Several factors suggest a growing demand for health care in the foreseeable future, the greatest of which is the aging of the population. The population of the United States has aged dramatically since the beginning of this century. In 1900, only 4% of the population was 65 years or older. This number had increased to 13% of the population (or 30 million people) by 1986 and is projected to grow to 21% in 2020 and 30% in 2050 (Aging America, 1987-88).
The healthcare system will have to respond to the aging of the population. As people age they make greater use of health services than do younger persons. According to the National Health Interview Study, in 1987 the rate of discharges from short-stay hospitals was 69.2 per 1,000 population for persons 15-44 years of age, 143.3 for those 45-64, and 255.8 per 1,000 for those 65 years of age and older. If current usage rates by the elderly were to continue, the increased number of elderly persons will result in twice as many physician visits and hospital stays in the year 2020 than at present and almost three times as many elderly residents in nursing homes than the current 1.3 million (DHHS, 1987).
The elderly have health care needs ranging from preventative services to long-term care. Of special interest is the fact that advancing age brings about a decline in mobility, with significant limitations evident in the eighties and nineties. In addition to physical limitations, a significant proportion of the elderly have mental health problems, such as Alzheimer's disease and multi-infarct dementia.
Another factor that will increase demand for medical care is the AIDS epidemic. Until an effective treatment for the underlying pathological processes of this disorder is found, the symptomatic treatment of sufferers of this disease will demand the most sophisticated medical supportive care available. This demand is primarily because the disease can affect multiple organ systems and because intermittent, technologically-sophisticated treatment can take a patient from near death back to productive life.
The hospitalized patient of today generally requires a higher intensity of care than that rendered 20 years ago. Many root causes underlie this trend. Technical, diagnostic, and treatment techniques have improved to the point that many diseases and procedures, that once could only be handled in hospitals, are now handled on some form of outpatient basis. Insurance carriers often demand that certain procedures be done on an outpatient basis, thereby saving the expense of a hospital stay. Patients have never wanted to be hospitalized if good outcomes are possible with outpatient procedures and medical treatment.
The advent of all the technological advances in hospital care has added an enormous amount of equipment to each room. The hospitalized patient of today almost invariably requires .pi.specialized monitoring (cardiac, neurologic, or pulmonary), intravenous therapy, and physical assistance of some sort. Monitoring requires attachment of patient sensors that are connected by wires to a portable transmitter or directly to a monitoring device.
Because of the additional equipment which has been added to each room, current hospital environments offer too much clutter and unavailable floor space and therefore increase risk in the patient's immediate environment. Cluttered hospital rooms, combined with sick or weak patients, lead to a large number of falls in hospitals across the nation each year. The direct cost of falls in hospitals today averages about $1,500.00 per bed per year or $150,000.00 per 100 beds each year. In the United States, the fall incident average is 1.7 falls per hospital bed per year. Five percent of these falls result in some form of serious injury, such as a hip fracture. The cost of these injuries averages between $10,000.00 and $25,000.00. Each of these figures does not include the cost of liability claims, extended rehabilitation, long-term care, lost time for professional staff, or loss of goodwill. With the increase of older patients and nursing staff reductions, the number of falls will only increase.
The design of existing hospital rooms does not contribute to fall prevention. Generally, a patient utility table is in each patient room and the table serves as a surface upon which the patient may place his meal tray, carry on correspondence, work with crafts, or perform grooming tasks. The table is generally cantilevered from a side support member which is in turn supported by a four-wheeled floor base. This arrangement has been necessary because of the need to place the work surface of the table directly over the bed. The physics of the arrangement requires the dimensions of the wheeled floor base to be virtually the same as the dimensions of the table surface. The height of the table surface is adjustable so as to allow the table to be adaptable to various patient sizes, bed heights, and chair use. The main difficulty with the current patient utility tables has to do with the large supporting wheel base. These bases are very difficult to maneuver about the other objects resting upon the floor, such as bed side chests, bed supports, chair legs, and intravenous infusion (IV) stands. Since these utility tables are not used most of the time, they contribute to floor clutter and become impediments to safe ambulation.
IV therapy is now occurring in almost 85% of hospitalized patients. This therapy requires the use of IV stands. All modem hospital beds provide for the use of an IV support pole, and some rooms are equipped with IV supports hung from the wall or ceiling. The IV supports that are attached by a single point to the bed, wall, or ceiling limit severely patient mobility and are generally not used by either patient or staff. Some ceiling-supported IV systems traverse a small distance in a simple linear fashion but do not provide much patient mobility. To address the lack of mobility inherent in other forms of currently used IV stands, a steady trend in IV therapy has been the use of a wheeled IV stand. The wheeled IV stand has many of the same problems as the wheeled utility table. These problems include difficulty in maneuvering within small spaces, difficulty of storage, and interference with patient ambulation resulting from increased floor clutter caused by the presence of the devices supported directly on the floor.
Telemetry transmitters and monitoring equipment such as EKG telemetry, apnea monitors, and oximetry telemetry require the attachment of patient sensors which are connected by wires to a portable transmitter or directly to a monitoring device. Currently the patient must wrestle with these transmitters as he or she tries to rest or sleep. When walking, the patient has to be concerned with transporting the monitor or transmitter along his or her side.
An integrated, expandable system which organizes, stores, and improves the function of these different devices is definitely needed. Preferably, such a system would remove each of these devices from floor spaces in the room and allow immediate accessibility to the devices at all points in the room.
Many patients with neuromuscular diseases and degenerative central nervous system disorders suffer from decreased bed mobility. They find it difficult to turn themselves in bed, or to come to the sitting or standing position from the lying position. Currently, one of the main approaches to facilitation of independent bed mobility is the use of the orthopedic frame equipped with a trapeze. Problems with this device are that it requires installation of the frame upon the bed by an orthopedic technician and it cannot be used anywhere except over a patient's bed. The trapeze is not available for the patient to use to rise from a chair or a portable commode. There is a need to make the trapeze both accessible to all parts of the room, as well as easy to install.
Patients who have impaired ambulation or central nervous diseases which cause difficulties with imbalance now often employ walkers while in their hospital environment. These walkers function fairly well in the home environment, but in the cluttered, cramped hospital environment, they are often not maneuverable enough to offer effective assistance to the gait impaired. Thus, there is a need for a different means of offering support for the gait impaired.
In physical therapy departments, an area is generally set apart for gait training. Currently, this part of physical therapy is very labor-intensive because of the need to have ample personnel present to prevent falls. Rehabilitation of the individual with gait disability (orthopedic or neurologic) who also has significant upper extremity weakness or injury is almost impossible due to the fact that all currently used gait assistance devices require some upper extremity function and strength. For example, a person unable to support himself with his arms is generally not able to walk with the aid of a walker or some form of hand rail. There is a need for a new form of gait assistance which is both reliable and independent of help of others. The device would preferably not rely on floor support for its use.
In the current hospital environment, multiple strategies have been employed to reduce falls. Most hospitals use some form of fall prevention program. The hospitals try to identify patients who have profiles that are known to carry higher risks for suffering falls and institute an appropriate individualized response in the at-risk patient. In some cases, it is as simple as asking the patient not to get out of bed unless assistance is called. This strategy works rather well for the passive, compliant patient, but it fails miserably in the impatient individual or in the confused or forgetful individual. If trouble with compliance with the up-only-with-assistance order is anticipated, other measures may be employed. The simplest and most acceptable measure would be for the patient to be in constant attendance by either a sitter or a family member. However, sitters are expensive and an adequate number of family members is generally hard to find. In addition, human observation fails because humans are not constantly vigilant and tend to become least attentive to the patient fall problem when the problem is most likely to occur: in the middle of the night. Moreover, even the weakest patient can move very quickly at times and falls occur despite the presence of a vigilant observer. Even if the patient's fall is prevented by the observer, there is some risk of injury to the attendant as he or she physically breaks the fall.
Sophisticated monitoring devices that tell the nursing staff when the patient is up and on the move have also been employed to prevent falling. However, these monitoring devices, such as Ambulert.RTM., provide only a simple monitoring function. The devices do not prevent an occurrence, but instead only allow the remote sensing or observation of an activity. Successful fall prevention depends upon timely response by monitoring personnel and sometimes even the fastest response is not fast enough. Thus, this method of fall prevention does not function in a real time mode. Video monitoring also involves a loss of privacy that some individuals find unacceptable.
Various bed rail configurations have also been designed to confine a patient to the bed. The bed rails are user-friendly only to the care givers, and the patient is forced to defeat them in ways that often make the bed rails a threat instead of a help to a patient's safety. Patients climb around, through, and most dangerously, over bed rails to freedom. Short falls turn into dives and the corresponding injuries are more severe. The Posey vest has been implemented to tie a patient to a bed or a chair. Although this vest prevents falls, it works by extracting a tremendous price in loss of patient mobility and dignity. The loss in patient mobility causes corresponding patient morbidity. Because of decreased patient turning and repositioning, there is increased likelihood of skin breakdown due to decreased patient hygiene and pressure damage. Pulmonary toilet is diminished with diminished mobility. Finally and most tragically, the Posey vest is often misconstrued to be a form of incarceration by the individual who is being confined. The misinterpretation as to the motivation for the employment of this safety device often converts a pleasantly confused individual into a belligerent, agitated, and paranoid one. There is a need for a method of supporting a patient so that he or she may be protected from falling out of bed while asleep.
Other patient support apparatus such as patient lifts or bed scales are much less frequently employed but suffer from the same difficulties as other floor mounted devices. For example, the devices in the patents to Asakawa (U.S. Pat. No. 5,072,840) and Vail (U.S. Pat. No. 4,125,908) disclose patient lifting systems. The device in the patent to Twitchell et al. (U.S. Pat. No. 4,243,147) is also a patient lifting device but also includes three-dimensional movement while in the device. The device is intended for moving individuals who are severely afflicted or at least greatly impaired in mobility and require complete lifting. In that manner, the device serves much the same function as a wheelchair, but removes the movable support from the base floor system. The device does not provide enhanced mobility and support for patients who regularly are mobile. These devices also require the active operation of device controls by the patient or the patient's attendant. There is a need for such a device to prevent falls and to increase ambulation in already-mobile patients that operates automatically for the patient.
In summary, there is a need for organization in hospital rooms such that unneeded clutter may be removed from floors. This organization should offer safety for the patient and easy accessibility for hospital staff. In addition, there is a need for an ambulatory support system for a patient which can offer passive restraint. This support system preferably could also support the patient while moving about a room or while sleeping.
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