By Guy Fragala, PhD, PE, CSP, CSPHP and the Midmark Medical Marketing Team
The right exam room equipment can make a difference in keeping caregivers safe and providing high-quality care to patients. All patients, including those with mobility limitations, should receive access to quality healthcare. Yet common poor patient-handling practices can put patients – and caregivers – at risk for injury.
Consider the examination chair, the focal point of interaction between the patient and the healthcare provider. Traditionally as a fixed-height, box-type table, the examination chair was often not adjustable, limiting a patient in a wheelchair or with other mobility issues the ability to transfer onto the chair without assistance from caregivers. Plus, with the average age of patients on the rise, a growing number of patients need assistance in accessing exam chairs and this requires more from caregivers.
“The exam table is the central and most important furnishing in the ambulatory care clinic,” said Guy Fragala, Ph.D., PE, CSP, CSPHP. “Using height-adjustable, accessible exam chairs can improve the environment of care by significantly reducing occupational risk to caregivers while improving quality of care for patients.”
As a foundational component of the connected point of care ecosystem, the exam chair’s impact on both the patient and the provider is still evident in many healthcare practices across the country. The following is an excerpt from a recently published perspective in Physicians Practice on the lasting impact and solutions available.
Impact on the Patient
Fixed-height examination tables – which limit and restrict patient access – can in fact have a negative impact on the quality of care a patient receives. In a recent survey, forty-four percent of practice administrators acknowledged that when examining a patient with disabilities, parts of an exam were skipped when a barrier was encountered. Seventy-six percent of practice administrators indicated that patients were examined in their wheelchairs when they could not transfer themselves onto an exam table.
When a physician is unable to perform an appropriate examination because a patient cannot get onto an examination or procedural table or chair, the patient may be misdiagnosed, because the physician may not have enough information. Alternatively, the patient might miss the benefit of early detection of a serious developing condition. By providing accessible examination chairs, caregivers can improve the quality of care provided to people with disabilities and mobility limitations.
The exertion required to get up onto a fixed height examination table, in addition to the patient’s risk of falling and the difficulty encountered by the patient when mounting examination tables, have been measured. Results of the study demonstrated how patients use less exertion with height adjustable examination chairs. This benefit was even greater for patients who have mobility limitations. In fact, patients reported feeling safer when attempting to mount a height adjustable examination chair versus a fixed height table.
Impact on the Provider
In addition to the difficulty encountered by the patient, fixed height examination tables can present further problems for the caregiver. Assisting a dependent patient, whether in a wheelchair or from a standing position, up onto a fixed height examination table is a difficult and demanding task. It often places the caregiver at risk for suffering a back injury or musculoskeletal disorder. If modifications are introduced to the design of examination tables and chairs, such as the ability to move up and down with automatic adjustable height controls, the process of getting a dependent patient up and onto the equipment can be facilitated not only for the patient but also for the caregiver.
Results from an additional study indicated that through application of height adjustable examination chairs, the difficult and high occupational risk activity of assisting a patient up onto an examination table can be made safer and easier for caregivers to perform. Caregivers reported that significantly lower perceived physical exertion was required to perform the task with a height adjustable examination chair. Greater physical exertion equates to greater stress on the musculoskeletal structure and increased risk for injury. Reduction in physical exertion translates into less force exerted on the musculoskeletal structure and a lower risk of injury.
As a result of facilitating the task of assisting a patient up onto an examination table or chair, caregivers may be more likely to comply with protocols for examinations in ambulatory care settings. This could result in improved quality of care for patients and positive outcomes related to a better experience for the patient when undergoing an examination.
A more ideal solution is an adjustable examination chair capable of achieving a low height at about 18 inches. Beyond the benefits to the patient that facilitate access to the exam chair, the adjustable-height feature also enables caregivers to elevate the chair to a comfortable height to be in a more ergonomically correct posture for conducting an examination or procedure, thus enhancing the ability to deliver a higher quality of care.
The implementation of new examination chair technology, employing the concepts of ergonomics, can help improve the environment of care in the ambulatory care setting resulting in better outcomes for both patients and providers.
Dr. Guy Fragala has more than 40 years of experience as a healthcare professional and is a recognized international expert in the application of ergonomics to the healthcare setting. He currently serves as the Senior Advisor for Ergonomics at the Patient Safety Center of Inquiry in Tampa, Florida. Dr. Fragala's study was sponsored by Midmark.