Architecture

Back pain is a serious problem among nurses and nurse aides. Studies have shown that nurses who have direct interaction with patients, performing manual lifting and transferring activities, are at particularly high risk of injury and back pain.1 According to Fragala and Bailey,2 44% of injuries to nursing staff in hospitals that result in lost workdays are strains and sprains (mostly of the back), and 10.5% of back injuries in the United States are associated with moving and assisting patients. Several factors contribute to these numbers: the aging workforce, the aging population, the alarming rise in obesity in the world’s children and adults, a lack of adequate and accessible mechanical lifting devices, and an almost complete lack of awareness in healthcare that we are, and have been, lifting frighteningly heavy weights.

In response to the pervasive problem of patient-handling injuries in U.S. hospitals, new mechanical devices have been developed to assist in patient-handling tasks, and there is a concerted effort to move toward a “no manual lift” environment. The benefits of using mechanical lifts for patient-handling tasks such as lateral transfers, repositioning, and vertical lifts are well established in the literature.3,4,5, Furthermore, there is a focus on ceiling lifts as opposed to floor lifts for their ease of use, storage, and patient safety.6,7

Here, we report on the findings from a longitudinal study conducted at PeaceHealth’s Sacred Heart Medical Center (SHMC) in Eugene, Oregon. Ceiling lifts were installed three years ago in patient rooms in two units at SHMC. The goal of installing patient lifts in rooms was to reduce the incidence and severity of work-related musculoskeletal disorders (MSD), excluding those related to slips, trips, and falls. This Pebble Project research study conducted by Lola Fritz and her team at SHMC at PeaceHealth Oregon Region tracked the number of injuries associated with patient handling and the costs of claims over a five-year period.

Why Ceiling Lifts?

SHMC has had several types of mechanical floor lifts available on the nursing unit or stored in a corridor off the unit. However, the problem with using these lifts was that often as many as three different devices were needed to perform various lifts, and they all needed to be easily accessible (within 50 feet) to the team. This meant more devices and more storage space. Furthermore, the time and number of steps involved in locating the equipment and moving the patient using floor lifts are considerable. In such a situation, it was next to impossible to force 100% compliance using lifts for patient-handling tasks. In comparison, mechanical ceiling lifts require fewer steps to accomplish the task, minimal physical effort to maneuver, and less space to operate and store, and they are available at hand when needed.8 Also, ceiling lifts are capable of lifting heavier loads.

These are some of the known benefits of a “Safe Patient Handling Program” (including use of ceiling lifts):9

• Reduction in incidence and severity of injuries to patient caregiver staff
• Decrease in patient falls, skin tears, and abrasions
• Increased patient comfort, security, and dignity during transfers
• Promotion of patient mobility and independence
• Enhanced toileting outcomes and increase in continence
• Improved job satisfaction and staff efficiency, and increased empowerment of nursing staff
• Enhanced regulatory compliance (it is expected that within five years, OSHA will have mandatory ergonomic standards for acute care much like long-term care)
• Enhanced compliance with JCAHO standards

Based on the evidence available about the benefits of ceiling lifts, the team at PeaceHealth decided to install ceiling lifts in patient rooms in the Intensive Care Unit and Neurology in SHMC’s 432-bed Hilyard Street campus. Ceiling lifts were installed in 26 of the 33 rooms in the ICU in September 2001 and October 2002, and in all 24 rooms in Neurology in late 2003. Incident report forms and claim costs were obtained from both units spanning a period of 60 months (January 2001 to December 2005). A cost-benefit analysis was conducted to assess the effectiveness of the ceiling lift program.

Findings

Based on its analysis of the number of injuries and associated claim costs, the team at PeaceHealth found that the use of ceiling lifts has virtually eliminated staff injuries from patient handling.

In the ICU, there were ten injuries related to patient handling in the two years before the installation of the ceiling lifts. The annual cost of patient-handling injuries was $142,500 (table 1). In the three years after lifts were installed in more than 75% of the ICU rooms, there have been only two injuries related to patient handling. One injury occurred in a room without a ceiling lift and is not included in the study. The second injury occurred when a patient crawled out of the end of the bed. The annual cost of patient-handling injuries in the ICU after the ceiling lifts were installed was zero dollars (table 2).

Table 1. Projected costs of patient-handling injuries based on cost per injury prior to celing lifts being installed

In Neurology, there were 15 injuries related to patient handling in the three years before the installation of ceiling lifts. The annual cost of patient handling injuries in this unit was approximately $222,645 (table 1). There have been six such injuries in the two years after ceiling lifts were installed in 100% of the rooms on the unit—one was a very minor injury; one involved a staff member who refused to use the ceiling lift; one occurred when staff helped a combative patient move; and the other three were fairly minor injuries where staff did not think to use the ceiling lifts. The annual cost of patient-handling injuries in Neurology after the ceiling lifts were installed was $54,660 (table 2).

Even though there has been a drastic reduction in injuries related to patient handling in both units, there is still some resistance to using ceiling lifts among some of the staff. Thus, this study not only demonstrates the benefits of using ceiling lifts in patient rooms for patient-handling tasks, but also emphasizes the constant need for a “no manual lift” policy and education/reinforcement among staff regarding the importance and benefits of using ceiling lifts.

PeaceHealth is building a new replacement hospital (SHMC at RiverBend) in Springfield, Oregon. Based on the dramatic findings from this study, the organization has decided to install ceiling lifts in the majority of the patient rooms in the new facility. It is going to spend approximately $1,639,695 at the new facility to make 309 rooms “lift ready,” with all the infrastructure in place except the transverse rail and the actual lift, and will buy and install 234 transverse rails and lifts on day one. The bottom line is that the annual cost of patient-handling injuries in these two units at Sacred Heart Medical Center’s Hilyard campus is approximately 83% lower than before the installation of the ceiling lifts. When these savings are applied house-wide, PeaceHealth estimates that it will get a return on its $1,639,695 investment in approximately 2.5 years in its new facility. With PeaceHealth’s new Ergonomic Program in place and 100% compliance in using the ceiling lifts, the savings could be phenomenal. HD

Table 2. Actual preliminary savings after lifts are ceiling-installed and used

Anjali Joseph is Director of Research for The Center for Health Design, headquartered in Concord, California. Lola Fritz is Director of Operational Facilities Planning at Sacred Heart Medical Center/PeaceHealth in Eugene, Oregon.

Reference

1. Engkvist IL, Hjelm EW, Hagberg M, et al. Risk indicators for reported over-exertion back injuries among female nursing personnel. Epidemiology 2000; 11:519–22.
2. Fragala G, Bailey LP. Addressing occupational strains and sprains: Musculoskeletal injuries in hospitals. AAOHN Journal 2003; 51:252–9.
3. Garg A, Owen B, Beller D, Banaag J. A biomechanical and ergonomic evaluation of patient transferring tasks: Bed to wheelchair and wheelchair to bed. Ergonomics 1991; 34:289–312.
4. Smedley J, Egger P, Cooper C, Coggon D. Manual handling activities and risk of low back pain in nurses. Occupational and Environmental Medicine 1995; 52:160–3.
5. Smedley J, Trevelyan F, Inskip H, et al. Impact of ergonomic intervention on back pain among nurses. Scandinavian Journal of Work, Environment & Health 2003; 29:117–23.
6. Chhokar R, Engst C, Miller A, et al. The three-year economic benefits of a ceiling lift intervention aimed to reduce healthcare worker injuries. Applied Ergonomics 2005; 36:223–9.
7. Villeneuve J. The ceiling lift: An efficient way to prevent injuries to nursing staff. Journal of Healthcare Safety, Compliance & Infection Control 1998; 2:19–23.
8. Engst C, Chhokar R, Miller A, et al. Effectiveness of overhead lifting devices in reducing the risk of injury to care staff in extended care facilities. Ergonomics 2005; 48:187–99.
9. American Nurses Association. Preventing back injuries: Safe patient handling and movement. Silver Spring, Md.:American Nurses Association, 2002.

Sidebar

The Pebble Report focuses on the research efforts and interests of The Center for Health Design’s Pebble Project partners, a project that began in 2000 with one provider and has grown to more than 30.