New powertransfer devices improve overall safety in patient management.

As medical costs continue to rise, health care facilities are scrambling to find the means to help maintain efficiency in the delivery of health care services. One of the areas that has become a focus is safe patient handling. The benefits of a safer work environment include the following:

• decreased rates of patient injury;

• reduced health care provider injuries rates;

• reduced workers’ compensation claims;

• reduced corporate liability;

• reduced insurance premiums for all parties involved; and

• increased employee retention.

Increasingly, reimbursement for surgical procedures, such as weight-loss surgery, are becoming tied to overall standards of care, which include documented safety-training programs, screening tools such as the Egress Test,™ and appropriate equipment prescriptions. An example of this required standard is “Centers of Excellence,” which is an emerging standard that is still being defined by accreditation agencies such as the American Society for Bariatric Surgery, The American College of Surgeons, and several large insurance companies such as Blue Cross/Blue Shield. Given the dramatic weight increase in the general population, weight-rated equipment is becoming a cornerstone to help medical facilities meet such standards.

To maximize safety at the transfer workstation, caregivers must examine the transfer method. In an attempt to meet safe patient-transfer standards, manufacturers have recently introduced power-transfer devices that also reduce the frequency of back injuries. Clinical directors must determine which device is best for their facilities.

Mechanical Transfer Devices

Here is a brief summary of patient-transfer products:

Sitting sliding boards. With sitting transfers, excessive tissue bulk makes it extremely difficult—especially for control and positioning—to use sliding boards with the bariatric population. Furthermore, staff members need to have significant experience to work with sitting sliding boards. Even for those patients who are of size and have experienced spinal cord injury, a sliding board seems to hinder—rather than assist—them, and the board often becomes lost under the patient. Should the patient’s center of gravity be placed forward of the center of the board during the sitting scooting attempt, there is a high risk that the board will tip toward the floor, causing the dependent patient to slide unstoppably.

Supine sliding boards. Usually, a plastic sheet 5 feet long and about 24 inches wide is an excellent investment for any department where side glide transfers are possible from a bed to a level surface, such as with an x-ray table, gurney or high-low chair. Caregivers may also mount these devices on the wall, enabling easier access. These products bridge up to a 4-inch gap, which makes side glide transfers to level surfaces a safe venture. Examples include transfers between beds, gurneys, and diagnostic surfaces. The products do not work well between uneven surfaces.

Stretcher Chairs. Stretcher chairs allow for laterally directed transfers of a supine patient from any level surface into the reclined chair for subsequent mobilization to full sitting. They hold great value in environments where a significant volume of dependent patients require mobilization to sitting. The orthopedic and medical wards are likely sites where these products can be effectively used. Good candidates for stretcher chairs are patients with vascular and orthopedic complications, such as acute fractures with restricted weight-bearing precautions; patients who have recently undergone hip-replacement surgery; and patients with external fixation, casts, and vascular and skin grafts. The most obvious benefit of the stretcher chair is that once the patient is positioned, he or she can easily be moved to a sitting posture.

Bedside weight-bearing or standing lift devices. An evolved version of the bedside lift sling device, the weight-bearing or standing lift device blocks patients’ knees and moves their upper bodies over their feet, achieving a semistanding posture. The goal is to maximize the patient’s natural body mechanics in the transfer event. These devices have gained popularity in long-term care and subacute facilities because of their efficiency in accomplishing pericare, dressing, bathing setup and transfer activity. The device can be transitioned in a single caregiver visit, without multiple equipment application. The standing frame becomes limited in acute environments where lower-body acute issues contraindicate application of the standing frame. Load limits now achieve up to 850 pounds.

Bedside sling loading lift devices. Possibly the most common modern transfer device—partly due to its versatility—is the bedside sling loading lift device. It allows quick access for safe transfer of moderately to severely obese patients, with load limits up to 1,000 pounds. Important features include an expandable base to fit the lift base around a bariatric wheelchair. The base of the lift should be low-profile (6 inches or less) to allow the lift base to fit under the bariatric bed. The sling-spreader bar should accommodate the patient’s width.

The boom of the lift also needs to accommodate the patient’s width, leaving sufficient distance (about 24 inches) between the spreader bar attachment point and the actuator lift mechanism’s point of contact. When in doubt, be sure to have a tall employee act as a model in the sling prior to purchase, to be sure that the sling can fully rotate 360 degrees without being hit by the employee’s knees; and that the product can easily perform floor transfers. These devices are also available with emergency motor braking during lowering, as well as manual backup. Scales are an excellent accessory purchase. The bedside lift’s versatility of use is a great advantage. It can pick up patients from almost any location that they can fall to, including the parking lot if needed.

Overhead ceiling-mounted lifts. These devices, which offer load lift capacities up to about 1,000 pounds, are gaining popularity. These lifts are not restricted by motor capability, but rather by load limits of the ceiling structure. Storage is not an issue, since they are always available and cannot be tipped over. They make transfers from the bed to the adjoining surfaces easier, and they may also readily help roll or boost the patient who is otherwise difficult to lift with a mobile base. Ceiling lifts become vital in regions where a significant number of dependent patients are to be managed.

The only disadvantage of the ceiling lift is in their difficulty of being shared and the mobilization of patients who fall outside the range of their tracking system. Ceiling lifts are going to become increasingly necessary pieces of equipment to meet the needs of any medical facility where dependent patients of all sizes are managed.

At medical facilities where a reasonable investment in appropriate transfer equipment is made, the overall safety in patient management is greatly enhanced. Employees find that the equipment physically enables them to perform the transfer task safely. Also, the overall job environment becomes less stressful, since their ability to meet patient needs are dramatically improved. Transfer equipment is becoming the silent partner in meeting patients’ needs.

Michael Dionne, PT, is founder of www.BariatricRehab.com, located in Gainesville, Ga, and helps medical facilities meet their safety needs through on-site training. He is internationally recognized for staff safety training for the safe management of obese patients.