvring the beds, the force was reduced by 34% when using powered drive beds.18 Insufficient numbers of beds with motorisation capabilities place caregivers who transport patients at a higher risk of injury than necessary. When staff are injured, patient safety and quality of care is impacted.
A new power transport design, IndiGo Drive Assist from Arjo is designed to reduce the work required to transport patients on their bed to help reduce the risk of staff injury. Unlike powered drive systems, the design does not change the user interface of the bed. Users push or pull the bed as usual from any touch point and IndiGo assists the movement in the direction the user wants to move. It provides drive and braking assistance based on caregiver input and has automatic slope detection. Blue lights project onto the floor when IndiGo is active, letting the user know the power device is operational. IndiGo is compatible with the Arjo Enterprise and Citadel bed frames and attaches so that it does not negatively impact any of the bed’s existing functionality. It requires less work to move a bed with IndiGo installed and has the potential to improve the bed transportation process and safety for those involved.
Conclusion Use of powered transport devices can have a positive impact on the safety and efficiency of a hospital work environment. Ergonomic risk and the potential for caregiver for injuries may be reduced by the decrease in push forces and the elimination of high risk lateral transfer tasks.
The introduction of IndiGo Drive Assist adds to existing technology – a ‘grab anywhere’ interface that complements the caregivers efforts when pushing or pulling the bed, delivering a measurable reduction in work/force, especially over longer distances, when accelerating and decelerating and particularly when moving up and down slopes. Work reduction at every bed movement can help to reduce ergonomic risks and improve caregiver safety whilst improving staff efficiencies when completing this routine task.
According to Arjo, unlike bed powered drive systems used on specialist critical care and bariatric beds, the IndiGo Drive Assist brings an affordable system that can offer work reduction benefits, particularly within med-surg wards, which account for the vast majority of bed transport activities.
Arjo
Head Office, Houghton Hall Business Park, Houghton Regis LU5 5XF
Phone: +44 (0) 8457 342000
Private customer: +44 (0) 3457 342000
Fax: +44 (0) 1582 745745
Email: sales.admin@arjo.com
www.arjo.com
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