By Christina Frangou
A unique pilot program designed to improve in-hospital mobilization of patients led to a 43% decrease in hospital-acquired pressure ulcers and a 38.5% drop in injuries among hospital staff.
“It’s really been a remarkable improvement in quality through a reduction in adverse events for both patients and employees,” said lead author Walter J. Pories, MD, an attending surgeon at Vidant Medical Center in Greenville, N.C., where the program was created.
The hospital created a specialized 24-person lift team with round-the-clock availability to transport and mobilize heavier and sicker patients.
When the expense of hiring and running the lift team was taken into account, the hospital reported an overall cost savings for the year, estimated to be at least $233,125 annually. The money saved was the result of reduced costs of care for pressure ulcers and the significant decline in employee injuries and associated costs.
Dr. Pories presented the study at the 133rd Annual Meeting of the American Surgical Association.
Greenville, located in the eastern part of the state, has a higher prevalence of severely obese patients, and poor and elderly patients, than most areas of the United States. This patient population often is difficult to mobilize and can pose risks to the hospital staff who are responsible for transport.
Over the past decade, staff at Vidant Medical Center reported an increasing number of work-related injuries and musculoskeletal disorders, frequently resulting from the manual lifting of patients. Direct and indirect costs associated with employee injuries topped $5 million.
“It became apparent that we were losing nurses due to injuries,” said Dr. Pories.
The hospital tried several ways to prevent staff injuries, including hiring an on-site ergonomist and installing motorized ceiling lifts. Neither strategy led to a significant drop in injuries related to patient handling.
In 2011, the hospital came up with a novel pilot program to target employee injuries. They created a 24-member “lift team” consisting of people from various fields who were then trained in safe moving and lifting techniques. Lift-team members came from widely varied backgrounds such as personal training and emergency management.
The teams worked in roving pairs, assisting the nursing staff with safe turning, mobilization, bed surface and moisture management compliance for patients who weighed more than 200 pounds, had a Braden score of less than or equal to 18 and/or pressure ulcers. Unlike previously reported studies of lift teams, Vidant Medical Center’s lift team provided 24-hour and weekend coverage.
The program was implemented in six pilot units, including cardiovascular intensive care, cardiac intermediate care, medical intensive care, medical intermediate care, surgical intensive care and surgical intermediate care. Program administrators selected the units because of their high incidence of patient-handling injuries among employees and/or hospital-acquired pressure ulcers.
In the first year of the program, outcomes improved for both staff and patients. Patient-handling injuries among employees dropped 38.5% from the prior year. At least two of the eight injuries reported would have been avoided had the lift team been involved in the transport of those patients, said researchers. In both cases, clinical staff did not contact the team to help move these patients.
One member of the lift team developed a rotator cuff injury over the study period but it was unclear if the injury resulted from her job.
Over the same period, patients developed fewer hospital-acquired pressure ulcers, the incidence of which fell by 43%, from 61 in 2011 to 35 in 2012.
Staff at the hospital reported high rates of satisfaction with the program. In surveys conducted at the one-, six- and 12-month periods, 92%, 95% and 89% of respondents, respectively, said the lift team had a positive effect on their job satisfaction.
Philip Schauer, MD, director of the Bariatric and Metabolic Institute at Cleveland Clinic, Ohio, said lift teams like the one at Vidant Medical Center could provide “tremendous benefit” to patients and hospital staff and reduce health care costs at the same time.
“The cost of fixing one decubitus ulcer would be in the range of $20,000 to $30,000. If this type of approach can prevent a few decubitus ulcers from developing, then it makes sense that these programs could be cost-effective,” he said.
Dr. Schauer also said that the project needs more testing, and additional information on things like lift-team training and financial implications is required before more institutions adopt similar programs. “This study finally calls attention to a very important, rarely discussed and often ignored problem: the challenge of mobilizing severely obese patients.”
According to the fiscal analysis performed by the investigators, the lift team cost about $1.3 million in 2012 and resulted in reduced costs of more than $1.5 million when employee injuries and cost of pressure ulcers were taken into account. Investigators said that their calculations were conservative.
The study also showed a high turnover rate among lift-team members. In one year, eight team members left their jobs, representing a 24% turnover rate. Half were terminated due to substandard performance and half resigned for personal or academic reasons. In an interview, Dr. Pories said turnover stabilized in 2013. He and his colleagues plan to do follow-up studies that will address the financial effects of the program and the causes of hospital-acquired pressure ulcers.
The program remains in effect in the hospital. “We would now like to cover all units,” Dr. Pories said.