By Janice Homola, ARM, Coverys Senior Risk Consultant

Overexertion from repeated lifting and assisting patients has long been understood as a challenge in hospitals and nursing homes, and result in some of the most costly and lasting injuries. Now, healthcare employees working in ambulatory care and other outpatient settings are beginning to face many of the same patient mobility challenges as their counterparts. Increasingly, these employees are experiencing back, shoulder and other injuries stemming from repetitively lifting, moving, and assisting patients. What created this trend, and how can injuries in outpatient settings be prevented?

Sicker, heavier, more elderly patients

The increasing outpatient employee injury trend has been attributed to a number of situations, impacted by a variety of risk factors. As the baby boomer population ages, the percent of elderly patients and staff increases. In addition, increases in obesity levels across the nation impact both caregivers and their patients.

Also, due to cost-containment measures spanning all of healthcare, more unwell and more physically ailing patients seek care in all manner of ambulatory and outpatient settings. More recently, there has been a finically driven impetus to reduce patient re-admittance into the hospital. As a result, more patients discharged from hospitals earlier — visit their primary care physicians soon after being discharged. Urgent care clinics are seeing an increase in referrals from emergency departments, especially in areas where they are located in the same or a nearby building. All of these changes mean that caregivers in outpatient settings are servicing sicker, heavier, and more elderly patients, often in environments not set up to adequately and safely accommodate this population.

Providing patient care to this “sicker” population often results in caregivers bending, lifting and assisting more, resulting in employees getting hurt, and when employees are injured, there is often a direct impact on the quality of patient care. For example, when a patient falls, getting lifted from under the arms creates a risk of a back or shoulder injury for the caregiver and is uncomfortable and embarrassing at best for the patient. Additionally, employees hurting from the last assist are often reluctant or simply unable to expend their full energies on patient care.

Even in the absence of injury, when an environment is not set up to enable safe care, patients may have difficulty with walking distances, getting up onto high exam tables, and using the restroom. As result, these patients often struggle through their outpatient experience.  One way to enhance the patient experience is to enable employees to be safe and comfortable when providing care, allowing them to fully devote their energies where they are needed: caring for their patient. And, according to a recent Deloitte study1, hospitals with better patient-reported experiences perform better financially; likely that outpatient areas would enjoy similar benefits.

Steps to Improve Safety

What steps can be taken to ensure that outpatient environments are safe and nurturing for patients and that ensure staff are safe as well? Some ideas include:
  • In ambulatory care, a culture of safety needs to be intentionally nurtured to include both staff and patients, as safety for one is not possible without safety for the other. Management and front line staff need to learn about and embrace a way of working in which safety challenges are identified, discussed, and improved.
  • A patient evaluation and support process is needed, beginning with short screening tool used by schedulers with questions to identify potential patient mobility challenges early on; second, staff need to know how to evaluate entering patients using straightforward, systematic risk protocol; and third, safe, secure support for identified, unstable patients from entry to exit needs to be provided.
  • Depending on the care provided, there are often varying levels of dependency throughout a patient visit. Some treatments or exams can make patients weak, nauseated, or light‐headed. When treatments that can result in mobility changes are anticipated, means to provide needed assistance can be made available ahead of time.
  • Environmental assessments can be used to identify trip hazards, hard‐to‐navigate areas, and areas where long distances from the parking lot may impact patient fatigue.

Location-Specific Improvements 

Outpatient areas are very different from each other, and would benefit from specific improvements that meet their individual needs. Examples of clinic improvements in specific areas include:
  • In physician offices, non‐adjustable exam tables are generally high to accommodate the doctor’s evaluation, but have been shown to result in employee and patient injury when there is difficulty getting a patient on and off the table. Providing sturdy step stools with handrails offer even relatively mobile patients more secure access. Also, some models of newer exam tables have adjustable height features.
  • In surgical clinics, lateral transfers for anesthetized patients are generally required after invasive procedures. These types of lateral transfers increase caregiver risk of a back or shoulder injury, and studies show that the traditional plastic slide boards do not reduce exertion to safe levels. While the gold standard is using ceiling lifts for lateral transfers, other solutions include the use of air‐assist lateral transfer devices that can be placed on the stretcher during pre‐op and move with the patient through their phases of care.
  • In dermatology clinics, clients that undergo Mohs treatments move back and forth between the surgical area and waiting room, and these patients may be present for many hours. Especially in the elderly, fatigue or dizziness can set in, and increased levels of assistance may be needed, even including use of walkers, wheelchairs and other mechanical equipment.

As the number of outpatient centers continue to grow, the number of patients enjoying extended recoveries at home — supplemented by a number of visits to ambulatory care centers — is growing as well. In an increasing number of clinics, environments are set up with the patient and employee in mind, and a culture of safety is implemented. In these settings, patients will enjoy a safe and comfortable environment, and employees will too.

  1. Deloitte Center for Health Solutions. “The Value of Patient Experience: Hospitals with Better Patient‐ Reported Experience Perform Better Financially.” Modern Healthcare. 2016. Taken on July 8, 2016 from
  2. PA Patient Safety Advisory. Falls in Radiology: Establishing an Unit‐Specific Prevention Program. Vol. 8, No.1. Mar 8, 2001. Taken on July 12, 2016 from

This post is a work product of Coverys’ Workers’ Compensation Services. This information is intended to provide general guidelines for educational purposes. It is not intended and should not be construed as legal or medical advice. Please consult with your loss prevention consultant/professional with respect to the use or development of your own safety management program.