A tool to measure the success of patient handling inter ventions            Mike Fray and Sue Hignett   Healthcare Ergonom...
Patient Handling Interventions Many reviews have failed to identify MSD  reduction from patient handling interventions  (...
Overview of Presentation 5 year part-time PhD programme Aim - Develop a tool to measure the success of  patient handling...
Methodology    Literature Analysis                                  Focus GroupsIntervention types                        ...
Literature Analysis Search strategies from existing publication    (Hignett et al 2003)   Intervention type, study desig...
Literature Analysis - Level of Outcome (Robson 2007)                     Intervention         Outcomes that measure quanti...
Literature Analysis Search strategies from existing publication    (Hignett et al 2003)   Intervention type, study desig...
Focus Group Study ‘Nominal Group Technique’ Higgins 1994 Range of outcomes at onset of scenario Secondary list of outco...
Focus groups Four EU focus groups (n=34)     UK     Finland     Italy     Portugal Two expert panels (n=10)   Holla...
Qualitative AnalysisOutcomes identified in focusgroups (210)         Identified themes             Included in priority   ...
Focus Group Results: Transformations of data   Grouping of themes gave clear definitions   Remove intervention definitio...
Most Important Outcomes (Ranks)Theme                             Italy   Port   Fin   UK    TOTALAccidents                ...
AnalysisDifference versus Association   Kendall’s Concordance (W)   Using tied ranks correction   Chi Square comparison...
Included outcomes            Outcome        Conversion                              factorSafety Culture                 1...
Measuring each outcome   Inclusion Criteria   Tool used in patient handling study   Level of the QR >50% (308 Included)...
IET – Outcome Measures QR>50% (308)    Preferred outcome          No. measures                                   included ...
Preferred outcome                       Method for collection                                Source paperSafety Culture   ...
IET to TROPHI DevelopmentIET (Vi)Peer review 2 UK hospitalsUK Peer review panel (Vii)                IET (Viii)           ...
TROPHIT ool forR isksO utstanding inP atientH andlingI nterventions
Field Trials: Aims Identify good and bad performers Assess applicability to other EU countries Final review panel (EPPH...
EU Trial Results (Positive Negative defaults)                               UK1     UK2     Po1     Po2     Fi1     Fi2   ...
Evaluation Range effects Scores collected 11/12 sections Data collection 3 hours per ward area Differences identified ...
EPPHE Review MSD and absence score could be age and  experience factored Validity issues regarding single point data Re...
Recent implementation UK, 2010. Mental health unit, Defined  minimal requirement of PH demand Portugal 2011, 8 wards are...
Why is Safety Culture No 1 Organisational   behaviour  measures(Safety Culture)
Why is Safety Culture No 1Organisational   Measures of safe  behaviour          or quality measures           behaviour   ...
Why is Safety Culture No 1Organisational   Measures of safe     Measures of  behaviour         or quality          effects...
Why is Safety Culture No 1Organisational   Measures of safe     Measures of       Financial  behaviour         or quality ...
Summary IET has been successful in measures from 4  EU countries 3 hour data collection Range of scores across 12 secti...
Future work Previously the outcome measure selected  restricted the ability to compare different  interventions but TROPH...
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A tool to measure the success of patient handling interventions

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Dr Mike Fray
Research Fellow, Loughborough Design School, Loughborough University
(P15, Thursday, NZI 6 Room, 3.30-4.15)

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A tool to measure the success of patient handling interventions

  1. 1. A tool to measure the success of patient handling inter ventions Mike Fray and Sue Hignett Healthcare Ergonomics and Patient Safety Research Unit Loughborough Design School Loughborough University UK Sponsors: Arjo-Huntleigh ab, EPPHE.
  2. 2. Patient Handling Interventions Many reviews have failed to identify MSD reduction from patient handling interventions (Van Poppel 2005, Bos et al 2006, Amick et al 2006, Haslam et al 2006, Dawson et al, 2007, Martimo et al 2008) More inclusive reviews identify that other outcomes could be used to show success (Hignett et al 2003, Fray and Hignett 2006) How can different interventions be compared when different measures are used?
  3. 3. Overview of Presentation 5 year part-time PhD programme Aim - Develop a tool to measure the success of patient handling interventions applicable across the EU Overview of the project methods Results Development and evaluation of the tool
  4. 4. Methodology Literature Analysis Focus GroupsIntervention types OutcomesOutcomes Outcome measuresOutcome measurement toolsAcademic Quality Preferred Outcome Intervention Ranked List Scoring System Intervention Evaluation Tool Evaluation Trials
  5. 5. Literature Analysis Search strategies from existing publication (Hignett et al 2003) Intervention type, study design Specific outcome recorded Level of outcome measure (Robson et al 2007) Measurement device used for outcome Academic quality score (Downs and Black 1998) Practitioner rating (Hignett et al 2003) Ranking of outcome from EU study 323 studies 2 reviewers
  6. 6. Literature Analysis - Level of Outcome (Robson 2007) Intervention Outcomes that measure quantities and qualities of the intervention Outcomes that represent a reduction in exposure to known risk factors Outcomes that measure real effects in the target population in a real situation
  7. 7. Literature Analysis Search strategies from existing publication (Hignett et al 2003) Intervention type, study design Specific outcome recorded Level of outcome measure (Robson et al 2007) Measurement device used for outcome Academic quality score (Downs and Black 1998) Practitioner rating (Hignett et al 2003) Ranking of outcome from EU study 323 studies 2 reviewers
  8. 8. Focus Group Study ‘Nominal Group Technique’ Higgins 1994 Range of outcomes at onset of scenario Secondary list of outcomes recorded at end of scenario discussion Ranked outcomes at end of scenario discussion Thematic and content analysis from transcriptions (NVivo)
  9. 9. Focus groups Four EU focus groups (n=34)  UK  Finland  Italy  Portugal Two expert panels (n=10)  Holland, USA, Australia, Belgium, Finland, Portugal, Italy, Germany  Cross comparison
  10. 10. Qualitative AnalysisOutcomes identified in focusgroups (210) Identified themes Included in priority (42) lists (38) 12 highest ranked outcomes included in Intervention Evaluation Tool
  11. 11. Focus Group Results: Transformations of data Grouping of themes gave clear definitions Remove intervention definitions (Robson 2007) Combined categories Separated categories Categories with < 5 votes excluded
  12. 12. Most Important Outcomes (Ranks)Theme Italy Port Fin UK TOTALAccidents 8 3 11 5.5 6Absence, Staff health 3 8 2 3.5 4Financial 11.5 11.5 7 10 12Risk Management, Safety culture 2 1 1 2 1MSD Measures 1 5 8 1 2Exposure Measures 11.5 9 5 12 10Compliance, competence 4 2 4 5.5 3Psychological well-being 10 6.5 9 3.5 7Patient injuries 8 11.5 11 9 11Patient perception 8 10 11 8 9Patient condition 6 6.5 6 11 8Quality of care 5 4 3 7 5
  13. 13. AnalysisDifference versus Association  Kendall’s Concordance (W)  Using tied ranks correction  Chi Square comparison  W= 0.623  Chi square = 27.7  Sig 0.005
  14. 14. Included outcomes Outcome Conversion factorSafety Culture 12MSD measures 11Competence Compliance 10Absence or staff health 9Quality of care 8Accident numbers 7Psychological well being 6Patient condition 5Patient perception 4MSD exposure measures 3Patient injuries 2Financial 1
  15. 15. Measuring each outcome Inclusion Criteria Tool used in patient handling study Level of the QR >50% (308 Included) Selection Criteria High QR scores Evidence of peer reviewed validation studies Used in a peer reviewed intervention trial Most frequently used measurement devices Complexity of the data collection in health
  16. 16. IET – Outcome Measures QR>50% (308) Preferred outcome No. measures included Safety Culture 5 MSD measures 45 Competence Compliance 21 Absence or staff health 19 Quality of care 1 Accident numbers 2 Psychological well being 8 Patient condition 1 Patient perception 26 MSD exposure measures 170 Patient injuries 0 Financial 10
  17. 17. Preferred outcome Method for collection Source paperSafety Culture PHOQS Documentation review Hignett 2005, 2007MSD measures Nordic Questionnaire (or derivative) Knibbe 1996 Lagerstrom 1997Competence Compliance Observational checklist. DINO Johnsson 2002, 2005Absence or staff health OSHA Logs. Standardised data per population Charney 1997, Nelson 2006Quality of care Meeting the clinical needs of the patient, patient evaluation. Nelson 2008Accident numbers Standardised incident numbers and non-reporting ratio Menckel 1997Psychological well being Job satisfaction Evanoff 1999 Psychosocial stressorsPatient condition Meeting the clinical needs of the patient, staff evaluation. Arjo Care Therm. 2007 Nelson 2008Patient perception Comfort, security, fear patient evaluation Kjellberg 2004MSD exposure measures Patient handling demand Knibbe 1999, Cohen 2004, Arjo Resident Gallery 2005Patient injuries Detrimental effects of poor case management New toolFinancial Calculation of costs v. investment Chokar 2005, Nelson 2006, Collins 2004
  18. 18. IET to TROPHI DevelopmentIET (Vi)Peer review 2 UK hospitalsUK Peer review panel (Vii) IET (Viii) 4 section data collectionTranslation and peer review4 EU sites4 EU trialsEPPHE peer review panel TROPHI
  19. 19. TROPHIT ool forR isksO utstanding inP atientH andlingI nterventions
  20. 20. Field Trials: Aims Identify good and bad performers Assess applicability to other EU countries Final review panel (EPPHE) to gain expert consensus on method and content
  21. 21. EU Trial Results (Positive Negative defaults) UK1 UK2 Po1 Po2 Fi1 Fi2 It1 It2Safety Culture 55.6 46.7 13.8 23.3 30.7 39.8 15.6 25.2MSD measures 40.0 50.0 55.0 51.5 22.6 21.6 38.5 100Competence Compliance 29.2 47.9 3.5 11.5 59.6 29.3 56.9 29.6Absence or staff health 0.0 10.7 95.9 64.6 71.2 0.0 100 99.5Quality of care 75.0 80.0 100 69.0 64.2 86.7 88.8 79.5Accident numbers 0.0 97.3 89.5 69.8 82.5 72.0 89.8 88.5Psychological well being 76.2 82.4 77.7 70.7 75.0 70.3 71.7 81.2Patient condition 64.5 79.9 45.0 65.9 64.2 62.5 69.1 84.4Patient perception 68.7 100 100 66.7 100 52.1 93.3 90.0MSD exposure measures 64.0 70.8 52.1 55.2 79.4 75.8 71.6 97.1Patient injuries 0.0 0.0 91.8 66.8 100 100 100 100Financial 100 100 100 100 100 100 100 100 IET SCORE 38.5 53.0 53.2 46.0 53.5 42.3 58.4 65.6
  22. 22. Evaluation Range effects Scores collected 11/12 sections Data collection 3 hours per ward area Differences identified and measured Only small differences were noted in subjective data collected (DiNO 80%) Improvements for data collection methods
  23. 23. EPPHE Review MSD and absence score could be age and experience factored Validity issues regarding single point data Reliability for different users and different systems MS workload exposure score
  24. 24. Recent implementation UK, 2010. Mental health unit, Defined minimal requirement of PH demand Portugal 2011, 8 wards areas acute hospital, (Cotrim et al 2012) UK 2011, 6 wards acute hospital. Audit review study. Repeatability of measures over 3 month period
  25. 25. Why is Safety Culture No 1 Organisational behaviour measures(Safety Culture)
  26. 26. Why is Safety Culture No 1Organisational Measures of safe behaviour or quality measures behaviour (1) (Competence, compliance, Quality of care, Accidents)
  27. 27. Why is Safety Culture No 1Organisational Measures of safe Measures of behaviour or quality effects on measures behaviour individuals (1) (3,5,6) (MSD exposure and prevalence, Absence, Well being, Patient condition and perception)
  28. 28. Why is Safety Culture No 1Organisational Measures of safe Measures of Financial behaviour or quality effects on outcomes measures behaviour individuals (12) (1) (3,5,6) (2,4,7,8,9,10,11) Strength of outcome by interaction The flow cannot be reversed
  29. 29. Summary IET has been successful in measures from 4 EU countries 3 hour data collection Range of scores across 12 sections Potential uses:  Pre-post intervention  Intra or inter site comparison  Benchmarking 12 sections and total score allow more directed use of resources than with single measurement tools.
  30. 30. Future work Previously the outcome measure selected restricted the ability to compare different interventions but TROPHI increases this process A large scale data collection is required to further validate the TROPHI methods Use section scores to direct future interventions Set standards for each section and total as a worldwide benchmarking tool
  31. 31. Thank you for listening

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