Efficiency of overhead ceiling lifts in reducing musculoskeletal injury among carers working in long-term care institutions
Introduction
There is a high prevalence of musculoskeletal injury (MSI) among healthcare workers (HCWs).9, 14, 23, 24 Those who regularly lift patients are at greater risk of injury than those who do not.5, 6, 11 Biomechanical analysis of spinal compressive and shearing forces3, 13, 25 and HCW perceptions2, 5 suggest that manual lifting tasks are particularly high-risk activities. The combination of elevated incidence and prevalence of MSI associated with patient handling and the corresponding estimates of biomechanical stress have spurred extensive efforts to develop safer methods for moving patients. Among nurses, back, neck and shoulder injuries are most common and debilitating.5 However, patients can be handled safely with the assistance of equipment which reduces these hazards and improves the quality of care.5
Mechanical devices such as floor lifts have frequently been advocated to assist in moving patients. However, these lifts are often not used to their full extent because of poor access, lack of space for use or storage, difficulty of operation, inadequate staffing or time required for use compared with manual methods.3, 10 In recent years, overhead lifting devices have been endorsed as replacements for mechanical floor lifts, to overcome most of the problems.12, 16, 19, 21 Ceiling lifts involve a ceiling-mounted track, an electric motor and a sling to assist with lifting, transferring and repositioning patients. A single lift may be configured to support handling of patients for one or more beds. Since ceiling lifts are mounted overhead, they are easier to store and require less room to operate than floor lifts, and have been more effective in reducing the risk of injury associated with patient handling.1, 19, 25 This style of lift requires minimal physical effort to manoeuvre, and offers the added feature of always being accessible for use in patient care areas. Collins et al.2 reported significant time savings when ceiling lifts were used for lifting and transferring patients. Additionally, Zhuang et al.25 found that using ceiling lifts to transfer patients from bed to chair eliminated approximately two thirds of the exposure to low back stress, when compared with manual methods.
A Memorandum of Understanding (MOU) was signed by the Healthcare Employers and Unions in British Columbia (BC) in March 2001, to eliminate unsafe manual handling of patients in BC healthcare facilities.7 The MOU states that ‘the parties agree to establish a goal of eliminating all unsafe manual lifts of patients through the use of mechanical equipment, except where the use of mechanical lifting equipment would be a risk to the well-being of the patients’. To reduce the number of patient-handling MSIs, Providence Health Care (a large healthcare provider in Vancouver), in cooperation with workers compensation board (WorkSafeBC) and the Ministry of Health, has been installing and using overhead ceiling lifts in its facilities since 2001.
The specific objectives of this research are to assess the rates of and days lost for MSI injuries among direct-care staff in long-term healthcare facilities over a 10-year period (before and after ceiling lifts were installed), and to evaluate the costs and benefits of the ceiling lift intervention from facility's perspective.
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Methods
Three long-term care facilities in Vancouver were chosen for this analysis. Facility A is a home for 221 long-term care residents. Facility B provides care to 150 extended-care residents, many of whom are armed forces veterans. Facility C is a multi-level care facility for 84 residents. Starting in 2002, ceiling lifts were installed in these facilities. By the end of 2005, a total of Can$1,081,410 had been spent to procure and install a total of 110 lifts in these three facilities. Associated
MSI claims, claim costs and working days lost
Data on MSIs related to patient handling, adjusted claim costs and working days lost among all direct-care staff at the three facilities are presented in Table 1. Claim costs per MSI, MSIs per bed, claim costs per bed and working days lost per bed were calculated for both pre-intervention and post-intervention periods and are detailed in Table 1. Decreases in costs per MSI (Can$6026.27 to Can$5319.98), costs per bed (Can$978.86 to Can$485.25), MSI rate (0.16–0.09) and working days lost per bed
Discussion
The current investigation provides evidence suggesting that overhead lifting devices are effective in reducing the risk of MSI to direct-care staff, and that the economic savings associated with this type of intervention outweigh the costs. The payback period also supports the continued use of ceiling lifts, in proportion to the magnitude and trends of the pre-intervention injury rate. Therefore, due consideration to the MSI rate associated with patient handling in a given facility is important
Conflict of interest
None
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