Mark G. Boocock Health and Rehabilitation Research Institute, Auckland University of Technology (P46, Thursday, NZI 5 Room, 4.30-5)

1. Bariatric patients and the use of mobile
hoists: user experiences from three hospitals
in South Australia
Mark Boocock*
Gunther Paul**
*Health and Rehabilitation Research Institute /
Centre of Occupational Health and Safety Research
AUT University, New Zealand
**Ergolab, Mawson Institute, University of South
Australia, Mawson Lakes SA 5095, Australia

2. Introduction - rationale
Nursing personnel - one of the occupational groups most at risk of
work-related musculoskeletal disorders
Hazards and risks associated with moving and handling of
bariatric patients is multi-factorial
 weight
 atypical body mass distribution
 mobility
 co-morbidity of symptoms
 patient co-operation
Equipment design for bariatric
patient care is often lacking

3. Introduction - rationale
Video clip available on YouTube at
http://www.youtube.com/watch?v=yO7sMFi1W2E

4. Aims and objectives
Undertake a literature review of patient handling
 to identify hazards and risks associated with the care and
rehabilitation of bariatric patients
 identify relevant design criteria for mobile hoists
Identify end-user experiences of bariatric patient handling
equipment
Develop end-user acceptance criteria appropriate to design

5. Methods: literature search
Six electronic databases
 EBSCO Host
 Medline via Ovid
 Scopus
 Web of Science
 AMED
 ProQuest Central
• Search terms and MESH headings were relating to patients
handling devices
• Supplemented with a search of relevant national and international
website (e.g. ISO, CEN, Standards Australia and Standards New
Zealand, Health and Safety Executive (UK), WorkCover)

6. Methods: interviews and observations
 Structured interviews - 6 experienced injury management staff
from the Manual Task Services department of 3 Adelaide hospitals
 Open-ended questions were structured around five main themes:
• patient factors
• building/vehicle space and design
• equipment and furniture
• communication
• organisational Hignett and Griffiths (2009)
• Focus - the use of mobile hoists for lifting and
transferring bariatric patients
• Walk-through of the hospital to view the types of
mobile hoists, and the location and storage

7. Results – literature search
Considerable variation in classification of bariatric patient
 BMI (>30 and >40)
 body weight (>45 kg ideal weight)
 waist-to-hip ratio
 waist circumference
 anyone who has limitations in health due to physical size, health,
mobility and environment access (Baptiste, 2007)
6 bariatric body shapes and identified concerns affecting lifting
of these patients (Grundy and Abate, 2003; Murphy, 2003)
Apple
Apple Pear
Pear

8. Results – literature search
• Design standards: AS/NZS ISO 10535:2011 ‘Hoists for the transfer
of disabled persons – Requirements and test methods’
• Barriers to the use of moving and handling equipment – 3
categories:
 Equipment design, e.g. weight limitations, instability, difficult
operations, storage problems, incompatibility with other
equipment
 Care provider, e.g. lack of training, cumbersome/inconvenient,
inability to locate, time constraints, levels of motivation,
governance
 Patient, e.g. aversion to equipment, loss of sense of control,
insecurity, discomfort, dignity, privacy

9. Results: interviews - patient factors
Bariatric classification
 considerable variation and ambiguity
 ≥120 kg, although general hospital policy ≥100 kg
 BMI sometimes used
 move to considering a range of factors, e.g. body anthropometry and
health status
Bariatric patient numbers – each of the hospitals
 10 per month ≥170 kg, 3 per year ≥250 kg
 5 per month ≥150 kg, 2 per month ≥180 kg
 4 patients per day considered bariatric (≥120 kg)

10. Results: interviews – building and space design
Equipment storage
 major problem identified at the 3 hospitals
 some had a central storage
 often disused wards, vacant store rooms, corridors
Space restrictions
 size and layout of room important for bariatric patients
 storage of equipment close to bariatric patient
 sufficient space in and around patient to allow safe
access
 accommodate visitors
 modifications made to wards, e.g. reduce from 6 to 2
or 3 bed wards

11. Results: interviews – equipment and furniture
Tasks performed - mobile floor hoists
 transferring and not transporting
 short transfer tasks, e.g. bed-to-chair, wheel chair
Poor design features – mobile floor hoists
 manoeuvring – view as most high risk tasks due to
pushing and pulling combined with trunk rotation
 handle positions – designed for moving in linear direction
not rotation
 height of the wheelbase – in and around adjustable beds
 relatively unstable (‘tippy’) with heavy patients
 In restricted/confined space – becoming trapped between
hoist and wall
 patient ‘swinging’ into the main support arm
 floor lifts
 collision type injuries

12. Results: interviews – equipment and furniture
Desirable design features – mobile floor hoists
 power assistance when manoeuvring hoists
 user-friendly controls – essential
 combined functions, e.g. assisted walking
 storage
 preference for 4 pt spreader bar and loop attachments
 scales built into hoist
 device for monitoring frequency of use
 height adjustability
 detachable, rechargeable battery/warning indicators
Mobile floor hoists vs ceiling/overhead hoists
 overhead hoists were considered to offer significant
advantages
 H-track designs offer greater flexibility

13. Results: interviews – communication/organisational
Communication – factors considered poor
 communication between wards
 often wards given responsibilities for equipment purchase – no central
equipment database
Organisational – factors considered poor
 no systems that keep track of equipment - slings getting lost
 often no systems for regular maintenance of equipment
 no designated central storage space for specialised equipment

14. Design requirements: end-user acceptance criteria
Mobile floor hoists
Compactness – suitable for use in confined spaces (e.g. bathrooms
and toilet areas) and when moving along narrow corridors
Compatibility – comply with appropriate standards and suitable for
use with other equipment (e.g. stretchers, wheelchairs)
Durability – low maintenance, high strength requirements (at least
300 kg)
Functionality - powered assisted for manoeuvring and patient re-
positioning
Adapted from Conrad et al., 2008

15. Design requirements: end-user acceptance criteria
(cont.)
Mobile floor hoists
Storability - easily stowed, foldable or collapsible for storage
purposes
Operability – quick, easy and intuitive to operate, and assemble and
disassemble
Clean-ability – easy to clean and disinfect
Stability – stable during patient transfers and when moving on
different floor surfaces (e.g. slopes and inclines, carpeted floor)
Adapted from Conrad et al., 2008

16. Conclusions
Limitations associated with mobile floor hoists for use with bariatric
patients
Significant improvements in design requires designer to consider
user and patient requirements
 improved appreciation of hazards
 user and patient involvement in design
A co-ordinated and collaborative approach for moving and
handling of bariatric patients is needed across the range of care
providers
Is there a need for bariatric classification?
Is the mobile floor hoist a necessary piece of handling equipment?