Taking a load off nurses: Hospitals eye installing patient lifts but face technical, cost challenges

Sheri Meyer, a cardiac nurse at Affinity Medical Center in Massillon, Ohio, tore a muscle in her upper back last March while helping a patient move into a chair. The 56-year-old nurse was assigned to light duty for eight months after the accident. Later, she was not able to return to work because of complications from surgery to repair the muscle.

Affinity, a 156-bed hospital owned by Franklin, Tenn.-based Community Health Systems, has two mobile patient lifts to move immobile patients, as well as other devices to help with moving patients who are able to move partly on their own, officials at the hospital said. At many hospitals, however, lifts and other patient-moving devices either aren't available or aren't immediately accessible.

Even though Affinity had assist equipment, at the time of the accident Meyer says she was not aware that it was available to help her move patients. “I shot my arm out to help,” she said. “We're caregivers; it's just our mindset. We sometimes encounter a situation, and you have to react.”

Most hospitals across the country have mobile, wheeled lifts at their facilities. But busy nurses and aides typically move average-sized patients themselves rather than taking the time to get an assistive device from elsewhere in the building.

The sparse use of devices to help move patients is the single biggest reason why healthcare workers have one of the highest rates of occupational musculoskeletal injuries in the U.S., experts say. The National Institute for Occupational Safety and Health reports that there are 75 lift-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.

Experts say permanent ceiling-mounted lifts in each patient room would significantly boost use of these assist devices, and some health systems, such as Kaiser Permanente and the Veterans Health Administration, have installed them. Mayo Clinic's Florida hospital recently asked Balfour Beatty Construction to retrofit lifts in all 194 of its existing patient rooms as well as 56 new rooms added in a vertical expansion, said Edward Hernandez, senior vice president at Nashville-based Balfour Resource Group, the construction firm's healthcare consulting arm.

Manufacturers of patient-handling devices see an opportunity to expand their business in the U.S. Chicago-based Hill-Rom acquired the Swedish lift-manufacturing company Liko in 2008, and it has become one of Hill-Rom's fastest-growing lines of business. Many lift manufacturers are or were headquartered in Europe, where rules require provider organizations to adopt comprehensive approaches to preventing injuries.

“One of the reasons Hill-Rom acquired Liko was because there was a recognition that the trend, not just in Europe but in the U.S. as well, was toward safe patient handling, and the value that having systems and a protocol provides for patients and caregivers,” said Alton Shader, president of Hill-Rom's North American unit.

But retrofitting rooms with permanent overhead lifts can be difficult and expensive. As a result, hospital systems are more likely to consider installing permanent lifts in new facilities rather than existing ones. “The retrofit piece is a very small percentage (of our business) because it's being done on a much smaller scale in existing facilities,” Hernandez said.

Overhead lifts consist of a motorized hoist that can lift a patient into the air while they're secured in a sling. An overhead rail system allows nurses to move patients around the room or between rooms. Models designed for obese patients have two motors and can lift as much as 1,000 pounds. Compared with mobile assistive devices, even basic ceiling-based models provide more clearance above beds, have higher load limits and are more durable.

Permanent overhead lifts cost an average of $16,000 per room to install and can be used only in that one room. 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 the ECRI Institute.

There is some controversy around the protocols for when lift devices should be deployed. Researchers say nurses and other caregivers should not lift more than 35 pounds without an assist device. But most caregivers balk at that recommendation, noting that they regularly move children and adults of average weight without help.

That stance has drawn criticism from the American Nurses Association, which wants hospitals to deploy equipment and adopt protocols so that no staffer ever moves a patient without device assistance.

“There are too many opportunities for a wrong angle or a slip,” ANA President Pam Cipriano said. “It is one of the key areas where nurses fear injury in the workplace because that could be career ending.”

Up to now, hospitals have faced little pressure from regulators to use patient-handling equipment. Only 11 states regulate patient handling, and until recently, the Occupational Health and Safety Administration hasn't widely cited hospitals for failing to have proper equipment and protocols in place. But OSHA Chief Dr. David Michaels announced last week that his agency would expand its enforcement to include a review of potential hazards involving musculoskeletal disorders related to patient handling, as well as slips, trips and falls.

“Workers in hospitals, nursing homes and long-term-care facilities have work injury and illness rates that are among the highest in the country, and virtually all of (them) are preventable,” Michaels said. “OSHA has provided employers with education, training and resource materials, and it's time for hospitals and the healthcare industry to make the changes necessary to protect their workers.”

Most states only require that healthcare facilities develop policies for securing equipment, training staff and collecting injury data, though a select few require policies that work towards eliminating or restricting unassisted handling. A recent report by consumer-advocacy group Public Citizen found that five out of the 11 states with patient-handling laws had 7% to 29% fewer injuries in 2013, compared to the year before their laws took effect. Missouri and Texas, two of the stricter states, saw some of the biggest injury declines.

Adding overhead lifts to an existing facility can be difficult. The overhead tangle of wiring, ductwork, water pipes and gas lines makes it impossible to install lifts without incurring significant costs, Balfour's Hernandez said.

Even after facility managers have dealt with the wiring and ductwork above the ceiling, they have to ensure the lift machine doesn't collide with what's below, such as fire sprinklers, lighting fixtures and air vents. Retrofits are almost always custom installations and can differ, depending on whether the room has a lay-in or hard ceiling. As a result, retrofit projects typically cost 25% more than lift installations that are part of new hospital construction, Hernandez said. Retrofit projects also put rooms out of use for a fair amount of time, depending on the size of the project.

One alternative is to anchor a lift's rail system on walls or below the ceiling. But that creates exposed nooks and crannies that can become bacteria nests and complicate infection-control efforts, said John Kouletsis, chief architect and national vice president of facilities and design for Oakland, Calif.-based Kaiser Permanente. Because of capital costs and potential lost revenue, retrofit projects are decided on a case-by-case basis, Kouletsis said. Hospital leaders have to make a case for the down time and why the overhead lift is needed. “We realize that every dollar we spend on facilities is less dollars on clinical care and access, so we're always doing that balance,” he said.

One way to reduce the cost of retrofits is for hospitals to determine how many rooms need lifts. Then they should identify patient-handling needs for each patient during the admission process, and place patients needing lifts in rooms that have one, said Dr. William Buchta, an occupational medicine physician at the Mayo Clinic's St. Mary's Hospital in Rochester, Minn., and chairman of the safe patient- handling committee for the system's Minnesota facilities.

Lift manufacturers say hospital administrators have to establish an environment that encourages the use of their new machines—or else they won't be used. “Managers have to implement rules that this is a must. There are no safe ways of manually lifting a patient,” said Anders Drescher, North American president for Guldmann, a major manufacturer of lifts based in Denmark.

At facilities that have assist devices, their low use rate is not because staffers are lazy, ignorant of risk or averse to using technology, experts say. Rather, they're focused on helping patients, without considering their own safety, Drescher said. “Caregivers in general are very focused on the task at hand with the resident or the patient,” he said. “Their mindset is to stay with the patient and get the job done.”

To improve safe patient-handling culture and help providers understand the dangers of unassisted lifting, the Veterans Health Administration designates safety champions at each facility. Their job is to coordinate and promote use of equipment with the help of unit-based peer leaders, said Kate McPhaul, chief consultant of occupational health in the Veterans Health Administration's Office of Public Health.

The VA requires that each of its facilities devise a comprehensive plan that includes adequate staffing and equipment, which can be either mobile or overhead lifts. In 2008, the system launched a major grant program to help facilities purchase equipment while also initiating training programs and formal policies. “That was a unique, one-time investment to get the medical centers enough medical equipment to get their programs off the ground and demonstrate that it made a difference,” McPhaul said. The VA subsequently found overhead systems were more effective than mobile devices in reducing worker injuries.

The biggest motivator for healthcare employers to install patient-handling assist devices is the high cost of worker injuries and lost work time. High injury rates can also harm a hospital's reputation.

Given the looming nursing shortage, the industry no longer can afford to have nurses forced into premature retirement because of workplace injuries. “Our industry isn't lifting things that are near as heavy as in other industries,” Buchta said. “It's about time we step up to the plate and handle our patients the way (other) industries have handled their products.”