THE MAGIC OF MOBILES

Providers are discovering the ergonomic and aesthetic benefits of today?s mobile imaging units.

From cell phones and smartphones to handheld tablets and electronic readers, technological advances in the consumer market continue with the trend toward portable compactness.

Inside today’s hospitals and practices, the popularity of portable and mobile imaging equipment is also on the upswing. Providers welcome the speed of exams and the resulting increased throughput and productivity. Technologists and nurses are attracted to the convenience of imaging at the bedside or in the operating and emergency departments. And purchasing departments are keen on the cost savings associated with eliminating the need for expensive fixed consoles and dedicated imaging suites.

Yet, often overlooked are two other valuable aspects of mobile units: ergonomics and aesthetics. Ergonomically improper techniques and sterile aesthetic design can lead to negative experiences for both end users and patients. However, if given special attention, these characteristics can translate into enhanced benefits for providers wishing to set themselves apart from the rest.

Ergonomics and the End User

Kathy Morreale, charge technologist in diagnostic imaging at Hamilton General Hospital in Canada, is already impressed with Carestream’s DRX-Revolution, which her facility acquired 3 months ago.

“It’s an x-ray tech’s dream,” she said. “The machine drives so well; it’s so maneuverable, which is a big bonus for us. Some machines, you really have to push. ? [They] have mechanical locks, so they may stick or there may be some resistance. With the Revolution, there is much less resistance, so it freely moves when it is unlocked.”

Sally Grady, former imaging director at Celebration Health-Florida Hospital, explained that technologists generally don’t enjoy doing portables. The equipment is bulky, space is limited, floors may be carpeted, and the types of patients who necessitate bedside imaging tend not to be helpful with their own mobility. That all changed with the acquisition of Agfa HealthCare’s portable DR, Grady said.

“You could push it down the hallway with two fingers,” she said. “No joke, because I did it.”

Yet, despite the efforts of manufacturers to incorporate more ergonomic features in their products, injury rates have remained unabated, at least for certain modalities. For example, a 1997 study found that 84% of sonographers were scanning in pain.¹ A little more than a decade later, another survey found that 90% of these health care workers were scanning through work-related injuries.²

Susan L. Murphey, founder and president of ergonomic consulting company Essential WorkWellness, believes that although there is more awareness of ergonomics, the competitive health care environment coupled with a lack of a proactive approach makes for injury-prone outcomes.

“We’ve gone to this culture in health care of doing more with less, increasing productivity and increasing throughput, so the exposure rate to risk factors has increased,” Murphey said. “We haven’t seen much change in clinical practice addressing ergonomics, so even though health care organizations may have good equipment in their facilities, they haven’t changed their procedures and protocols to allow workers to incorporate ways to reduce the risk factors in their workflow.”

Risk factors for the musculoskeletal disorders associated with imaging include awkward postures, repetitive movements, manual transferring of patients onto the imaging table, and patient positioning.

According to Murphey, with CT, MRI, and nuclear medicine, technologists’ injuries are primarily neck- and hand-related due to the computer interaction; ultrasound typically affects the shoulder, neck, and right arm and hand. Mammographers suffer from hand issues associated with pulling breast tissue to smooth it out between plates. Back injuries generally arise from patient positioning.

“With portable radiography, we’re lifting people all the time, driving the machinery, extending the arms, our shoulders are always up in the air. It’s a physical, heavy load for techs, which can lead to shoulder and back injuries,” Morreale said. “What also makes portable heavier is patient condition. You wouldn’t do a patient portably unless they were too ill to come to the department.”

Murphey pointed out that ultrasound is heading toward the direction of compact or handheld units, whose limited dimensional range and adjustability can pose problems for health care workers. She also has fielded an increasing number of requests for education on computers on wheels (COWs) and workstations on wheels (WOWs). “While it has some advantages associated with the transport of equipment, there’s a whole host of other risk factors related to the awkward postures of utilizing a compact device that are not necessarily being recognized,” she continued, adding that the neck, wrist, and hand, in particular, are susceptible for injury.

In her work with Essential WorkWellness, Murphey is brought into health care organizations, mainly in the Pacific Northwest, to address concerns from departments with high rates of injury, as well as to meet with individual workers as part of their workers’ compensation claims or return-to-work plans.

Although she wishes that hospitals, clinics, and departments sought out her expertise as a preventative measure, Murphey said that she generally steps in retroactively, after workers are already symptomatic. Nevertheless, hospital management does not hold the sole blame for this delay in action, she points out. “The employers are not being proactive in preventing injury, but also the employees are not recognizing their symptoms and doing something about it,” she said. “One of the things about health care providers is that they are caregivers to a fault. They are in that profession precisely because they are caregivers. They always put someone else’s well-being before their own.”

Possible solutions for ergonomically related injuries include providing a fully adjustable cart for compact equipment or, as Murphey endorses, simply looking at workflow processes and reexamining what justifies a bedside exam.

“Maybe in lieu of compact equipment, you can consider keeping a standard sized ultrasound system that is more adjustable, on those units that have frequent imaging needs,” she said. “There are a lot of bedside exams that are done for nursing convenience or reasons other than patients being in critical health. Those sorts of things should be looked at to reduce risk factors and wear and tear on equipment.” Updated standards from the Intersocietal Accreditation Commission also should help. In order for echocardiography and vascular sonography labs to receive accreditation, health care organizations must institute appropriate policies to address technical staff safety, comfort, and avoidance of work-related musculoskeletal disorders.

Education and Training

During what she refers to as “Ergo Evaluations,” Murphey assesses a department’s equipment as well as its employees’ work habits. More often than not, she says, there is a significant amount that can be done through education and training. Through employee engagement sessions, Murphey helps workers identify risk factors and brainstorm possible solutions. “I’m very devoted to making it a participatory approach to learning,” she said. “I find it’s much more effective for employees to discover their own solutions and for me to facilitate and guide them to that, rather than for me to go in and tell them how to do their work differently. The compliance and sustainability are better if they’ve had some input into developing their own solutions.”

Frequently during employee engagement sessions, workers identify solutions that are even less expensive than management anticipates—for example, retrofitting current equipment instead of buying the latest model, Murphey said. “No one else knows their work better than they do,” she continued. “They know what their patient population is. They know about what is and isn’t practical as far as implementing changes. They have a much better sense of what’s going to be feasible and what’s not. They come up with ideas that are not just unique to their workplace but they are also excited about them because it was their idea.”

Back at Hamilton General Hospital, Morreale said injuries to techs are few and far between (Morreale herself has not experienced an injury during her 31 years in the field). She credits this to the administration’s focus on education and training; not only is ergonomics included in an annual review, but the department also has an ergonomist on staff: “It depends on education because here they impress upon us proper body mechanics,” Morreale said, adding that teamwork also played a major factor in reducing work-related injuries.

Morreale’s colleague, Kelly Reekie, a senior technologist in charge of portable and operating room radiography, said she remembers to remain on the lookout for common improper techniques, such as leaning forward, not bending knees, overreaching, and overextending. Reekie said she specifically pays attention to her coworkers’ positioning practices, especially among new hires. “We watch someone new coming in to make sure they are using their body correctly, relieving strain on their shoulders and back,” she said. “We don’t want anybody to get hurt.”

The Art of Healing

Aside from enhancing the user experience, portables and mobile equipment can be designed in a way to better the experience of the population they serve. For example, when Grady worked for Celebration Health, she was challenged by administration to make imaging different. “Celebration Health was really built to try to do new things first and be on the cutting edge, not just of technology but the patient experience,” she said.

That led to the creation of Seaside Imaging, an immersive, virtual beach environment. Initially, it was specific to CT and MR, two modalities known to be intimidating for many. Scent machines throughout the area emit the faint smells of suntan lotion, while birds, boats, and waves are heard through sound machines. A three-dimensional sand castle covered each imaging modality. Flooring was changed to look like a boardwalk, while Adirondack chairs replaced stretchers. Furthermore, patients were instructed to enter cabanas and change into surfer shorts and tops instead of typical hospital gowns.

“It was just such a different feeling for the patient than going into a cold, sterile area,” Grady said. “People have a lot of preconceived notions when they come in for a test like that. They’ve talked to people and haven’t been told great stories. They come to us already thinking that they are not going to like this. So by changing the environment and creating something that makes for a better experience for the patient, they can get through the exam and cooperate a lot better.”

The results were tangible. “We were able to show medical validity to doing that environment,” Grady said. Adult patient MRI sedation rates that were once at 6.5% were down to 2% within a year of Seaside Imaging opening. “There are dollar savings as well. There’s additional revenue you get. These were people who canceled 35 minutes into the study, while your tech has spent all that time setting up and trying to encourage them. The patient also doesn’t get a diagnosis.”

Over the years, Seaside Imaging expanded into mammography and portable imaging. “With mobile imaging, you’re going to the patient,” said Grady, who, in her current post as director of clinical innovation at “environmental theming” company DreamThinkImagine, designs custom immersive environments for health care clients. “You’re typically going to the patient who is a little more ill than someone who can come into the department. We decided it would be great to take the environment to them.”

Portable units, while not entirely unattractive, are not things that catch patients’ eyes, Grady said. “It rolls in, it’s a little noisy, and there’s nothing about it that is aesthetically pleasing,” she said. Therefore, Grady decided to bring a little bit of the beach to patients, embellishing a portable unit with an underwater theme. Because portables normally take a beating, Grady wanted to make sure the themes were durable. Instead of paint, the units were outfitted with skins that could be easily wiped down and thoroughly cleaned.

“It does take their mind off [their particular ailment], and it can become a conversation piece,” Grady continued, discussing the benefits of aesthetics for mobile imaging. “It becomes a helpful tool. If you’re talking to the patient about the beach on the side of the unit you brought in, and you are also going through the motions of getting them ready for the exam, they’re not as nervous or apprehensive about what’s going on.”

According to Grady, an increasing number of health care organizations are looking to environmental design in the hopes of improving their Hospital Consumer Assessment of Health Providers and Systems (HCAHPS) scores, where 70% comes from the clinical element and 30% comes from the patient experience. “The patient experience is coming to the forefront,” Grady said. “I never had a patient write me a comment card that said, ‘Your CT doesn’t have enough slices.’ It’s always about the experience.”

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Elaine Sanchez Wilson is a contributing writer for Axis Imaging News.

REFERENCES

1. Pike I, Russo A, Berkowitz J, Baker J, Lessoway V. The prevalence of musculoskeletal disorders among diagnostic medical sonographers. Journal of Diagnostic Medical Sonography. 1997;13(5):219-27.
2. Evans K, Roll S, Baker J. Work-related musculoskeletal disorders (WRMSD) among registered diagnostic medical sonographers and vascular technologists: a representative sample. Journal of Diagnostic Medical Sonography. 2009;25:287-299.