If you factor in the cascade of downstream consequences that affect workers, patients, and the hospital’s bottom line, safe patient handling programs make both business sense and common sense, says Dan Roberts, RN, MBA, of the Association of Safe Patient Handling Professionals (ASPHP).
Making the business case for safe patient handling programs in a recent ASPHP webinar, Roberts outlined the evidence like an attorney delivering a closing argument. Employee health professionals can convince administration that safe patient handling equipment is a good investment if they show how an increasingly immobile patient population affects the physical health of the worker and the fiscal health of the hospital. In general, using equipment to enhance patient mobility offsets a variety of adverse health events and spares workers back and shoulder injuries that are at epidemic levels.
“Why shouldn’t this be a priority right now in hospital spending?” he said. “This is a business case that there is a significant opportunity to improve clinical practice. That is at the center of this whole value proposition: improved clinical practice. Immobilized patients are not always moved safely and as frequently as they should be. This directly contributes to staff injuries and patient hospital-acquired conditions, impacting pay for performance and [other] quality measures.”
Estimating that some 70% to 80% of patient care physical tasks are still performed manually, Roberts said that results in a high variability of care that is anathema to hospitals looking to increase reliability through standardization. In a typical 200-bed hospital, there may be some 30-35% of patients who need maximum assistance for movement, and another 30% needing moderate mobility assistance.
“If you are getting patients out of bed twice a day or if you have to pull up patients eight times during a 12-hour shift, you can actually calculate out pretty close to about 3,000 physical tasks would be done in this particular [200-bed] hospital over a 24-hour period,” Roberts said.
Factor in reimbursement and penalties from the Centers for Medicare & Medicaid Services (CMS), including hospital-acquired conditions, total performance score, and drawing a red flag for readmissions within 30 days of discharge.
“What we are trying to do is align with hospital practice and specifically identify what measures the hospital requires in order to compete with some of those other spending projects,” he said. “[If you can] argue strongly enough that you can significantly improve performance in the current year, you will definitely get the ear of administration. You have to convince administration that current practice — the present state — is not meeting the needs, and as a result you have a huge gap of variability in care practice.”
Make sure that you have an “executive sponsor” within the hospital that understands what you are doing, why you are pursuing it, and agrees to support the business case for safe patient handling, Roberts said.
“Staff are getting hurt moving immobilized patients, which is still primarily [performed] manually across most of the U.S.,” he said. “There are many patient adverse events that can be related to mobility, but some of the core ones are hospital-acquired pressure injuries, patient falls, falls with injuries, [and] pulmonary complications. All of these are measures that negatively impact the hospital as either sentinel events and/or directly as part of the penalty and reward programs of CMS.”
Apply average national incidence rates for these adverse patient events to your hospital, he recommends. “On average, if you took that population and incidence rate, you will see that 6% to 7% of those patients combined will experience one of those events,” he says. “So, you end up with a fairly sizeable rate of patients affected by adverse events.”
For example, early mobilization can reduce readmissions after discharge.
“There are data that show that patients that have early mobilization return to the hospital less, leave the hospital with less functional decline, and less physical deterioration,” he said. “As a result, they have the ability to thrive and continue to improve post-discharge. That is much [better] than those patients who leave with significant functional decline. It makes logical sense that early mobilization can impact the hospital in a 30-day readmission reduction plan. Readmission is a huge area — probably over 50% to 60% of U.S. hospitals have 30-day readmission penalties.”
Reduced Turnover Means Saving Money
In an average 200-bed hospital, the overall Medicare reimbursement total is in the range of $150-200 million, he added. “The losses could be $1-2 million based on early readmission penalties. And many of the patients that return to the hospital have mobility-related issues.”
Patients that remain primarily immobile during hospitalization are at risk of healthcare-associated infections, particularly pneumonia.
“Pneumonia is a [high] impact area related to mobility — there is no question about that,” Roberts said. “Patients who move regularly have significantly less propensity to develop pneumonia.”
In terms of staff benefits, a safe patient handling program can clearly offset the original injury, the additional cost for replacement workers, lost work time, and restricted work time even after an employee returns. Moreover, having such programs can improve staff efficiency by reducing turnover, improving retention, and boosting new staff recruitment.
That last point had a surprisingly big effect on a safe patient handling program at Stanford University, where reduced staff turnover increased the value of the program by some $2.5 million.1
“Make sure in the business case you are measuring your direct cost for the workers’ compensation,” he said. “Many hospitals are self-insured to a catastrophic ceiling, so it is definitely coming out of cash flow when we have these types of injuries. What gets overlooked, and it is not so easy to capture, is all the lost work days and restricted work day costs.”
An average 200-bed hospital will have an estimated 28 to 32 patient handling injuries per year, he estimates.
“That’s just using the number of staff — probably in the range of about 500 to 600 full-time equivalents — with a mixture of titles: RN, nurses’ aides, techs,” Roberts said. “Those are the folks at the bedside that are experiencing this increased injury risk workload. Those injuries total about $700,000 in direct costs and lost work days and restricted work days combined. In the same-size hospitals, that is an estimated 13,000 and 14,000 patients, so applying an adverse incidence rate of the [aforementioned] adverse events, there would be 900 patients [with mobility-related complications].”
Direct cost related to employee injuries, plus the cost of adverse patient events, “could easily be in the $8 million range,” Roberts says. He suggests building a spreadsheet report with an executive summary, breaking down the details within a dashboard to present to administration.
“With the limited or reduced reimbursements [now], managing complications and margins is much more important than it was 10 years ago in a more volume-based system,” he said. “The concept is: ‘We are not delivering standardized mobility to this population of patients. If we were, we could reduce the incidence rates [of these complications].’ Immobility is usually not mitigated unless you equip, enable, and empower staff to execute this safely. That is the impact part that we are trying to take ownership of.”
- Celona J. Making the business case for a safe patient handling and mobility program. American Nurse Today 2014;9:(9): http://bit.ly/2sRncWY.