It is always top of mind for them – the sooner they can get their patients up and moving, the sooner those patients can go home to their families. For a multi-disciplinary team of occupational and physical therapists at Henry Ford Hospital in Detroit, MI, that thought led to something truly innovative.
“We’re always brainstorming ways to make things work more smoothly – to be more efficient,” said Justine Kenyon, OTR. “But, the question we always come back to, is, how do you become more efficient without sacrificing safety?”
Kenyon is part of a five-member team, tasked with caring for critical care patients in the hospital’s MICU unit. The team is also part of an early rehab program, armed with a mountain of evidence that suggests early mobilization, especially of mechanically ventilated ICU patients, has a huge impact on outcomes – decreased ventilator days and overall length of stay, fewer occurrences of blood clots or pulmonary embolisms, as well as a reduction in the overall cost of care.
“The evidence is overwhelming,” said the team’s supervisor, Adele Myszenski, MPT. “The problem is, getting a patient up and around the unit with a traditional walker or wheelchair can take three people or more. It can also be extremely time consuming, especially if the patient has multiple lines and equipment to manage.”
“There are a few products out there already, fancy walkers that can do more than the traditional ones,” said Kenyon. “But, they can cost thousands of dollars and even they can’t do everything we want them to do.”
So, the team set out to design and build their own customized walker, with the help of Henry Ford Innovations, a business unit within Henry Ford Health System, dedicated, in part, to helping employees take ideas like this and bring them into reality. The team met several times with a designer, talking through what it would take to build a walker that could manage a patient and his or her equipment safely, while also reducing the time and number of therapists needed to perform the task.
Product designer and licensing associate, Eric Myers, put all five team members through a rigorous design process. “I had them identify the need, analyze products that are already on the market, and then, go home and actually draw the solution.”
“He literally gave us homework,” said Kara Luplow, OTR. “I can’t draw to save my life, but one thing I’m really good at is making lists.” Luplow wrote down everything she thought a customized walker needed to have for her patients: a walking mechanism with an easily accessible brake, a seat for the patient to sit down and rest, equipment to manage IV poles, oxygen tanks, multiple lines, and a highly visible location for monitoring systems including telemetry. “But, I didn’t stop there. It also needed extras, like a tray that we could get close enough to a sink, and, easy toilet access. Even though our patients are in the hospital, as occupational therapists, we still do everything we can within that environment to simulate their lives at home.”
Another team member, Romina Bello, DPT, did actually draw a walker, focusing on one part in particular: flexible tubing that could manage not just massive lines, but, also, could move as the patient moves. “The flexible tubing was key. If something is going to happen mid-treatment and someone is going down, that tubing comes down with the patient. Everything stays intact.”
All five team members brought their designs and wish lists to the Henry Ford Innovations’ “MakeWell” space, an area on the main hospital campus, filled with tools and materials, dedicated to rapid prototyping by therapists, nurses, physicians, housekeepers, anyone with an idea for how to improve a task or customize something for a patient. Four hours later, they’d built a rough prototype from materials like PVC pipe and other plastics.
“The design process was awesome,” said Tiji Sebastian, PT. “It was a wonderful opportunity to use our experience to solve problems. We often face many difficulties in mobilizing patients, and this allowed us to identify those concerns and look for alternatives. It was truly thinking beyond traditional patient care.”
“We learned more from that exercise than anything else,” said Myers. “There is true problem-solving in the actual building. I did a lot of listening that day. My job then, was, to take everything these therapists needed and apply it to a professionally designed, working prototype.”
The team is calling that engineered prototype a “high acuity walker.” It’s painted Henry Ford blue and currently the “talk of the town” on the therapists’ MICU unit. The walker has traditional handles but also a seat if the patient needs to rest during the trip. It can hold an IV pole and oxygen tanks, and, manage multiple lines. The braking system is easily accessible and the entire walker collapses and folds for storage on the unit. It can support the weight of up to 400 pounds. And, certainly not to be forgotten, it has a flexible tube made from material traditionally used for industrial coolant that can manage multiple lines and move with the patient.
“Eric’s prototype exceeded our expectations,” said Myszenski.
For Luplow, having the chance to be part of something so innovative was exhilarating. Speaking about the build day, she said, “I’ve never felt more accomplished. One of the biggest challenges for us in OT school, was to find a need, to be creative and build things. I vividly remember an assignment – we had to craft something with just $4 and a trip to a home improvement store. To come here and execute this walker idea with Eric and the team was so meaningful – it gave me that creative feeling again.”
“For me, the building process allowed me to almost take the place of the patient,” said Bello, “how it would feel to be in the walker and having to use it. It really helped me process what worked and what didn’t.”
All that said, ask any member of the team what the best thing about this whole project was, and, they’ll take you back to the first patient who used it, a woman named Anne, who came to Henry Ford Hospital under acute respiratory distress. Luplow said she was a perfect candidate to try the walker. “She was fairly mobile, but wouldn’t have been able to do many steps because of the multiple lines.”
Luplow and Bello wanted her to do one full lap around the MICU unit, about 400 feet. The two of them positioned her in the walker, along with all of her equipment, including full ventilator support with ET tube, an arterial line to measure her blood pressure, a central venous line, two peripheral IV’s, a foley catheter, two oxygen tanks, and a telemetry monitor. It took just five minutes – and off they went.
“It was like a parade,” said Luplow. “When we got her out into the hall, every single nurse in the unit was standing there watching. They were cheering her on and clapping for her, and, she was waving back at them. It gave us chills.”
Bello said the patient did need to stop and sit down a few times, but, loved the feeling the walker provided, from start to finish. “It was a real humanizing experience for her. She was able to choose to be part of this project, and, with only two of us there with her, she could maintain much of the control. She was so happy and I think using that walker reaffirmed to her that she would be OK and could do all of this at home.”
“What I value most about this walker is that I can mobilize my patients safely with less manpower,” said Sebastian. “I can mobilize both vented and non-vented patients with multiple lines and I can do it with just the help of one or two therapists at most.” It’s certainly welcome news for all of them, since their unit is quickly growing from 12 beds to 68 beds.
The team recently received approval for a six-month study with the walker at Henry Ford Hospital. They’ll measure things like patients’ gait speed and distance, and, the number of therapists it takes for each task. Myszenski says everyone is fairly certain the results will be positive. “We’re obviously so excited about the walker, but, our whole early rehab program is so much bigger than just that – it’s about empowering therapists to go beyond our capabilities to help these critically ill patients.”
“I have patients that celebrate being able to brush their teeth,” said Kenyon, “things we take for granted. It’s a small thing to all of us, but, huge for them. This whole experience has been such an encouragement for all of us.”