Obesity epidemic's hidden cost: Hospital staff injuries

INDIANAPOLIS – A major hidden cost of the obesity epidemic is the physical toll it takes on hospital nurses and other employees in helping to move heavy patients. The cost of these workplace injuries is skyrocketing, not only in terms of direct medical care bills, but also in terms of work absenteeism, activity restrictions, retraining, and employee dissatisfaction and fear.

The solution at one large tertiary academic medical center in eastern North Carolina has been to create specially trained two-person lift teams available 24/7. The results of a pilot study have been impressive, particularly in light of the fact that nothing else hospital officials tried earlier – including spending more than $1.5 million for motorized patient ceiling lifts – had any significant impact, Dr. Walter J. Pories said at the annual meeting of the American Surgical Association.

Hospital employee injuries incurred in handling obese patients are an issue that has until now been largely beneath physicians’ radar.

"I don’t think anybody here would ask two nurses to pick up a washing machine, or a 400-lb calf, or an 800-lb lathe, and yet whether we like it or not we ask our staff to move patients with such weights daily," observed Dr. Pories, professor of surgery at East Carolina University in Greenville, N.C.

He practices at Vidant Medical Center, a 909-bed hospital where administrators noticed back in 2005 that employee workplace compensation claims for injuries during patient transport were rapidly escalating. In that year, 98 staff experienced patient-handling injuries, resulting in 670 lost workdays and 3,022 restricted workdays.

Hospital officials tried several interventions. First came an intensive education program on safe lifting and patient mobilization conducted by an ergonomist.

"It didn’t make a bit of difference," Dr. Pories recalled.

Indeed, during 2008 there were 2,141 lost workdays due to these types of injuries, more than triple the number in 2005.

Next came a big investment in ceiling-mounted motorized lifts. The impact was minimal: roughly a 10% reduction in staff injuries. Problems with the lifts abounded. They broke. Some staff had difficulty operating them. But the biggest issue was that the rooms with the lifts weren’t always available because the hospital is always fully occupied.

Dr. Pories credited the nursing staff with providing the leadership in developing what he calls the Vidant Medical Center lift team model. Coverage is available 24/7. There are three teams of two individuals on duty during the day and two teams of two at night. They work 12-hour shifts. There is one supervisor for 23 lift team technicians, including three women. They are paid an average of $10 per hour, which the surgeon called "a pretty good wage in eastern North Carolina."

Individuals must pass a rigorous physical assessment before they can join the lift team. Members take a 3-week orientation program in which they learn safe lift techniques, skin and wound care, and infection control. They have their own uniforms to foster esprit de corps.

Many other organizations had tried using lift teams, with disappointing results. That’s because they limited the teams to the day shift or scheduled transfers, according to Dr. Pories.

"The real problems happen late at night," he said.

Dr. Pories and his coinvestigators conducted a pilot study in which they utilized the lift teams in the five hospital units having the highest staff injury rates due to patient-handling mishaps. The lift team was called to those units for moving patients who weighed more than 200 lb, had pressure ulcers, or who were at risk for pressure ulcers by virtue of a Braden scale score of 18 or less.

During the pilot study, 8 employee injuries resulted from patient handling in the five test units, for a rate of 0.134 injuries per 1,000 patient-days, compared with 71 injuries and a rate of 0.319 injuries per 1,000 patient-days in control units.

Once use of the lift teams expanded hospital-wide, the result was a 39% drop in employee injuries due to patient handling, as well as a 43% reduction in hospital-acquired pressure ulcers. Multiple staff surveys have shown 90%-99% satisfaction rates with the lift teams as having improved the workplace while demonstrating that the hospital cares about employee safety.

The total direct and indirect cost of staff injuries due to patient handling was approximately $2.76 million per year prior to introduction of the lift teams. The lift teams provided an estimated $423,152 in savings due to fewer staff injuries and hospital-acquired pressure ulcers, even after factoring in team salaries and equipment, Dr. Pories reported.

The next step in this project will be to document whether the presence of the lift teams also has resulted in fewer patient injuries, he added.

Discussant Dr. Philip R. Schauer commented that if the favorable Vidant experience with dedicated lift teams can be confirmed elsewhere, this is the type of program that should be widely instituted all across the country.

"It’s quite extraordinary to improve patient care and employee health while at the same time reducing overall cost," noted Dr. Schauer, professor of surgery and director of the Bariatric and Metabolic Institute at the Cleveland Clinic.

Discussant Dr. William B. Inabnet III said many malpractice insurance carriers are now offering hospitals incentives for reduced premiums for implementation of best-practices clinical pathways for management of obese patients.

"I think your work will support that type of mission. It’s a win-win for all parties involved," said Dr. Inabnet, professor of surgery at Mt. Sinai Hospital in New York.

Dr. Pories reported having no conflicts of interest.

bjancin@frontlinemedcom.com

INDIANAPOLIS – A major hidden cost of the obesity epidemic is the physical toll it takes on hospital nurses and other employees in helping to move heavy patients. The cost of these workplace injuries is skyrocketing, not only in terms of direct medical care bills, but also in terms of work absenteeism, activity restrictions, retraining, and employee dissatisfaction and fear.

The solution at one large tertiary academic medical center in eastern North Carolina has been to create specially trained two-person lift teams available 24/7. The results of a pilot study have been impressive, particularly in light of the fact that nothing else hospital officials tried earlier – including spending more than $1.5 million for motorized patient ceiling lifts – had any significant impact, Dr. Walter J. Pories said at the annual meeting of the American Surgical Association.

Hospital employee injuries incurred in handling obese patients are an issue that has until now been largely beneath physicians’ radar.

"I don’t think anybody here would ask two nurses to pick up a washing machine, or a 400-lb calf, or an 800-lb lathe, and yet whether we like it or not we ask our staff to move patients with such weights daily," observed Dr. Pories, professor of surgery at East Carolina University in Greenville, N.C.

He practices at Vidant Medical Center, a 909-bed hospital where administrators noticed back in 2005 that employee workplace compensation claims for injuries during patient transport were rapidly escalating. In that year, 98 staff experienced patient-handling injuries, resulting in 670 lost workdays and 3,022 restricted workdays.

Hospital officials tried several interventions. First came an intensive education program on safe lifting and patient mobilization conducted by an ergonomist.

"It didn’t make a bit of difference," Dr. Pories recalled.

Indeed, during 2008 there were 2,141 lost workdays due to these types of injuries, more than triple the number in 2005.

Next came a big investment in ceiling-mounted motorized lifts. The impact was minimal: roughly a 10% reduction in staff injuries. Problems with the lifts abounded. They broke. Some staff had difficulty operating them. But the biggest issue was that the rooms with the lifts weren’t always available because the hospital is always fully occupied.

Dr. Pories credited the nursing staff with providing the leadership in developing what he calls the Vidant Medical Center lift team model. Coverage is available 24/7. There are three teams of two individuals on duty during the day and two teams of two at night. They work 12-hour shifts. There is one supervisor for 23 lift team technicians, including three women. They are paid an average of $10 per hour, which the surgeon called "a pretty good wage in eastern North Carolina."

Individuals must pass a rigorous physical assessment before they can join the lift team. Members take a 3-week orientation program in which they learn safe lift techniques, skin and wound care, and infection control. They have their own uniforms to foster esprit de corps.

Many other organizations had tried using lift teams, with disappointing results. That’s because they limited the teams to the day shift or scheduled transfers, according to Dr. Pories.

"The real problems happen late at night," he said.

Dr. Pories and his coinvestigators conducted a pilot study in which they utilized the lift teams in the five hospital units having the highest staff injury rates due to patient-handling mishaps. The lift team was called to those units for moving patients who weighed more than 200 lb, had pressure ulcers, or who were at risk for pressure ulcers by virtue of a Braden scale score of 18 or less.

During the pilot study, 8 employee injuries resulted from patient handling in the five test units, for a rate of 0.134 injuries per 1,000 patient-days, compared with 71 injuries and a rate of 0.319 injuries per 1,000 patient-days in control units.

Once use of the lift teams expanded hospital-wide, the result was a 39% drop in employee injuries due to patient handling, as well as a 43% reduction in hospital-acquired pressure ulcers. Multiple staff surveys have shown 90%-99% satisfaction rates with the lift teams as having improved the workplace while demonstrating that the hospital cares about employee safety.

The total direct and indirect cost of staff injuries due to patient handling was approximately $2.76 million per year prior to introduction of the lift teams. The lift teams provided an estimated $423,152 in savings due to fewer staff injuries and hospital-acquired pressure ulcers, even after factoring in team salaries and equipment, Dr. Pories reported.

The next step in this project will be to document whether the presence of the lift teams also has resulted in fewer patient injuries, he added.

Discussant Dr. Philip R. Schauer commented that if the favorable Vidant experience with dedicated lift teams can be confirmed elsewhere, this is the type of program that should be widely instituted all across the country.

"It’s quite extraordinary to improve patient care and employee health while at the same time reducing overall cost," noted Dr. Schauer, professor of surgery and director of the Bariatric and Metabolic Institute at the Cleveland Clinic.

Discussant Dr. William B. Inabnet III said many malpractice insurance carriers are now offering hospitals incentives for reduced premiums for implementation of best-practices clinical pathways for management of obese patients.

"I think your work will support that type of mission. It’s a win-win for all parties involved," said Dr. Inabnet, professor of surgery at Mt. Sinai Hospital in New York.

Dr. Pories reported having no conflicts of interest.

bjancin@frontlinemedcom.com

INDIANAPOLIS – A major hidden cost of the obesity epidemic is the physical toll it takes on hospital nurses and other employees in helping to move heavy patients. The cost of these workplace injuries is skyrocketing, not only in terms of direct medical care bills, but also in terms of work absenteeism, activity restrictions, retraining, and employee dissatisfaction and fear.

The solution at one large tertiary academic medical center in eastern North Carolina has been to create specially trained two-person lift teams available 24/7. The results of a pilot study have been impressive, particularly in light of the fact that nothing else hospital officials tried earlier – including spending more than $1.5 million for motorized patient ceiling lifts – had any significant impact, Dr. Walter J. Pories said at the annual meeting of the American Surgical Association.

Hospital employee injuries incurred in handling obese patients are an issue that has until now been largely beneath physicians’ radar.

"I don’t think anybody here would ask two nurses to pick up a washing machine, or a 400-lb calf, or an 800-lb lathe, and yet whether we like it or not we ask our staff to move patients with such weights daily," observed Dr. Pories, professor of surgery at East Carolina University in Greenville, N.C.

He practices at Vidant Medical Center, a 909-bed hospital where administrators noticed back in 2005 that employee workplace compensation claims for injuries during patient transport were rapidly escalating. In that year, 98 staff experienced patient-handling injuries, resulting in 670 lost workdays and 3,022 restricted workdays.

Hospital officials tried several interventions. First came an intensive education program on safe lifting and patient mobilization conducted by an ergonomist.

"It didn’t make a bit of difference," Dr. Pories recalled.

Indeed, during 2008 there were 2,141 lost workdays due to these types of injuries, more than triple the number in 2005.

Next came a big investment in ceiling-mounted motorized lifts. The impact was minimal: roughly a 10% reduction in staff injuries. Problems with the lifts abounded. They broke. Some staff had difficulty operating them. But the biggest issue was that the rooms with the lifts weren’t always available because the hospital is always fully occupied.

Dr. Pories credited the nursing staff with providing the leadership in developing what he calls the Vidant Medical Center lift team model. Coverage is available 24/7. There are three teams of two individuals on duty during the day and two teams of two at night. They work 12-hour shifts. There is one supervisor for 23 lift team technicians, including three women. They are paid an average of $10 per hour, which the surgeon called "a pretty good wage in eastern North Carolina."

Individuals must pass a rigorous physical assessment before they can join the lift team. Members take a 3-week orientation program in which they learn safe lift techniques, skin and wound care, and infection control. They have their own uniforms to foster esprit de corps.

Many other organizations had tried using lift teams, with disappointing results. That’s because they limited the teams to the day shift or scheduled transfers, according to Dr. Pories.

"The real problems happen late at night," he said.

Dr. Pories and his coinvestigators conducted a pilot study in which they utilized the lift teams in the five hospital units having the highest staff injury rates due to patient-handling mishaps. The lift team was called to those units for moving patients who weighed more than 200 lb, had pressure ulcers, or who were at risk for pressure ulcers by virtue of a Braden scale score of 18 or less.

During the pilot study, 8 employee injuries resulted from patient handling in the five test units, for a rate of 0.134 injuries per 1,000 patient-days, compared with 71 injuries and a rate of 0.319 injuries per 1,000 patient-days in control units.

Once use of the lift teams expanded hospital-wide, the result was a 39% drop in employee injuries due to patient handling, as well as a 43% reduction in hospital-acquired pressure ulcers. Multiple staff surveys have shown 90%-99% satisfaction rates with the lift teams as having improved the workplace while demonstrating that the hospital cares about employee safety.

The total direct and indirect cost of staff injuries due to patient handling was approximately $2.76 million per year prior to introduction of the lift teams. The lift teams provided an estimated $423,152 in savings due to fewer staff injuries and hospital-acquired pressure ulcers, even after factoring in team salaries and equipment, Dr. Pories reported.

The next step in this project will be to document whether the presence of the lift teams also has resulted in fewer patient injuries, he added.

Discussant Dr. Philip R. Schauer commented that if the favorable Vidant experience with dedicated lift teams can be confirmed elsewhere, this is the type of program that should be widely instituted all across the country.

"It’s quite extraordinary to improve patient care and employee health while at the same time reducing overall cost," noted Dr. Schauer, professor of surgery and director of the Bariatric and Metabolic Institute at the Cleveland Clinic.

Discussant Dr. William B. Inabnet III said many malpractice insurance carriers are now offering hospitals incentives for reduced premiums for implementation of best-practices clinical pathways for management of obese patients.

"I think your work will support that type of mission. It’s a win-win for all parties involved," said Dr. Inabnet, professor of surgery at Mt. Sinai Hospital in New York.

Dr. Pories reported having no conflicts of interest.

bjancin@frontlinemedcom.com