The three-year economic benefits of a ceiling lift intervention aimed to reduce healthcare worker injuries
Introduction
There is a high prevalence of back pain among nurses and nursing aides (Eriksen, 2003; French et al., 1997; Jensen, 1990; Maul et al., 2003; Pheasant and Stubbs, 1992; Yassi et al., 1995; Yip, 2001), influencing up to 81% of the nursing population (French et al., 1997). Nursing staff who regularly handle patients are at a greater risk of injury than those who do not (Engkvist et al., 2000; Jensen, 1990; McAbee and Wilkinson, 1988; Owen, 1989). Biomechanical analysis of spinal compressive and shear forces (Daynard et al., 2001; Garg and Owen, 1992; Marras et al., 1999; Owen and Garg, 1994; Zhuang et al., 1999), and worker perceptions (Cato et al., 1989; Knibbe and Friele, 1996; Vasiliadou et al., 1995) suggest that manual lifting and transferring tasks are particularly high-risk activities.
Estimates of the compressive forces on the L5/S1 disc associated with manually handling patients usually exceed the upper limit suggested by NIOSH as safety guidance for occupational tasks that involve manual materials handling (Gagnon et al., 1986; Garg et al., 1991a, Garg et al., 1991b; Garg and Owen, 1992; Marras et al., 1999; Ulin et al., 1997; Varcin-Coad and Barrett, 1998; Winkelmolen et al., 1994; Zhuang et al., 1999). The combination of a high injury prevalence associated with patient handling, and the characteristically large estimates of biomechanical stress associated with manual techniques for patient handling, have spurred considerable efforts to develop safer methods for moving patients.
The use of mechanical lifts has been frequently advocated as an assistive device for lifting or transferring patients; however, some mechanical lifts are not as effective at reducing back stress as some manual methods (Garg et al., 1991a). Mechanical lifts are often not used to the extent that was intended, reportedly due to poor access, lack of space for use or storage, inadequate staffing, or increased time required for use of the lift compared to manual methods (Daynard et al., 2001; Evanoff et al., 2003; Garg et al., 1991a, Garg et al., 1991b).
In recent years, overhead lifting devices have been endorsed as an alternative to mechanical floor lifts (Holliday et al., 1994; Ronald et al., 2002; Spiegel et al., 2002; Villeneuve, 1998). Ceiling lifts utilize a ceiling mounted track, electric motor, and a sling to provide mechanical assistance for lifting and repositioning patients. A single lift may be configured to support handling patients in one to six 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 at reducing the risk of injury than mechanical floor lifts or manual methods of patient handling (Ronald et al., 2002; Zhuang et al., 1999).
Ronald et al. (2002) evaluated the effectiveness of a ceiling lift program one year after implementation in a 125-bed extended care facility. Implementing a ceiling lift program significantly reduced (58% reduction, p=0.011) the rate of musculoskeletal injuries (MSI) to nurses and care aides caused by lifting and transferring. Spiegel et al. (2002) estimated the payback period for direct costs associated with this ceiling lift program to be 3.85 years. A shorter payback period of 1.96 years was estimated if indirect savings and the trend of rising compensation costs were also considered.
However, studies have shown that ceiling lifts may not be suitable for all patient handling tasks (Ronald et al., 2002; Villeneuve, 1998). Ronald et al. (2002) demonstrated that ceiling lifts did not positively impact rates of MSI caused by repositioning patients in bed.
The purpose of the current study is to determine whether the initial positive results reported by Ronald et al. (2002) and Spiegel et al. (2002) were representative of the longer-term effectiveness of overhead lifts in reducing the risk of injury to nursing staff.
Section snippets
Resident lifting system project
The resident lifting system project was implemented in 1998 to reduce the risk of MSI to health care staff and to improve the quality of care for the residents of an extended care facility. A no-unsafe manual lift policy was initiated in March 1998.
Sixty-five ceiling lifts, servicing 125 beds and three bathtubs, were purchased and installed between April and August 1998. Patient handling education on use of the ceiling lifts was provided to all staff who handle patients.
Injury tracking
Injury reports spanning
Frequency of MSI claims
Table 1 and Fig. 2 display the number of claims for ‘all’, ‘lifting/transferring’, and ‘repositioning’ claims. Table 2 summarizes the results of linear regression and comparison of pre- and post-intervention trends. The number of claims increased during the pre-intervention period for ‘all’ (b=1.49 claims/6 months; r2=0.804), ‘lifting/transferring’ (b=1.14 claims/6 months; r2=0.463), and ‘repositioning’ (b=0.34 claims/6 months; r2=0.134) claims. During the post-intervention period, the number of
Discussion
Ronald et al. (2002) reported that overhead lifting devices reduced the rate of MSI caused by lifting and transferring but had no effect on injuries associated with repositioning, based on a 1-year post-intervention analysis. The current study provides evidence to suggest that overhead lifting devices have long-term implications in reducing the risk of MSI to nursing staff, and that the benefits of this type of intervention may require several years to fully recognize. A 3-year pre- and
Conclusion
This study demonstrated the longer-term effectiveness of ceiling lifts in reducing the risk of injury to workers. The number of claims, compensation costs, and time loss all decreased after the implementation of an overhead ceiling lift program, and continued to decline for 3 years post-intervention. The progressive decline in injuries and associated costs may have been related to the expected latency between exposure to physical demands and the onset of cumulative trauma disorders, or to the
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