Some of the goals that helped guide the objectives for Kern Medical’s investment in lift technologies included reducing staff injuries by 60%, reducing bed rest orders by 25%, and reducing falls by 10%.
by Travis Eckard, PT, MPT, DPT
The clinical evidence is overwhelming—getting patients up and moving sooner aids in their recovery. But for many public hospitals with aging infrastructure and growing funding challenges, that’s easier said than done. The gap between what should be done and what can be done is wide. As manager of therapy services at Kern Medical, Bakersfield, Calif, I have seen and lived the issue firsthand. In this facility’s case, a resolution was found to bridge that gap. And, in the course of doing so, the staff uncovered several valuable lessons in its long and often painful journey to constructing a mobility plan that makes sense in a 21st-century healthcare environment.
Keeping Up with Explosive Community Growth
This year marks the 150th year Kern Medical and its predecessors have provided care to the Kern County community. At the time of its incorporation in 1873, Bakersfield was a small farming and trading community with a population of approximately 600. Oil was discovered in 1865, driving decades of growth so that by 1970 Bakersfield’s population reached 70,000. The city subsequently became a transportation hub, helping to push the metropolitan area to its current population of more than 800,000.
The effects of that growth on the demands on the city’s public hospital have been profound. The community’s public hospital grew from a one-room adobe structure to a 40-bed facility built in 1925 that became the core of Kern Medical Center. Through several additions and renovations, the campus grew to 222 beds. By the beginning of the 21st century excellent medicine was being practiced at the facility, and the Level II trauma center is the only one of its kind from Fresno to Los Angeles.
Meeting the challenges of growth has not been easy for the facility. Kern Medical was not immune to the deteriorating finances of public, safety net hospitals across the nation, leading to the decision by Kern County to create a hospital authority to own and operate the enterprise.
Safe Patient Handling: A Prime Concern
By 2011 the issue of safe patient handling had become top-of-mind at the state’s capitol in Sacramento. Nurses, through their unions, were pointing to alarming injury statistics. The practice of having nurses lift patients from beds, from gurneys, and from chairs was taking a toll. At Kern Medical it was estimated that half of its 1,400 employees were at some point called on to hoist patients. That was not a sustainable approach as the staff aged and the patient population continued to grow heavier. There had to be a better answer, the unions told legislators. But the answer the unions desired—a mandate for investment in lift technology across all California hospitals—would be costly.
Legislators instead took a smaller step, passing a mandate, effective January 2012, that every hospital have a plan for safe handling of patients.
Path to a Safe Solution
The issue was certainly not new to the facility’s staff members, all of whom had seen the statistics and knew nurses who had been injured. The question that needed to be asked was, what kind of plan would spur improvement?
A consultation with Kern’s administrators confirmed that there were no dollars to buy a solution, which meant creativity had to be called into play. What followed was a long and arduous series of experiments that mixed staffing and policy to minimize adverse results. None of the results could be termed a solution, but those results did eventually meet the definition of a plan. At this point a few sling lifts were located in the facility’s high-use areas, but they weren’t numerous enough or mobile enough to significantly improve the problem.
In moving patients, one of the greatest—yet often overlooked—needs involved radiology. There was a constant flow of patients who needed to be lifted from their beds or chairs, placed on a gurney, rolled to radiology, and lifted into position for a test. The process was subsequently repeated in reverse. The transport and radiology staff bore the brunt of this repeated movement of patients. While research studies and the facility’s own analysis had shown that the nursing and therapy staff members were at risk of injury with patient mobilization, the radiology aspect needed to be addressed.
As a step toward a solution, the staff appended a policy of “just in time” delivery of its few shared mobility devices. Taken from a then-trendy business phrase, the “just in time” model proved ineffective in this setting.
During one exceptionally difficult day, one lift was needed in three places at once. A choice had to be made. Would the lift be used for the patient waiting curbside to get into a car for the ride home? For the patient waiting to be moved for treatment? Or for the patient whose family gathered at the bedside for pre-release training in safe transfer practices? While the facility had a policy, it clearly did not provide an answer.
Big Solution for a Big Problem
A turning point was reached when the Kern Medical Foundation bought the facility a piece of lift and transfer technology that helped stakeholders understand what was possible. The device was a standing and raising aid that could be adjusted so patients who are unconscious, sedated, or mechanically ventilated can be mobilized in sitting or standing positions. The acquisition marked progress, but a large-scale fix still was needed.
A solution materialized during a meeting in 2015 when a team from the Kaiser Permanente Community Benefit Program met with Kern Medical to discuss possible grant opportunities. That meeting opened discussion about the facility’s need for mobility equipment—a project that fit the criteria of directly affecting patient welfare and applied across departments. It was a capital cost that fit within the grant guidelines, and included staff education and training to help ensure sustainability while the ongoing costs seemed within our reach.
A solution was beginning to take shape aided by a project champion to help guide staff members through the paperwork. Kern Medical representatives asked for everything they thought possibly would be needed, which amounted to nearly $600,000—all of which was granted to Kern.
There was some consternation about whether the funding would actually come through, since Kern Medical competes with a Kaiser Permanente-affiliated hospital across town. In the end, the foundation was good to its word. Left to its own budget, Kern Medical would have required up to 6 years to equip its facility. With funding in hand, however, the staff could uniformly purchase and implement a program across the entire organization.
Vendors had already been contacted and equipment evaluated prior to the partnership with Kaiser. The determining factors for the lift and transfer equipment that was purchased were small footprint and ease of use. Price was a factor as well as vendor reputation, product warranty, and expected lifespan. A single line of equipment was chosen which promised easier employee training and equipment maintenance.
Far from being cavalier in its spending, the staff members thought long and hard about its objectives, thereby establishing a set of goals for guidance:
• Reduce staff injuries by 60%;
• Empower nurses to assess all cases and initiate mobilization in 25% of cases;
• Reduce “bed rest” orders by 25%. Work with doctors to make sure “bed rest” is a conscious choice rather than part of a one-size-fits-most package; and
• Reduce falls by 10%.
Challenging patients to be mobile speeds their recovery. This was a principle to guide the staff’s choices.
Conversations with engineers ruled out the installation of ceiling lifts in parts of the complex. It was also understood that despite sound planning, there would be surprises and disappointments once the equipment was in service. As a result, one-third of the money was held back for a second wave of purchases.
The initial order consisted of the following:
• Two ceiling lifts, each with 1,000-pound capacity;
• 10 lift/sling units, each with a 500-pound capacity;
• One unit with a 700-pound capacity;
• Two units specifically for car transfers;
• Five motorized stand-up units;
• 11 low-tech, non-motorized units;
• Two wheelchair movers for patient transportation; and
• One additional wheeled standing and raising aid.
Looking back on the journey, many heroes emerged both inside and outside Kern Medical and success did not come quickly or easily. It came because of a willingness and persistence to look for new ways to deal with a large-scale, critically important issue. For every public hospital looking up at a similar problem, the winning strategy is persistence. Try every funding source. Look for allies who may point to someone or some group with the ability and willingness to help. Approach the problem with creativity, and simply do not give up. RM
Travis Eckard, PT, MPT, DPT, is manager of Therapy Services at Kern Medical in Bakersfield, Calif. For more information, contact [email protected].