A tool to measure the success of patient handling interventions

Mike Fray and Sue Hignett

Healthcare Ergonomics and Patient Safety Research UnitLoughborough Design School

Loughborough UniversityUK

Sponsors: Arjo-Huntleigh ab, EPPHE.

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?

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

Methodology

Literature Analysis

Intervention types

Outcomes

Outcome measurement tools

Academic Quality

Focus Groups

Outcomes

Outcome measures

Preferred Outcome

Intervention Scoring System

Ranked List

Intervention Evaluation Tool

Evaluation Trials

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

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

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

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)

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

Qualitative Analysis

Outcomes identified in focus groups (210)

Identified themes (42)

Included in priority lists (38)

12 highest ranked outcomes included in Intervention Evaluation Tool

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

Most Important Outcomes (Ranks)

Theme Italy Port Fin UK TOTAL

Accidents 8 3 11 5.5 6

Absence, Staff health 3 8 2 3.5 4

Financial 11.5 11.5 7 10 12

Risk Management, Safety culture 2 1 1 2 1

MSD Measures 1 5 8 1 2

Exposure Measures 11.5 9 5 12 10

Compliance, competence 4 2 4 5.5 3

Psychological well-being 10 6.5 9 3.5 7

Patient injuries 8 11.5 11 9 11

Patient perception 8 10 11 8 9

Patient condition 6 6.5 6 11 8

Quality of care 5 4 3 7 5

Analysis

Difference versus Association Kendall’s Concordance (W) Using tied ranks correction Chi Square comparison

W= 0.623 Chi square = 27.7 Sig 0.005

Included outcomes

Outcome Conversion factor

Safety Culture 12

MSD measures 11

Competence Compliance 10

Absence or staff health 9

Quality of care 8

Accident numbers 7

Psychological well being 6

Patient condition 5

Patient perception 4

MSD exposure measures 3

Patient injuries 2

Financial 1

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

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

Preferred outcome Method for collection Source paper

Safety Culture PHOQS Documentation review Hignett 2005, 2007

MSD measures Nordic Questionnaire (or derivative) Knibbe 1996 Lagerstrom 1997

Competence Compliance Observational checklist. DINO Johnsson 2002, 2005

Absence or staff health OSHA Logs. Standardised data per population Charney 1997, Nelson 2006

Quality of care Meeting the clinical needs of the patient, patient evaluation. Nelson 2008

Accident numbers Standardised incident numbers and non-reporting ratio Menckel 1997

Psychological well being Job satisfaction Psychosocial stressors

Evanoff 1999

Patient condition Meeting the clinical needs of the patient, staff evaluation. Arjo Care Therm. 2007Nelson 2008

Patient perception Comfort, security, fear patient evaluation Kjellberg 2004

MSD exposure measures Patient handling demand Knibbe 1999, Cohen 2004,Arjo Resident Gallery 2005

Patient injuries Detrimental effects of poor case management New tool

Financial Calculation of costs v. investment Chokar 2005, Nelson 2006, Collins 2004

IET to TROPHI Development

IET (Vi) IET (Vi)

IET (Viii) 4 section data collectionIET (Viii) 4 section data collection

Peer review 2 UK hospitalsPeer review 2 UK hospitals

Translation and peer review 4 EU sitesTranslation and peer review 4 EU sites

4 EU trials4 EU trials

EPPHE peer review panelEPPHE peer review panel

UK Peer review panel (Vii)UK Peer review panel (Vii)

TROPHI

TROPHI

T ool for

R isks

O utstanding in

P atient

H andling

I nterventions

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

EU Trial Results (Positive Negative defaults) UK1 UK2 Po1 Po2 Fi1 Fi2 It1 It2

Safety Culture 55.6 46.7 13.8 23.3 30.7 39.8 15.6 25.2

MSD measures 40.0 50.0 55.0 51.5 22.6 21.6 38.5 100

Competence Compliance 29.2 47.9 3.5 11.5 59.6 29.3 56.9 29.6

Absence or staff health 0.0 10.7 95.9 64.6 71.2 0.0 100 99.5

Quality of care 75.0 80.0 100 69.0 64.2 86.7 88.8 79.5

Accident numbers 0.0 97.3 89.5 69.8 82.5 72.0 89.8 88.5

Psychological well being 76.2 82.4 77.7 70.7 75.0 70.3 71.7 81.2

Patient condition 64.5 79.9 45.0 65.9 64.2 62.5 69.1 84.4

Patient perception 68.7 100 100 66.7 100 52.1 93.3 90.0

MSD exposure measures 64.0 70.8 52.1 55.2 79.4 75.8 71.6 97.1

Patient injuries 0.0 0.0 91.8 66.8 100 100 100 100

Financial 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

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

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

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

Why is Safety Culture No 1

Organisational behaviour measures

(Safety Culture)

Why is Safety Culture No 1

Organisational behaviour measures

(1)

Measures of safe or quality

behaviour (Competence, compliance,

Quality of care, Accidents)

Why is Safety Culture No 1

Organisational behaviour measures

(1)

Measures of safe or quality

behaviour (3,5,6)

Measures of effects on individuals

(MSD exposure and prevalence, Absence, Well being, Patient condition and perception)

Why is Safety Culture No 1

Organisational behaviour measures

(1)

Measures of safe or quality

behaviour (3,5,6)

Measures of effects on individuals

(2,4,7,8,9,10,11)

Financial outcomes

(12)

Strength of outcome by interaction

The flow cannot be reversed

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.

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

Thank you for listening