by Emil Scardato

I’m constantly seeking new challenges in product engineering and could find no better source of acute problems susceptible to engineering solutions, than the modern hospital.

In 1963, a prominent New York hospital approached my consulting firm asking us to develop an idea by one of its staff physicians to automate and perfect what was then a crude, manual, slow and inaccurate test for determining the coagulation time of human blood. After about five years of tedious development effort, and at great personal expense, aided by the contributing efforts of a small engineering staff, the project became highly successful. The result was the creation of a highly sophisticated automatic instrument that revolutionized blood coagulation testing worldwide. Since I had funded most of the R&D for its development I became a major proprietor of the project. With the help of a small staff, I founded Medical Laboratory Automation (MLA) and began to manufacture the instrument, named ELECTRA, for sales to hospitals internationally. The company grew steadily to a work force of 400 employees before being sold. In 1977, MLA, of which I was principal stockholder, purchased a small company named Stretchair Patient Transfer Systems, located in Clearwater, FL.

This company manufactures a unique wheelchair, which can be converted into a stretcher. This wheelchair’s backrest hinges downward while the footrest hinges upward, and together with the horizontal seat section these three components form a flat horizontal surface upon which a patient can lie prone, as on a stretcher. When in the stretcher position, it can be positioned next to a bed, ideal for effecting a lateral patient transfer.

In its early days, the chair proved to be a useful product for hospitals because of its versatility, and, it was marketed internationally. However, it was manually operated and designed to accommodate only patients of normal weight. Recent studies of hospital equipment, facilities and procedures reveal that hospital personnel are presently attempting to handle and serve obese patients using outdated equipment and methods. Bariatric patients are sometimes unable to walk or stand unassisted because they lack the strength to cope with their excessive weight. It has become clear that a total re-assessment of the total process is needed to deal with the U.S. population of which 60% are overweight. Of those, a substantial percentage is grossly overweight. Some weigh in the area of 500 or 600 pounds or more. Wheelchairs, beds, gurneys, commodes, exam tables, x-ray and operating room facilities, waiting room equipment, bedroom furniture and other hospital furnishings are all inadequate to handle patients of this bulk. Even the size of the hospital’s rooms, doorways, entranceways and waiting rooms must be re-evaluated.

Obese individuals, in the past, have hesitated to enter a hospital because of the psychological stigma arising from their physical appearance, and their presumption that they would not receive the best of care. That situation is now in the process of changing. The appearance stigma is slowly diminishing through sheer familiarity with large numbers of these individuals. Pressure groups against any sort of discrimination have also come into existence, creating influential political forces. Admittances of obese patients are now growing. This increasing frequency is also due to the fact that the very obese are susceptible to related afflictions such as diabetes, hypertension, heart disease, arthritis, and shortness of breath.

As a result, everyday problems and costs for hospitals are severely magnified when they accept and ineffectively try to treat bariatric patients. Awareness is growing that, first, these patients must be accepted, and secondly, older hospital equipment is not built to hold them. It is too weak, and too risky to be used by heavy patients. The risk and cost of obese patient care applies to both the patient and hospital personnel. The costs of personnel injuries include extra expenses for caregiver substitutes, insurance premium increases, and potential for legal actions by victims of an accident.

obese, it is beneficial to appreciate how an engineering organization like Stretchair proceeds to develop new products, such as those especially designed for the needs of the heavy patient and his/her caregiver.

Every successful new product idea answers the question "Is there a better way?" No one is better qualified than an experienced design engineer to answer that question. His knowledge of design principles, practical experience and ingenuity offer the most authoritative answer. If the response is positive then the assignment to produce the desired product proceeds along a well established, logical development path. Finally the break-through comes that leads to a successful new product.

Once created, the product market triggers a chain reaction of both concurrent and sequential steps that manufacturing must take to produce the product. The engineering development function is also involved in production because of needed changes to simplify the manufacturing process. Such changes might include simpler design details, alternate materials, changes in parts, fits, tolerances, finishes, reduction in number components, assembly improvements, and so forth.

From the standpoint of attaining the customer’s confidence and faith in the company and its products, the design engineer must completely supply all the information necessary for optimum use of the company’s products. This includes clear, illustrated manuals, videotapes, simple trouble shooting instructions and spare parts lists. He must always be available to answer any type of question about the product, technical or otherwise.

The foregoing has been presented in order to create some awareness of what successful product development entails. It may also help to explain why only meticulously developed products in the hand of professionals are ever functionally or economically successful. Stretchair has undergone vigorous, disciplined thought and development processes in order to satisfy the customer’s uncompromising usage and expectations.

All hospitals work in an atmosphere of high pressure, crucial life-death emergency conditions. Many are short-handed in terms of caregiver personnel such as nurses, orderlies and other patient handlers. Fewer still are qualified to make evaluations or detailed studies of highly engineered sophisticated equipment. For these reasons Stretchair is pleased to begin to assume the role of a trusted, well experienced organization specializing in engineering development of unique bariatric patient transfer and moving equipment. Its continuing studies in this field are dedicated to producing products to enhance the safety and comfort of both patient and caregiver, while aiming to eliminate the need for, and use, of the caregiver’s physical strength to effect patient movement.

Much has been learned through interaction with our knowledgeable 500 pound consultant, Patty Horton. She is our informative and enthusiastic test patient for acquiring ergonomic and other practical data needed to design useful chairs. Stretchair has also acquired valuable knowledge from Patty about how to move and manipulate patients of great size and weight. A most trying aspect of care for the severely obese is attempting to use deficient techniques and equipment for moving heavy patients. Diagnosis and treatment of patients, whether obese or normal, requires frequent changes in bodily orientation, or patient relocations and transfers from position on one surface to another surface-not simple operations if the patient weighs 600 pounds.

Nevertheless this is Stretchair’s chosen niche of hospital procedures because of its expertise in product development and techniques as applied to heavy patient logistics. This is because patient transfer has been a technologically neglected, but now formidable facet of patient care, made so because of the bulk and weight of obese patients. Stretchair can supply the scientifically designed transfer products, along with the heavy patient handling technology needed. Introduction of safe, electrical power for strategically chosen chair component articulations, formally accomplished manually, has eliminated the need for the caregiver to exert strenuous, injury-prone effort.

Stretchair is therefore pleased to have the opportunity to offer the hospital facility the benefit of its equipment, knowledge and services. The heavy or grossly obese patient, upon admittance, now expects care no less thorough, complete or sensitive than that furnished to patients of normal weight or appearance. HPN