Patient Handling: Another Big Log on the Health Care Fire

Thursday, December 5, 2013 | 0

Musculoskeletal (MS) injuries to nurses and nursing aides have become an epidemic in America. At least, according to the American Society of Safety Engineers' (ASSE) recent "Safety Culture in Healthcare, The $13 Billion Case," a peer-reviewed feature in the October issue of "Professional Safety," the Society's journal.

The article's author, Scott Harris, Ph.D., MSPH, says, "Pick any other industry, and the injury rate is less." And he's pretty much right.

Patient handling is the driver. According to the National Institute for Occupational Safety & Health, the most a nurse or aide in the 90th percentile of strength should lift at any one time is 46 pounds. But a typical eight-hour workday in this field involves lifting about 1.8 tons. Twelve percent of registered nurses who quit the field reported that they did so because of back pain due to patient handling.

This resonates with me. Lynch Ryan opened its doors in 1984. Our very first paying client was a community hospital, where patient-handling injuries had caused the hospital's experience modification factor to balloon to 2.77. Working with the nursing staff and human resources vice president, we were able to introduce necessary management policies and procedures as well as a sophisticated modified-duty program that cut workers' comp losses by more than 80%. However, the musculoskeletal injuries kept happening, because patients kept having to be moved. So, the hospital bought two Hoya Lifts, yes, there were Hoya Lifts in 1984.

Getting staff to use the Hoya Lifts was an entirely different problem. It was actually harder than creating and systematizing the modified-duty program, because using the lifts significantly increased the time it took to move the patient, and one thing nursing staff didn't have a lot of, and still don't, was time. Instituting the new patient-handling protocols involved a lot of training. We had to create rules, procedures, metrics and accountability. Even so, it was incredibly difficult.

Through the years, we've worked successfully with more than 120 hospitals, from tertiary care systems to single-site community hospitals. But regardless of how much we're able to help reduce workers' comp loss costs, the patient-handling problem never goes away.

Back to the Future

Now, nearly 30 years from that first engagement, the only thing that seems to have changed is that the problem has become more dire, turning into an industrial many-head Hydra.

The average age of a registered nurse is now nearly 47. For home health aides, it's 46; for certified nursing assistants, 39. Wages for the aides and assistants average between $11 and $12. Forty percent have been on food stamps and many get their own health care through Medicaid. (See: HHS Direct Care Workforce) The U.S. Bureau of Labor Statistics estimates that the demand for home health aides between 2010 and 2020 will grow by 69%; CNAs, 40%. Collectively, we are confronted with a critical shortage of health care talent. According to the U.S. Department of Health & Human Services, "Direct care work is difficult, the wages are low and fringe benefits are often limited."

It's the same with registered nurses where, oftentimes, the shortage is self-inflicted. A study of 21 hospitals in the Twin Cities found that when registered nursing positions were decreased by 9%, work-related illnesses and injuries among nurses increased by 65% (Trinkoff et al., 2005).

Nonetheless, the BLS reports that between 2010 and 2020, the fastest growing occupation in America will be registered nursing (HHAs and CNAs follow close behind). The need is an additional 1.2 million nurses. In 2011, one out of every five new jobs created in America was in health care. We should be graduating 30% more nurses than we are per year. But a shortage of nursing faculty prevents nursing schools from expanding to accommodate the demand. In 2011, nearly 76,000 otherwise qualified candidates were turned away by nursing schools. This means that there will be fewer nurses and aides to go around at a time when hospital populations are growing much larger (both in numbers and size), meaning that the stresses involving patient handling will continue to intensify.

Patient-handling injuries account for 53% of health care workers' compensation loss costs. The mean average costs are five times higher for injured employees older than 45 than for those under 25. Musculoskeletal losses per full-time equivalent are well over $300, regardless of age.

I asked Rick Graham about this. Rick is corporate director of insurance and risk control for Crozer Keystone Healthcare System in Delaware County, Pa., and a Lynch Ryan client. Patient handling bedevils Crozer Keystone in general and Rick in particular. Crozer, like many hospital systems, has been wrestling with the issue for decades. Through Rick's efforts, the system has introduced a number of initiatives to deal with the issue, and, while many have proven somewhat successful, the problem remains. Rick now concludes that the only answer is to remove the people factor from the lift factor.

He also realizes that having lifting equipment built into every patient room is the only way to significantly increase patient-handling protocol compliance. The system has done this in an acute care setting and has seen a significant decrease in injuries and costs. It's the simplest solution, but the costliest. Trained lift teams could work (they've been shown to in one California hospital study dating from 1997), but lift team members get hurt, too, and they present logistical difficulties. Rick estimates that the return on investment from installing the equipment is two years, but the budget issue is still daunting.

The bottom line is this: As Crozer Keystone is demonstrating, the health care industry, confronted with a tsunami of personnel, safety and workers' comp issues, has got to begin finally to meet these challenges with the resources necessary to overcome them. Anything less will send health care in America to a far worse place than the rocky place it now inhabits.

Tom Lynch is a principal for Lynch Ryan & Associates, an employer consulting firm based in Massachusetts. This column was reprinted with the firm's permission from its Workers' Comp Insider blog.