Hill-Rom’s innovative bed frame, surface and associated equipment technologies are designed to assist you in reducing pulmonary complications and help you to manage the high risk patients within your department

It is well recognised that Critical care departments are facing ever more complex patient admissions, shortages of experienced caregivers and tightening of healthcare budgets.  Let's examine some of the key issues........

Aging population

By 2025 21.3% of the European population is expected to be over 65 with 5% over 80¹. This means that patients are increasingly frail with multiple co morbidities. It also, however, affects the caregiver population, in some countries the number of nurses under 30 has changed from 1:4 to 1:8 in just over 1 decade ².

Risk of caregiver injury

Nurses continue to be at a high risk of back injuries – there have been many studies and reports that confirm this issue from countries across the globe:

• 52% injuries involve the bed area³
• 52% nurses injure back during career – leading to 12% leaving profession³
  
• In one European country a recent report suggested that 80,000 nurses injure backs annually with 3600 retiring at a cost of $912m pa cost to NHS⁴
  

One of the biggest recent global concerns is the growth in obesity rates world wide- the WHO estimate that there are 300m citizens who are overweight and predict 50% increases by 2015⁵. Recent report suggest that today....

• 205m EU citizens are obese⁶
• 50% increase in obesity prevalence has been reported in China in 1 decade⁷
• Key Latin America countries are reporting growing obesity rates for example Argentina now has 31% of the population with a BMI >30⁷

Increasing awareness of infection control issues 

The incidence of nosocomial infections is rising in most countries across the globe – this is leading to healthcare facilities investing in revised infection control procedures and looking to healthcare equipment providers such as Hill-Rom to support their activities:

• MRSA is now a major concern in most European countries⁹
• HAI’s (hospital acquired infections) contribute to 5000 deaths per year in UK – 1/3 are thought to be preventable¹⁰
• Acinetobacter rates increasing with increasing antibiotic resistance- particularly an issue in ICU departments¹¹
• MRSA VAP independently prolongs ICU length of stay and costs¹⁵ 

The combination of the above factors heightens the dependancy of the patient population potentially leading to reduced mobility – a recognised risk factor in the development of nosocomial infections such as Ventilator Assocaited Pneumonia.......

For many years healthcare professionals have recognised the importance of mobility particularly for the prevention of tissue damage. In more recent years however the concept of early mobility has become more accepted as the potential impact becomes more deeply understood by the multidisciplinary team in terms of preventing complications and promoting recovery. In many situations however repositioning a critically ill patient is challenging – in one study 49.5% of patients did not move during an 8-hour period¹², more recently in a study involving 48 UK ICU’s  the authors reported an average time between turns of 4.85 hours with significant differences between hospital in the frequency in which they turned their patient’s¹³.

It is now well recognised that immobility has a number of detrimental effects (especially in the supine position) for example: 

• Reduced functional residual capacity
• Mucus accumulatlation in the dependant regions
• Alveolar collapse potentially leading to atelectasis and infection development

These detrimental effects are known to be key contributing factors to the development of VAP which has been reported to affect between 10-20% of patients receiving mechanical ventilation for greater than 48 hours¹⁴. VAP is known to increase the costs of treating a patient reports vary from an incremental $10,019¹⁴ to $40,000¹⁶ per patient and is also reported to increase treatment periods both in the ICU and hospital¹⁶
Early mobility programmes are reported to drive reductions in ICU length of stay – in one such study patients who underwent early mobility had a medican length of stay of 4 days whilst a similar group of patients who did not achieve the early mobility targets had a reported median length of stay of 9 days¹⁷.

Healthcare manufacturers have now understood the need for earlier and more aggressive patient mobility and are now designing equipment to help meet the need for more intensive patient mobility even at an earlier stage of their care pathway.
The TotalCare® System from Hill-Rom is one such design. TotalCare® offers a unique frame design, which allows for the promotion of mobility at the earliest possible stage. Only the TotalCare® frame offer the full range of mobilisation techniques that are independantly proven to reduce ventilator days and length of stay such as Continuous Lateral Rotation Therapy.

For more information on the TotalCare® Frame please visit the virtual showroom.

Continuous Lateral Rotation Therapy		Preliminary Tilt Table
FullChair® Position		Chair Egress Position

References

1. World Population Prospects 2002

2. Royal College of Nursing, UK

3. Royal College of Nursing

4. Smith G et al Manual Handling Issues for Nurses. RCN/IES. 1996

5. World Health Organisation 2005

6. IOTF 2002

7. World Health Organisation Obesity Prevalence Database accessed 2007

8. Akinnusi M E. etal. Crit Care Med 2008, vol 36, no.1

9. European Antimicrobial Resistance Surveillance System

10. Payne T Health Estates Journal March 2007