[MCOH-EH] bariatric transfer

[Cunha, Bruce E.]

This is a great topic and one that we have been really working a lot on.

Some hospitals have set up areas in parking garages where a lift can be used to assist getting patients out of vehicles.  For Clinics, this is a lot more difficult in that most have a single drive up area and the time it takes to get a lift to the car, get it set up and get the patient out, can significantly block up the front of the Clinic.  There are some devices that can assist in getting patients out of vehicles. Slide pads that assist in rotating the patient.  Handles that can be attached to the window frame or the door lock hook on the car pillar to assist the person out of the car.   There are also disks that can be put on the ground to assist in turning the patient to position them to get into a wheelchair.

http://www.wrightstuff.biz/car-transfer-aids.html
http://www.mobility-aids.com/car-transfer-aids.html

All of these are things that can assist, but also take time and a lot of training to use.

The next issue is once they are out of the car how do you transport the patient?   This is another issue that clinical systems have.  The patient is not going to be at the facility for more than the day, so anywhere they go in the facility, they will need a way to get around.   While traditional wheelchairs may be appropriate for some patents, with the larger patients we are seeing, manual pushing of a wheelchairs is accounting for a large number of our injuries.

We recently did a study on the amount of force needed to push various weights in a wheelchair on smooth surfaces and on carpeted surfaces.  I have attached our results.  This was not an absolute controlled scientific study; we just put different amounts of weights in a wheelchair and then used a force gauge to see how much force it took to start the chair moving on the different surfaces.   I have attached our results.  I would love it if others could reproduce these to see what they get.

According to Liberty Mutual Snook Table (http://libertymmhtables.libertymutual.com/CM_LMTablesWeb/pdf/LibertyMutualTables.pdf) guides to pushing, 90% of males and females should be able to exert an initial pushing force of approximately 46 pounds for a 36" handle height when doing one push in 8 hours..  This works out to about a 160 pound patient on a carpeted surface and about a 200 pound person on a smooth surface.

These are estimates and pushing factors have a number of variables.

The availability of powered systems to assist in pushing a patient are somewhat limited.  There is a company that makes powered wheelchair pushers, but these are limited in the types and width of the wheelchair that they can attach to.   There are powered wheelchairs and scooters, but the availability of units that can be driven by an attendant are limited.

Patient weight is another factor.  As the weight of the patient goes up, the availability of powered equipment is reduced considerably (and costs go up considerably).  One solution we have found for very large patients (> 600 pounds) is the Sizewize program.   (http://www.sizewise.net/).   Sizewise, makes a powered chair that will hold up to 1000 pounds (shuttle B series) and  has power systems that can convert it to a flat surface that can be used for examinations.   They have a program where you can rent their chairs and they can also be set up to deliver and pick up the chair.  (not an advertisement for this company, it is just the only program we have found that will work for our very large patients).   The only drawback is the width of this chair.  You have to have wide doors to get it into an area.

Hopefully more companies will be getting into this issue in the future.


Bruce E. Cunha RN MS COHN-S
Manager, Employee Health and Safety
Marshfield Clinic
Marshfield WI.

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We have been challenged with the same issues at our clinics.
We looked at some new people moving/lifting equipment that look like a great fit for the out-patient setting (assisting getting out of cars, etc) but the cost and training has kept them on my wish list.  The VA has great resources and are way ahead of the game with patient assistance and Safe Patient Handling specialist at their  facilities.

Gwen Long, PA-C
Employee Health & Safety Specialist
Office:608-251-4156 ext 4517
Cell:    608-438-3539
Fax     608-662-4190
Be a LIFE SAVER; Get vaccinated to protect the ones you love



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