A comprehensive evaluation of outcomes from patient handling interventions

Assisting less able people to move in a healthcare setting is a very common occurrence but carries risks to staff and patients. The scientific study of patient handling activities and interventions to help reduce musculoskeletal disorders in the workplace is a relatively new but growing area. Recent literature reviews have identified two key factors, the lack of high quality studies and the lack of strong links between patient handling interventions and reduced musculoskeletal injury. This study has systematically reviewed the available literature and investigated the potential outcome measures used to show benefits of improved patient handling. A wide range of outcomes has been identified concentrated on the benefits to staff, patients and organisations. No methods were identified to compare different benefits, outcomes or intervention strategies. This study used mixed methods to develop a tool to compare the results of all types of interventions: a.Focus group studies in four EU countries recorded a priority list of the 12 most important outcomes from patient handling interventions b.The most suitable method for examining the 12 outcomes was identified c.The Intervention Evaluation Tool (IET) was developed as a single measurement tool d.The IET was translated and used in four EU countries to evaluate its usability and its usefulness to patient handling practitioners The EU trials and subsequent expert review have given favourable feedback for the IET. The IET creates 12 outcome evaluations with detail and differentiation, and an overall performance score to assist an organisation to target its future interventions. The method can be used to compare interventions, and the performance between organisations and countries across the EU. Though the IET needs more field trials and validity testing it is hoped that a wider application may be to create a benchmarking method that can assist in the improvement of patient handling systems across Europe

J Occup Environ Med

Objective:We performed an integrated cross-sectional analysis of relationships between long-term care work environments, employee and resident satisfaction, and quality of patient care.Methods:Facility-level data came from a network of 203 skilled nursing facilities in 13 states in the eastern United States owned or managed by one company. K-means cluster analysis was applied to investigate clustered associations between safe resident handling program (SRHP) performance, resident care outcomes, employee satisfaction, rates of workers\u2019 compensation claims, and resident satisfaction.Results:Facilities in the better-performing cluster were found to have better patient care outcomes and resident satisfaction; lower rates of workers compensation claims; better SRHP performance; higher employee retention; and greater worker job satisfaction and engagement.Conclusion:The observed clustered relationships support the utility of integrated performance assessment in long-term care facilities.U19 OH008857/OH/NIOSH CDC HHS/United StatesU19OH008857/ACL HHS/United States2019-05-18T00:00:00Z28945639PMC65253366283vault:3220

Hum Factors

Objective:The aim of this study was to obtain a comprehensive analysis of the physical workload of clinical staff in long-term care facilities, before and after a safe resident handling program (SRHP).Background:Ergonomic exposures of health care workers include manual handling of patients and many non-neutral postures. A comprehensive assessment requires the integration of loads from these varied exposures into a single metric.Method:The Postures, Activities, Tools, and Handling observational protocol, customized for health care, was used for direct observations of ergonomic exposures in clinical jobs at 12 nursing homes before the SRHP and 3, 12, 24, and 36 months afterward. Average compressive forces on the spine were estimated for observed combinations of body postures and manual handling and then weighted by frequencies of observed time for the combination. These values were summed to obtain a biomechanical index for nursing assistants and nurses across observation periods.Results:The physical workload index (PWI) was much higher for nursing assistants than for nurses and decreased more after 3 years ( 1224% versus 122.5%). Specifically during resident handling, the PWI for nursing assistants decreased by 41% of baseline value.Conclusion:Spinal loading was higher for nursing assistants than for nurses in long-term care centers. Both job groups experienced reductions in physical loading from the SRHP, especially the nursing assistants and especially while resident handling.Application:The PWI facilitates a comprehensive investigation of physical loading from both manual handling and non-neutral postures. It can be used in any work setting to identify high-risk tasks and determine whether reductions in one exposure are offset by increases in another.20142021-11-03T00:00:00ZU19 OH008857/OH/NIOSH CDC HHSUnited States/U19OH008857/ACL/ACL HHSUnited States/U19-OH008857/OH/NIOSH CDC HHSUnited States/25029893PMC85660241060

J Occup Rehabil

PurposeThis study examined the impact of a Safe Resident Handling Program (SRHP) on length of disability and re-injury, following work-related injuries of nursing home workers. Resident handling-related injuries and back injuries were of particular interest.MethodsA large national nursing home corporation introduced a SRHP followed by three years of training for 136 centers. Lost-time workers\u2019 compensation claims (3 years pre-SRHP and 6 years post-SRHP) were evaluated. For each claim, length of first episode of disability and recurrence of disabling injury were evaluated over time. Differences were assessed using Chi square analyses and a generalized linear model, and \u201cavoided\u201d costs were projected.ResultsThe SRHP had no impact on length of disability, but did appear to significantly reduce the rate of recurrence among resident handling-related injuries. As indemnity and medical costs were three times higher for claimants with recurrent disabling injuries, the SRHP resulted in significant \u201cavoided\u201d costs due to \u201cavoided\u201d recurrence.ConclusionsIn addition to reducing overall injury rates, SRHPs appear to improve long-term return-to-work success by reducing the rate of recurrent disabling injuries resulting in work disability. In this study, the impact was sustained over years, even after a formal training and implementation program ended. Since back pain is inherently a recurrent condition, results suggest that SRHPs help workers remain at work and return-to-work.U19 OH008857/OH/NIOSH CDC HHS/United StatesU19OH008857/ACL/ACL HHS/United States2020-06-01T00:00:00Z29785467PMC64227237736vault:3165

The effect of a transfer, lifting and repositioning (TLR) injury prevention program on musculoskeletal injury rates among direct care workers

Problem Statement: The burden of musculoskeletal injuries among workers is very high, particularly so in direct care workers involved in patient handling. Efforts to reduce injuries have shown mixed results. Strong evidence for intervention effectiveness is lacking. Specific Aims: The goal of this study was to evaluate the effectiveness of a patient handling injury prevention program implemented in the Saskatoon Health Region (SHR) comparing it with a non-randomized control group, Regina Qu’Appelle Health Region (RQHR), in a pre-post design. Injury rates, lost-time days, and claim costs were the outcomes of interest. Intervention: A Transfer, Lifting and Repositioning (TLR) program, consisting of engineering and administrative ergonomic controls, was implemented in SHR hospitals from 2002-2005. Methods: Data on time loss and non-time loss injuries, lost time days, and claims costs were collected from the SHR and RQHR for corresponding time periods one year pre and one year post-intervention. Age, length of service, profession, and sex were selected as covariates. Full Time Equivalents (FTE) data were collected for each time period. Univariate and multivariate Poisson regression were performed. Results: Rates for all injuries (number of injuries/100 FTE) dropped from 14.68 pre-intervention to 8.1 post-intervention. Control group all injury rates, while overall lower in absolute value, dropped to a lesser degree, from 9.29 to 8.4. Time loss injury rates decreased from 5.3 to 2.51 in the SHR, while they actually increased from 5.87 to 6.46 in the RQHR, for the same intervention periods. Poisson regression showed the greatest reduction in injury rate, both time loss (Rate ratio=0.48, 95% C.I: 0.34-0.68) and non-time loss (Rate Ratio=0.25, 95% C.I: 0.15-0.41) in the smaller long term care facility controlling for hospital size. Analysis of injury rates, incidence rate ratios, and incidence rate differences showed significant differences between the intervention and comparison group for all injuries and time loss injuries. Mean claim cost/injury decreased from $3906.20 to$2200.80 and mean time loss days/claim decreased from 35.87 days to 16.23 days for the SHR. Conclusions: The study provides evidence for the effectiveness of a multi-factor TLR program for direct-care health workers, and emphasizes their implementation, especially in smaller hospitals