October 2015  |  The American Journal of Safe Patient Handling & Mobility

This blog article is a summary of a peer-reviewed scientific article published in Volume 5, Issue 3 of The American Journal of Safe Patient Handling & Mobility

James Carlson, RN, moves quickly all day long to accomplish his tasks in his hospital’s geriatric unit. Because he’s in a hurry he often lifts and transfers patients by himself. In rare cases, such as very heavy patients, he seeks help from other staff.

It’s not unusual for James to leave work with what he calls a “stiff back.” One day, carrying the groceries into his home, he bends over and reaches into the refrigerator to put away a six-pack of soda, and TWANG! —“out” goes his back. Technically it’s not an on-the-job injury, but it’s still a dreaded occurrence for both James and his employer.

If you’re working in a hospital or rehabilitation facility these days, you know this is true: Today’s caregivers are working in a hurry and for average patients they often don’t have the time to slow down to seek help from others, or to obtain the necessary patient transfer equipment. Consequently they injure themselves performing unassisted, or under-assisted, moves and transfers.

And, these days, even if you can find the equipment, it is often inappropriate for the task. Given the obesity issues faced in this country today, available equipment is often designed for patients who fall somewhere on the bariatric scale. The truth? Transferring an extraordinarily heavy patient is a rare problem. The fact is that more than 99% of your patients will weigh between 110 – 250 pounds. Bariatric equipment will be inappropriate for nearly every patient your facility serves.

This is what we call the Critical Lift Zone: the general patient population, where routine but unsafe patient handling practices lead to the greatest risks to caregivers, and to the greatest financial burden for the facility.

  • Care facilities often devote budget to expensive equipment for handling extremely heavy patients, but there are far greater numbers of patients in the normal weight range, and the tools needed to handle them safely are typically not easily available.
  • A common perception is that average-weight patients can be handled without special assistance, compared to the occasional extremely heavy patient for whom additional caregivers and special lifting equipment is obviously necessary. Yet ergonomics research reveals the dangers in handling even very small amounts of weight at arm’s length.
  • Minor back injuries due to unsafe patient handling are cumulative. Routine handling of typical patients can cause strains and tears that add up over time and lead to major injuries and chronic impairments.

What is the Critical Lift Zone?

Though bariatric-class patients are typically defined in terms of body mass index (BMI), 300 pounds (136 kg) is considered a reasonable lower threshold in terms of weight. The NIOSH safe lifting limit and the bariatric weight threshold are shown in Figure 1.


Figure 1. Bariatric weight class and the NIOSH safe lifting limit.

Bariatric patients are obviously far heavier than the NIOSH guideline for safe lifting and generally require specifically designed equipment.

The NIOSH-bariatric gap becomes truly alarming, however, when viewed in the context of the weight distribution of the adult population, shown in Figure 2. As the chart illustrates, the body weights of virtually 100% of the U.S. adult population exceeds the NIOSH safe lifting limit. At least 95% of the population weighs less than 125 kg (273 lbs)12, well under the bariatric threshold.

Despite such statistics and the lifting limit established by NIOSH, in our experience the patient care industry is often preoccupied with the requirements of morbidly obese patients and bariatric units, as evidenced by the large volumes of scholarly research, types of equipment purchased and caregiver focus on bariatric safety. Handling of bariatric patients is a real and growing issue, certainly, but we believe it overshadows the ever-present risks encountered in handling the vast majority of the patient population.


Figure 2. U.S. body-weight data. More than 95% of the adult population is in the Critical Lift Zone.

To bring attention to this issue, we define the range of patient weights below the adult 95% percentile and above the NIOSH lifting limit as the Critical Lift Zone—‘critical’ precisely because it represents by far the greatest portion of patient handling activities and risks for injuries, yet is often under-recognized and under-served by available SPH practices and tools.

The facts are simple: Continuing to lift and transfer normal-weight patients without appropriate assistance ignores the obvious risk and perpetuates the safety crisis for care organizations, caregivers and their patients.

Equipment Can Help

To encourage caregiver compliance with Safe Patient Handling principles, Wy’East offers a variety of affordable devices designed for the general patient population. Click on the following links to learn more:

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Inexpensive, disposal friction-reducing devices such as slip sheets Transfer chairs Standing assists and lifts

Your Wy’East representative will be happy to discuss these tools with you, and also help you locate firms in your area that rent equipment for accommodating occasional extremely heavy patients. In this way you need not add significantly to your Safe Patient Handling budget, but simply reallocate spending to achieve the maximum benefit.

In Summary

Safe Patient Handling has become an important theme for a reason. Too many nursing careers are cut short by musculoskeletal injuries, and too many hospitals are feeling the effects of compensation claims, lost productivity, and other burdens to already-tight budgets. Addressing the Critical Lift Zone is part of this equation, ensuring that your caregivers are enabled and equipped to employ safe practices routinely and to avoid risky shortcuts, all while assisting the 99%.

Evaluate and assess your practices and equipment within the context of the Critical Lift Zone. When you do, you’ll see how your healthcare facility will gain in day-to-day efficiency and your caregivers will suffer far fewer injuries.