These new beds can help make the life of a nurse easier, are safer for both patient and caregiver and can even help patients to recover, or move more quickly to lower-acuity care suites.

The next generation bed
If you want to know what future beds will look like just imagine them incorporating all sorts of technological components centered around gleaning information.

"It’s fair to say that the bed of the future will become smarter," said Kevin Conway, director of marketing for Stryker Medical. "Right now, there’s a lot of patient-centric and bed-centric information that’s stuck at the bedside. Today, the infrastructure of a hospital can limit the type and location of information that can be transmitted, but that’s quickly changing. Beds in the future will be smarter and capable of transmitting some of this patient-centric information to other parts of the hospital."

Look to bed-tracking software as one hot-button that may soon become a reality for the typical hospital. As designed, this software could let you pinpoint the exact location of any bed in the facility along with its status.

"It is important for our customers to know where and when the next available bed is located in their facility on a real-time basis," continued Conway. "If our customers know where the bed is located, what type of bed it is and whether it’s clean or it’s dirty, they can make a really informed decision as to where to put the next patient."

Conway says that exact capability is just around the corner for Stryker customers thanks to a strategic partnership with the Premise Development Corporation and its enterprise-wide patient tracking software. "Collectively we’re going to advance bed and patient tracking technology."

Following a similar concept, Hill-Rom recently acquired the NaviCare software system, which communicates the location of patients throughout the continuum of care. "One of the things we’re spending a lot of time on is helping hospitals manage and increase the utilization of their beds and other equipment," said Kimberly Tipton, director, corporate communications, Hill-Rom." One of the issues facing hospitals today, because census is running very high, is making sure they have the beds they need, when they need them, where they need them. So we’re also looking at locating and tracking technologies that allow you to locate that bed and equipment when you need it.

"It’s all about helping hospitals be more efficient with fewer nurses, and also the rising sense of how they manage the assets they have. We want to look at the bed as a point of connection with other information that the nurses may need. Obviously with the growth of information technologies within hospitals, we’re going to look at ways to interact where it makes sense to make the care easier to deliver and monitor at the bedside."

Hill-Rom makes use of its advisor groups to help gather input on ways to improve their bed offerings, involving them in product development cycles. At the top of their list is developing new ways to make it safer and easier for both the caregiver and the patient, as well as adding clinical functionality where appropriate.

"I was in a session recently with some hospitals and they were asking us, ‘are there better ways to put things on the bed when you’re transporting the patient?’ Because some of these patients might have three, four or five monitoring devices, are there ways to make it easier to transport those devices along with the patient? That’s something that we can probably help with," she said.

Hill-Rom Total Care Sport

Today’s bed market
While facilities may be able to choose among many types of beds in the market, they have few suppliers from which to shop, particularly in the med/surg bed business.

Hill-Rom (Batesville, IN) has been making hospital beds for 75 years, and has been a significant leader in that segment for quite some time. But companies like Stryker Medical (Kalamazoo, MI), which entered the market in 1993 with impressive offerings, have moved a noteable percentage of that market.

According to Conway, Stryker’s products are popular with nurses because of their intuitive, easy-to-use design. The company’s flagship med/surg bed, the Secure, was introduced 11 years ago, and Conway said it has answered many unmet needs in the marketplace.

Stryker’s new MA204 med/surg bed was launched earlier this year and provides many of the features of the Secure bed at a slightly lower price point, plus additional benefits like an extra-low bed height and full side rail coverage.

Hill-Rom’s new Total Care line consists of the CareAssist bed for low acuity patients, VersaCare for medium acuity, and TotalCare for higher acuity patients. Each line has progressively more features that support clinical therapies and enhance caregiver and patient safety.

Stryker MA204 cardiac chair position

Patient positioning and transport
Because so many nurses experience back injuries when transferring patients in and out of bed, features have emerged that assist with this task.

Hill-Rom’s TotalCare includes an "Up in Chair" position in which the bed goes into a full chair position. "By doing that we allow the healthcare giver to be able position the patient in a more upright position versus having to transfer them out of the bed and into a side chair," said Jim Mulligan, vice president, operational marketing, Hill-Rom. This feature is particularly helpful for difficult post-surgical situations, such as with a cardiac surgery or stroke patient, where it would normally take numerous caregivers to get that individual over into a chair, according to Mulligan.

All Stryker beds have a feature called intermediate side rail position that allows the side rails to go halfway down to provide support for the patient and caregiver, giving the caregiver access to the seat section of the bed. The caregiver can place the patient in the seat section, rotate their legs around and eliminate the need to "scoot" the patient up in bed.

One key feature on the Secure bed is a patented load-cell based bed-exit system that tracks the patient’s location in the bed. The feature allows the bed to determine the difference between a patient reaching for something off a bedside stand, versus them trying to get out of bed unasssisted. In that case, an alarm sounds at the bed and the nursing station. "It’s been very effective at driving down our customer’s bed-related falls," said Conway.

The Secure bed also incorporates scales that don’t require patient or bed adjustments to obtain a patient’s weight. "The caregiver simply walks into the room, does a visual inspection, makes sure there’s nothing on the bed that shouldn’t be there, then takes the patient’s weight without having to reposition the bed or the patient," adds Conway.

Hill-Rom’s FlexAfoot feature helps eliminate the problem of patients migrating to the foot of the bed, and nurses having to reposition them back up in the bed. FlexAfoot allows you to retract the foot of the bed, back to meet the size of that patient, thus reducing the potential for the patient to slide down.

Low height positions such as those offered on the Stryker MA204 and Hill-Rom’s VersaCare will also prove valuable in helping patients to get in and out of bed.

Both Hill-Rom and Stryker offer options that allow for easy mobility of the beds themselves.

Stryker’s self-propelled bed capability called Zoom technology, allows a caregiver to transport a 500lb. patient in the bed, over carpet or up and down ramps with virtually no push force required. Hill-Rom’s Intellidrive system offers similar easy transport capabilites.

Stryker XPRT pulmonary care mattress

Therapeutic sleep surfaces
The sleep surface or mattress is a key feature of all hospital beds, particularly for critical care patients. Mattresses can serve as therapy aids, providing wound care, pulmonary therapy, vibration and percussion, continuous lateral rotation therapy (CLRT) and more.

Hill-Rom’s TotalCare SpO2RT Pulmonary Therapy System works with the TotalCare frame to provide CLRT, percussion and vibration therapy as well as a TurnAssist feature that can help reduce the potential for caregiver injury.

"Previously, if you had to do percussion and vibration, you’d have to wait for the respiratory therapist to come down," Mulligan noted. "If you needed pulmonary therapy for a patient you’d have to think about ordering a rental bed. The key to all therapy today is getting it started sooner, and the sooner you get it started the better your outcomes will be."

Stryker offers a continuum of sleep surfaces, from foam mattresses to high-end mattresses that provide pulmonary therapy capabilities. What’s unique about the Stryker mattresses is that their offerings are non-integrated into the frame of the bed. "The controls for the mattress are actually contained within the mattress rather than in the bed frame," said Conway.

"One of the hospital’s biggest challenges is to have the right surface under the right patient at the right time to minimize the chance of that patient developing a bed sore," said Conway.

For one, bed frames last longer than surfaces so a non-integrated mattress gives customers financial and clinical flexibility over the life of the frame. "There have been significant advances in surface technology over the last ten years, and there are many yet to come," said Conway. "Our customers want and need the flexibility to evaluate various surface technologies and select the technology that best fits their needs without being concerned about what bed frame they purchased."

Stryker’s new XPRT pulmonary care mattress is an example of this non-intregrated approach. The mattress provides pressure relief, low air loss, rotational percussion and vibration therapy.

Bariatric beds
With new reimbursements approved for bariatric surgery, coupled with more patients of heavy stature, bariatric business is booming.

"The whole bariatric market has awoken like a sleeping giant," agreed Michael Klein, vice president, TSK Products Inc., an Eatontown, NJ-based supplier that strictly provides bariatric beds and a comprehensive line of bariatric equipment and accessories. TSK Products also provides a comprehensive on-site bariatric equipment assessment and survey for hospitals seeking to become a Bariatric Center of Excellence. "With hospitals being able to get medical reimbursements for the surgeries it’s only going to increase," he added.

)

TSK Products ExpandaCare

Klein affirmed that the number of hospitals that have a dedicated bariatric program is "growing unbelievably.

"It is a profitable piece of business," he said. "Not only for the doctors, but also the hospitals. I can’t tell you how many calls I get a week from hospitals requesting our Bariatric Equipment & Products Binder. When I ask them whether they have a bariatric program or they’re just seeing larger patients, they all say they’re seeing larger patients, but a good portion of them are also thinking of starting a bariatric program. It is the new horizon for a lot of revenue for hospitals, so we get a lot of questions about it."

Klein estimates that hospitals who have a bariatric surgical program in place may have anywhere from three to 10 bariatric beds on site. He recently dealt with one facility that already has seven bariatric suites and is looking to set up seven more. In that case, they may have a dozen bariatric beds. Other facilities that don’t have an active bariatric program may have one or two beds on site.

Historically, most hospitals have rented their bariatric beds, simply because they had a limited number of bariatric patients coming through their doors and couldn’t cost-justify spending capital dollars on equipment so seldom used.

Klein points out that while renting bariatric beds may have been a hassle and a pain it usually made more sense financially.

"Now the utilization rate is swinging to the point where purchasing needs to weigh whether it’s more cost-effective to buy than to rent" he said. In fact, utilization rates for bariatric beds in some hospitals are nearing 20 days a month, he estimated.

To help solve the problem of having a bulky bariatric bed on hand with limited usage capabilities, TSK offers the ExpandaCare bed that accommodates up to 1,000 lbs. and actually converts from a standard-sized bed to a bariatric bed with ease.

"What we’re very excited about with the Expanda-Care bed is that is closes the door completely on the question of whether to rent or buy because it allows for 100% utilization of the bed."

The bed expands from a 39-inch width for use on average sized patients and to allow it to pass through standard hospital doorways and elevators to a 54-inch width suitable for the bariatric patient. The ExpandaCare can be put into the trendelenberg position without the bed having to be either completely up or down. It can be lowered to 16 inches and raised to a height of 30 inches. It has a single button for cardiac chair position. And it has options for a built-in-scale, extra side rail pads, steer-lock and total-lock casters.

And at just more than $6,000, ExpandaCare is about half the price of some other beds. "Of course," Klein quipped, "some of those other beds do everything but make you coffee."

All of Stryker’s beds are designed to hold up to 500 lbs. Conway notes, "The average weight of a bariatric patient is less than 400 lbs. Our customers like that not only our frame, but the bed exit system, our surfaces as well as our scale are all rated for 500 lbs. They buy the bed with the Zoom feature on it and they find it can address a significant portion of their bariatric needs."

Hill-Rom has its TotalCare Bariatric and Magnum II beds. The Magnum and three other beds acquired as part of the company’s Mediq acquisition earlier in the year are super-sturdy workhorses designed to accommodate the largest Bariatric patients up to 1,000 lbs. The TotalCare bariatric incorporates the same features as the rest of the TotalCare line and is rated to hold up to 460 lbs.

Specialty beds
In addition to bariatric beds, there are a multitude of specialty beds. Hill-Rom offers a comprehensive line, including maternity beds and its Clinitron II Air Fluidized Therapy Unit, which is designed for serious wound care patients or burn care victims.

Hill-Rom TurnAssist feature

Stryker also offers a complete line of specialty beds, and has a notable entry into the labor and delivery bed market with its new LD304. According to Conway, "the new labor & delivery bed has been really well received, specifically for its unique locking foot section which answers the long-standing need for a foot section that locks in place".

Beds in the OR
For facilities such as ambulatory surgery centers who may be looking for an OR table-bed crossover, Stryker offers the TRIO. "The TRIO is a new concept," explained Conway. "What we’ve been able to do is offer a solution to back injuries by eliminating the need for patient transfers in the surgery center by doing pre-op, the procedure and the post-op recovery all on the TRIO."

He describes the popularity of the TRIO in new surgery centers. "As new surgery centers are going up, we are able to incorporate this approach into the design of the facility to increase the overall efficiency. Simply stated, the TRIO can increase the number of cases that can be done in a day. They can move patients through the procedure quicker and in turn generate more revenue."

Stryker also offers an electric stretcher, which Conway describes as a half-bed, half-stretcher. "It takes up the same footprint as a stretcher, but it has patient controls in the siderail and a mattress that makes it comfortable for a patient who might be on the bed for anywhere from 6 to 23 hours."

Accessories
There are just about as many combinations of accessories available for a bed as there are reasons for patients to be in the hospital. And that can cause a problem when you’re trying to move the bed from one location to another, while keeping the accessories, monitors or other devices attached.

Stryker Secure II

"When it comes to accessories or other equipment that’s used or applied to the patient, we go out of our way to make them convenient and easy to use," said Conway. "For instance, instead of the caregiver trying to push the bed and drag the IV caddy along, we offer permanently mounted heavy duty IV poles that conveniently store at the head-end of the bed, which can eliminate the need for a stand-alone IV stand. In addition, we’ve designed the footboards so that ancillary equipment like pumps and therapy machines mount nicely to the footboard."

Conway said the Stryker beds are also designed to accommodate a hospital’s fracture frame equipment without having to replace it. "That’s really key," he said. "If you buy 200 beds and they are not compatible with your fracture frame equipment, now you have to buy 200 beds worth of fracture frame equipment."

Stryker also just introduced a new overbed table, which Conway says has been really well received. The TrueFit Overbed table has a unique low-profile base that fits well under beds, stretchers, wheelchairs and seating products. He notes that the TrueFit is designed to be aesthetically pleasing as well as intuitive and easy to use.

Purchase, rental, financing
Because beds are an expensive investment, it may suit your facility to look at the variety of financing options available.

Both Stryker and Hill-Rom offer purchase, rentals and financing options.

Hill-Rom also offers leasing options. In addition, they have more than 200 service centers across the country that allows them to get rental beds to their customers in about four hours or less in most cases.

One hospital system in New York recently standardized on Hill-Rom beds throughout its seven owned hospitals. Beside the fact that their previous beds were old and no longer viable for patient care, high costs for specialized sleep surface rentals were also cited as a prime motivator by Gary Leonard, North Shore-Long Island Jewish Health System’s assistant vice president of materials support services.

"We were spending an enormous amount of money each year at each facility for specialized sleep surfaces," he said. "The patient would come in, start on a regular mattress, develop problems, and we’d have to rent specialized sleep surface beds."

Hill-Rom Patient Egress feature

The initiative, which took place over a seven-to-eight month period and involved the installation of 1,600 new beds, was a collaborative one from the get-go. "We had nursing involved from the very beginning," said Leonard. "Basically nursing drove it from the point of view of what they required. I went to the nursing committee councils that represented all the hospitals, told them of the initiative, and asked them what they would need. We also worked with quality management, risk management, engineering, biomed, environmental services and obviously we had administration. I presented this to all of the site administrators because of the tremendous amount of money we were looking to spend. At the end of the day everyone got on board. All the site administrators got in line and said, ‘I’ll find a way to absorb this into our budget.’"

The purchase by North Shore-LIJ was unique in that it didn’t involve a capital outlay. "We actually are being billed on a per patient day per bed basis," noted Leonard. "Basically we’re taking our annual patient days at each of the facilities and costing it out that way. And then we do a true-up the following year, when we know the actual patient days at each of the hospitals. I went to the site administrators and said, ‘based on your patient days for the past two or three years, here’s what you can expect to be paying with the beds that are going into your facility."

The 60-month program encompasses the equipment, the service and any specialty bed rentals, allows for future product upgrades, and even takes into account facility renovations.

"Let’s say in three years, Hill-Rom develops a new sleep surface that does twenty more things," Leonard explained. "I have the availability to take my current ICU sleep surfaces out, and bring the new ones in.

"Or, let’s say I have an acute care floor with 42 beds, and the administrator wants to convert that floor to an ICU setting," suggests Leonard. "With this program, Hill-Rom will take back those 42 beds, and I won’t pay for those beds while the floor is under construction. Then when it’s finished, Hill-Rom will bring in ICU beds."

At the end of the 60-month program North Shore-LIJ has the option of buying the beds, continuing with a similar program or bringing in brand new technology.

Leonard gives this advice to purchasing managers considering a major bed purchase: "Get all of the needed departments involved right at the outset. And look towards the future. Don’t just look at what you’re going to need today, look at what you’re going to need in three years."

Hospital bed resources:
www.hill-rom.com
www.strykermedical.com
www.tskproducts.com
www.fda.gov/cdrh/ocer/guidance/1537.html (bed entrapment)
www.fda.gov/cdrh/safety/bedfires.html (bed fires)