Products & Services

Patient transport: Healthcare’s movers and shakers 

by John Hall

They spend their days and nights cruising the hallways of our nation’s hospitals, in tow, some of the sickest patients around.

They log hundreds of thousands of miles a year and are arguably the most physically challenged — and fit — hospital workers around. They also are among the lowest paid and highest at risk (alongside nurses) for severe and debilitating injuries. And while they haven’t cornered the market on dedication to their profession, patient transport workers are the real “movers and shakers” of healthcare.

Task-oriented
The job of patient transport can be most aptly described in terms of tasks. Transport technicians, as they are most often classified, do the work of handling, transferring and moving patients from nursing units to other hospital treatment units, and ultimately, discharge at the curb. They also move more than just patients, often carting supplies, biomedical equipment, even mail from one end of the hospital to the other.

Transport technicians are uncredentialed and like so many other kinds of hospital workers these days, often leave the hospital for better pay and less risky work. Many patient transport departments report to materials management; it’s not uncommon, however, for them to fall under other areas such as admitting, support services or patient care services. To understand how physically challenging their jobs are, consider the dedicated transport team at Banner Desert Medical Center in Mesa, AZ, which has the busiest emergency department in the state.

During any given eight-hour shift, a transport tech at the 600-bed facility will log an average of 14 miles through the cavernous facility’s hallways and towers. During a typical day, techs will perform about 250 patient transports. They logged more than 16,000 such trips from January to February this year alone.

Mary Kellis, who supervises Banner Desert’s patient transport department, is a career patient transporter. On a sunny summer day back in 1982, she walked out of a coffee shop across the street from the hospital and, “on a whim,” applied for a job in the facility’s small patient transport department.

Back then, the department’s staff of seven transport techs had a simple job, transporting lab specimens and wheeling discharged patients from their rooms. Twenty-one years and two additional patient care towers later, Kellis manages the work of 50 patient transport technicians, who, in addition to supporting nursing units and acting as transport support for the facility’s 20 O.R. suites, move patient care equipment and supplies, lab specimens, medical records, and food trays.

Also charged with managing the facility’s mailroom, Kellis rarely has time to check e-mails or catch up on world events. Her department’s workload more than doubled last November, when it merged with radiology transport.

While they are not clinicians, patient transport technicians are integral parts of sophisticated, multi-disciplinary teams who transport critically ill patients on a daily basis.

Critical care transport teams are charged with moving patients from intensive care areas of the hospital (including intensive care units, emergency departments, operating theaters and recovery rooms) to areas typically not involved in the delivery of such care.

Standard equipment includes cardiac monitors with defibrillators; airway management equipment and resuscitation bags (to allow for emergency intubation, coniotomy and manual ventilation via mask and tube); gas supplies; standard resuscitation drugs and intravenous fluids, portable ventilators for patients receiving mechanical ventilation; as well as specific essential medications (regulated by battery operated infusion pumps) required by the transported patient.

Risky business
While most technicians watch enough pulse oxymetries taken and telemetry monitors adjusted on a daily basis, they are not qualified or permitted to interpret diagnostic equipment readings. “Transport techs who do ‘tele-patient’ rounds are required to be accompanied by a nurse at a minimum,” said Kellis. “Patient transport techs aren’t certified or trained to read monitors. At one time, there was a movement to have them certified, but turnover is too high.”

That said, patient transport technicians must be ever vigilant, keeping their eyes and ears open at all times. But often, it’s what they don’t know that puts them at risk.

“Our transport techs often are hindered because they don’t have the information they need to do their jobs,” said Kellis, who, like many transport supervisors, provides her team with “scripts” so they know the right questions to ask. The first question when accepting a patient for transport is, “What kinds of precautions do I need to take?” Knowing key information about a patient’s medical condition not only protects the patient, but the transporter as well. Until recently, that kind of information had been hard to come by. But the Health Insurance Portability and Accountability Act (HIPAA) changed all that.

“In the past, getting that information was very difficult and it put our techs at risk,” Kellis said. “HIPAA is opening the doors for workers to get the information they need about a patient in order to make it the safest transport possible.

Even so, transporting very sick patients is risky business. One recent study found that adverse events may occur in up to 70 percent of transports, more than one-third of which are equipment-related. According to the American Association for Respiratory Care, transportation of mechanically ventilated patients for diagnostic or therapeutic procedures is always associated with a degree of risk. Every attempt should be made to assure that monitoring, ventilation, oxygenation and patient care remain constant during movement. Critically ill patients, in particular, are at high risk for complications during transport. Such adverse events are usually related to intensive care problems such as lead disconnections, loss of battery power, loss of intravenous access, accidental extubation, occlusion of the endotracheal tube (or exhaustion of oxygen supply), and physiologic deteriorations, such as worsening hypotension or hypoxemia.

Backbreaking work
Healthcare workers, including those in patient transport, sustain nearly five times more overexertion injuries than any other type of worker, and can be found among six of the top 10 professions at greatest risk for back injury, according to the Department of Labor. Following the common cold, back injuries are the most common reason for absenteeism in the general workforce. Moreover, patient transferring and handling injuries typically represent at least half of worker’s compensation costs.

Most healthcare work-related musculoskeletal injuries occur from cumulative injuries such as repeated improper patient lifting and transfer. Otherwise known as “cumulative trauma disorders,” these types of injuries often lead to devastating long-term health consequences.

“There definitely is a heightened awareness today at the hospital about back injuries and the cost to our hospital in terms of claims and lost days,” said Kellis, whose staff has endured more than their share of sprained backs and busted knees. “Corners are hard on a tech’s knees because they bang into them a lot wheeling stretchers. We require all stretchers to be handled by two techs, but mishaps still occur.” And for Kellis’ team, Banner Desert’s long, carpeted hallways provide ample opportunities to stub toes and strain legs.

Heavy Americans
The escalating rate of musculoskeletal injuries among patient transport technicians mirrors the nationwide trend of obesity in our society; heavier patients pose much greater risks for strains and other injuries.

According to the National Center for Health Statistics of the Centers for Disease Control and Prevention (CDC), more than 60 percent of U.S. adults, or approximately 97 million people, are overweight and 20 percent are morbidly obese. Morbid obesity (defined as 100 pounds or more overweight) grew 50 percent in men and 67 percent in women between 1996 and 2000. Hospitals call these kinds of patients bariatric. According to the American Society for Bariatric Surgery, more than 57,000 bariatric procedures were performed in 2001, a 29 percent increase from 2000.

While obesity has nearly doubled in 20 years, the increase in the number of morbidly obese individuals represents a growing patient population and a higher risk for healthcare workers during patient handling and movement tasks. Managing obese patients offers special challenges for patient transport technicians, including turning and repositioning a patient in bed and transferring in and out of bed. There are environmental concerns, such as doorway clearance, accommodation of scales, and strength of equipment.

Kellis only has to look at her product requisitions to know about how these kinds of trends are affecting Banner Desert Medical Center. Aside from managing the usual troubles with wheelchair shrinkage (“We often locate them at local flea markets.”), Kellis hasn’t ordered a standard-sized adult wheelchair in years. “I can’t purchase standard wheelchairs anymore because nobody fits in them,” she said. “We only order the larger size models.”

GPOs like Irving, TX-based Novation report that customer demand for bariatric products is increasing. “Risk management is a big deal right now; there’s a huge focus on innovation in bariatric products such as combination stretchers and patient lifts,” said John Engles, Novation’s patient transport product manager. Engles said he’s witnessed “a substantial increase” in member interest in bariatric products. One recent Novation contract included the addition of a special stretcher that can accommodate 1,000-pound patients.

How have hospitals responded appropriately to heavier patient populations? In a variety of ways they have, including remodeling units to accommodate self-contained patient-care delivery rooms designed exclusively for obese patients and buying new technology. Some hospitals are creating bariatric surgery clinics.

One healthcare facility reportedly improvised by wiring two operating tables together to accommodate an obese patient, while another hospital installed ceiling-mounted bariatric lifts above all beds. Others have installed floor-mounted toilets after some obese patients accidentally broke toilets off the walls.

Many hospitals are enjoying positive results after addressing the problem. A few examples include the following:

• From 1996-1999, 440-bed St. Mary’s Hospital, Huntington, WV, found that 66 percent of work-related injuries occurred during patient transport and transfer. A formal back injury prevention program cut those injuries in half.
• In 2000, 300-bed North Colorado Medical Center, Greeley, CO, posted 60 injury claims with costs of $350,000. One year after implementing a ‘no-lift’ program, the facility recorded just seven claims totaling $8,227.
• After Kennebec Health System, Augusta, ME, implemented an ergonomic management program (including engineering controls and lifting devices), its lost work days dropped to 48 from 1,097. Insurance premiums also dropped to $770,293 from $1.6 million.

Products/innovation
The manufacturing community has responded to these trends by developing ergonomically-designed products to reduce or eliminate back injuries. In fact, a great deal of innovation addresses the demands of the bariatric patient. A few examples:

• The TRIO system from Stryker Medical, Kalamazoo, MI, a combination bed, stretcher and chair. The system is equipped for use in pre-op, procedure and post-op and according to Stryker, greatly reduces or eliminates patient transfers, helping to cut the likelihood of occupational injuries. Novation’s Engles said he is working with the GPO’s non-acute care purchasing arms on a possible contract that would cover the stretcher.
• The Magnum II Bariatric Patient Care System from Hill-Rom, Batesville, IN, which the company says is a comprehensive solution to address the obese patient’s care needs, since it can function as a bed, chair and transport vehicle.
• Hill-Rom’s ON3 lateral transfer device is a one-person machine that allows a worker to transfer a patient in less than 20 seconds.
• Hill-Rom’s TotalCare IntelliDrive aims to allow a single person to easily transport patients throughout a healthcare facility. 

Resources
For a wealth of resources and tools about patient transport, visit the following websites:

VISN 8 Patient Safety Center of Inquiry – Operated by the VA hospital, Tampa, FL.

Premier Safety Institute back injury Web module – an Internet-based clearinghouse of tools and resources designed to help reduce musculoskeletal injuries in patient care.

John Hall a former senior editor of Healthcare Purchasing News is a Chicago-based freelance writer specializing in healthcare.

HPN

June