Explore the vast range of titles available.

Aims: To report, analyse, and discuss the results of a systematic review looking at intervention strategies to reduce the risk factors associated with patient handling activities. Methods: A search strategy was devised to seek out research between 1960 and 2001. Inclusion/exclusion criteria limited the entry of papers into the review process. A checklist was selected and modified to include a wide range of study designs. Inter-rater reliability was established between six reviewers before the main review process commenced. Each paper was read by two reviewers and given a quality rating score, with any conflicts being resolved by a third reviewer. Papers were grouped by category: multifactor, single factor, and technique training based interventions. Results: A total of 2796 papers were found, of which 880 were appraised. Sixty three papers relating to interventions are reported in this paper. The results are reported as summary statements with the associated evidence level (strong, moderate, limited, or poor). Conclusion: There is strong evidence that interventions predominantly based on technique training have no impact on working practices or injury rates. Multifactor interventions, based on a risk assessment programme, are most likely to be successful in reducing risk factors related to patient handling activities. The seven most commonly used strategies are identified and it is suggested that these could be used to form the basis of a generic intervention programme, with additional local priorities identified through the risk assessment process. Health care providers should review their policies and procedures in light of these findings.

BackgroundPatient safety culture is measured using a range of survey tools. Many provide limited data on psychometric properties and few report findings outside of the US healthcare context. This study reports an assessment of the psychometric properties and suitability of the American Hospital Survey on Patient Safety Culture for use within the UK.MethodsA questionnaire survey of three hospitals within a large UK Acute NHS Trust. 1437 questionnaires were completed (37% response rate). Exploratory factor analysis, confirmatory factor analysis and reliability analyses were carried out to assess the psychometric performance of this survey instrument and to explore potential improvements.ResultsReliability analysis of the items within each proposed scale showed that more than half failed to achieve satisfactory internal consistency (Cronbach's α<0.7). Furthermore, a confirmatory factor analysis carried out on the UK data set achieved a poor fit when compared with the original American model. An optimal measurement model was then constructed via exploratory and confirmatory factor analyses with split-half sample validation and consisted of nine dimensions compared with the original 12 in the American model.ConclusionThis is one of the few studies to provide an evaluation of an American patient safety culture survey using data from the UK. The results indicate that there is need for caution in using the Hospital Survey on Patient Safety Culture survey in the UK and underline the importance of appropriate validation of safety culture surveys before extending their usage to populations outside of the specific geographical and healthcare contexts in which they were developed.

Objective: To comparatively evaluate the three most widely used ambulance stretcher loading systems; easi-loader, ramp/winch and tail lift to identify a preferred system based on safety and usability evidence. Methods: Three data types were collected in the field, the laboratory and from a national questionnaire. Field data were collected using the qualitative methods of observation (link analysis and hierarchical task analysis) and interview (critical incident technique) over 12 months during 2004–5. Laboratory data were collected for detailed postural analysis. A national ranking questionnaire was used to prioritise the resulting design issues. Results: The field study data were analysed, triangulated and summarised in a taxonomy to identify the design and operational issues. A list of 14 criteria was used in a national ranking exercise with 134 ambulance staff and manufacturers. Patient and operator safety was ranked as the highest priority, followed by manual handling. The postural analysis found that the easi-loader system presented the highest postural risk. Conclusions: The tail lift was found to be the preferred and safest loading system from both the field and laboratory research and is the recommended option from the evaluated loading systems.

BackgroundIn recent years UK government policy has increased the provision of urgent care in the community. As part of this initiative the emergency ambulance service is gradually changing from an organisation designed to convey patients to hospital to a professional group capable of assessing urgency and delivering the appropriate treatment to the patient.MethodsThis paper explores the portable technology requirements needed to support the new professional roles and draws on examples from ambulance trusts (emergency care practitioner services), primary care (out-of-hours general practitioner services and minor injuries units), and acute trusts (emergency departments) to investigate the workplace layout and clinical activities, including the use of equipment and consumables. It describes the iterative process used to develop the design specification for portable technologies using a qualitative exploratory methodological framework with data collected at stakeholder workshops, responder bag audits, clinical treatment observations and design decision groups.ResultsThe results are discussed as a three-level technology system for: personal kit; assessment packages (and storage for other clinical treatment packages), a clinical workspace. Future developments are predicted to improve diagnostic and decision-making services through both miniaturisation (eg, portable diagnostic imaging) and improved real-time support (communication systems).ConclusionThis study has provided empirical research for portable technology requirements in urgent care.

Background:In 2005 the Department of Health set out a vision for the provision of future ambulance services with an increasing range of quality mobile healthcare services for patients with urgent and emergency care needs. This paper describes a scoping study funded by the National Patient Safety Agency and Ambulance Service Association to investigate the short and longer term requirements of future emergency ambulances.Method:Four stakeholder workshops were held to explore the wishes, concerns and preferences of the clinicians, operational staff and manufacturers about the future provision of ambulance services and problems and possible solutions relating to ambulance design and use. Incident reports relating to ambulance design and use were reviewed from three national and international databases.Results:Nine design challenges were identified: access/egress; space and layout; securing people and equipment in transit; communication; security, violence and aggression; hygiene; equipment; vehicle engineering; patient experience. These were validated at the national UK ambulance conference (AMBEX 2006) with a rating questionnaire.Conclusion:The results are being used in the development of a national specification for future UK emergency ambulances.

The aim of this study was to produce a recommendation for selection of a tunic top for female nurses, based on previously established ergonomic criteria. Four tunic top designs were evaluated using functional tests, including anthropometry, body-part discomfort charts, product feature questionnaires and comparative ranking. A convenience sample of nurses from one trust wore the tunics during the study tests. The trial draws heavily on previous research on nurses' uniforms and applies ergonomic criteria to tunic top design. The researchers were not able to identify on optimum design using the results of the trial. The tunics compared were relatively restrictive, with one tunic being identified as the least restrictive of the four. The researchers are now taking this initiative forward in a participatory ergonomics project with nursing staff to try to produce a uniform design that will meet functional ergonomic criteria. Prototypes will be evaluated using the protocol from this trial.

To identify and explore the manual handling risks for patients and caregivers using bariatric patient pathways in health and social care. A mixed methodological approach, including focus groups and questionnaires, was used in this study. Participants were recruited for the focus groups from the National Back Exchange (NBE) Special Interest Group on Bariatrics and the National Ambulance Risk and Safety Forum (NARSF). The questionnaire was distributed to all members of the NBE and NARSF in 2006. The data sets were analysed thematically (focus groups: n = 25) and descriptively (questionnaires: n = 230). Patient pathways were mapped for medical (acute), community and maternity admissions resulting in five generic themes: patient factors; building and vehicle space and design; equipment and furniture; communication; and organisational and staff issues. A total of 59% (n = 136) of respondents reported that their organisation did not have a bariatric manual handling policy. Of all responding organisations (n = 230), 77% (n = 177) had access to specialist equipment but only 32% (n = 68) of NBE respondents (n = 212) provided specialist bariatric manual handling training for staff. Lack of formal communication systems between and within organisations contributed to manual handling risks at admission and discharge. There is a need to review and design more appropriate buildings, vehicles, furniture and equipment to reduce the manual handling risks to health professionals and bariatric patients. More research is required to examine the implementation of policies, in particular focusing on the use of equipment and the communication between care-providing agencies.