WHITEPAPER

The case forpowered bed transport
Matz, M., Morgan, J. (2018)

Introduction
Transporting patients in beds throughout hospitals is an ergonomically high risk patient handling task1-8 and has been rated
as one of the top patient handling tasks that result in complaints of musculoskeletal pain.9 Performing such an activity
can stress the musculoskeletal system and exceed the body’s
capabilities, frequently resulting in low back pain, spinal
problems,10 shoulder injuries 11, 12 and, in general, many of thepatient handling injuries that are found in healthcare environments.13 Ergonomic interventions are available to decrease therisk of injuries for this high risk task.
This White Paper discusses the physical impacts of transportation and resultant push/pull forces on caregivers along withsuggestions for decreasing the amount of work required fromusers by utilizing new technology such as the IndiGo drive assist.
Factors that impact push forces on caregivers are also discussed and transportation technologies are reviewed.

Ergonomics of patient transportation
Pushing and pulling excessive loads (patients) on a repeatedbasis, constitutes a high ergonomic risk, as does any task or
motion that negatively impacts the musculoskeletal system due to excessive stress or force. The spine is subject toextensive mechanical stress from both compressive and shear
forces14 but it has a greater tolerance for compressive forces
than shear. Shear force tolerance in spinal discs is nearly onethird less than compressive force tolerance. 15, 16 Examples
of compressive forces on the spine are lifting heavy objects(people) and lifting lighter weight objects for long periodsof time. Shear forces come from both lateral and anterior/posterior movements of the spine, and are an outcome fromtwisting, turning, bending, reaching, and awkward postures.

Awkward postures are due to various factors such as available
space, equipment used, number of caregivers handling thepatient, and caregiver anthropometry.17 As can be surmised,very high shear forces are common during pushing/pulling
activities.18 These high shear forces create excessive loads on
the spine and resultant injuries to the spine.
Reducing shear forces on the spine, i.e., ergonomic risks,
while transporting patients is critical. The Liberty Mutual
Manual Materials Handling Tables relayed that only 49% of
women and 65% of men can be expected to initiate a pushof a bed (weighing 800 pounds), with an average patient(weighing 200 pounds), with an average wheel diameter ofsix (6) inches, on a hard floor surface.19 To reduce the excessive ergonomic effort and push forces when transporting
patients, adaptations have been made to some beds adding
power drive features and fifth wheels. Battery-powered bed
pushing devices have also been designed to assist in bed
transport.20-22

Factors impacting forces on caregivers
during manual transportation tasks
Many factors impact ergonomic risk while caregivers aremanually transporting beds without power assistance. Whenthese factors are accounted for, as they are with the IndiGo,
forces are greatly reduced and caregiver risk of injury diminishes. Increases in the shear forces to the spine are attributable
to the following.
Lateral Transfers. The most effective injury risk control measureis elimination of a hazard.23 Transportation of patients cannot
be totally eliminated, but lateral transfers for transportation

purposes can. Use of power drive technology eliminates theneed to laterally transfer a patient from/to bed and stretcher
in order to transport them. If you can keep a patient in their
bed to move them, then you have eliminated the need for alateral transfer and the risk of injury associated with it.

safely maneuvering beds and other rolling equipment. Whena patient must be laterally transferred onto a stretcher to betransported to another area and there is insufficient space,room furniture must often be moved, putting caregivers at
high risk.

Flooring. Rolling Resistance (or surface resistance) of flooringmaterial is a critical factor related to push forces.24 It is related
to the difficulty in overcoming inertia when initially pushingor pulling a wheeled object.25 The lower the resistance, theeasier to move the object and the less work it takes.26 There is
growing concern about caregiver risk associated with the movement of patients on carpeted or padded tile surfaces, especially when performing turns.27 Flooring with soft cushioning
features has a higher rolling resistance, and is more difficult
to push over than a flooring that is less resilient, such as tile.
Other design features impact push forces and safety. Thresholds should be flush with the floor surface to facilitate safe
movement of rolling equipment. Transitions between different
adjacent floor surfaces should eliminate tripping, bumps, andstrain on staff pushing or guiding equipment and should benoticeable. Slopes should be eliminated or minimized.28

Elevator Dimensions. Elevator dimensions may prevent theuse of high-tech and bariatric beds.35 Standard elevators may
also not accommodate beds that are extended with power
drive features.

Weight of Bed. The weight of the bed impacts push forces29,
as it is the load that must overcome inertia for movement tooccur. When all else is equal, the heavier the load, the greater
the push forces required to initiate the move and sustain it.
Some beds, without a patient, weighs 800 pounds, and an
occupied bed may weigh more than 1,000 pounds.30

Bed transfers between clinical units are on the increase
according to researchers who aimed to quantify frequenciesof transfers between and within wards. Within the hospitalresearch site, they found that a patient was moved, on average, 2.4 times during their stay. Transfers between clinicalunits took an average of 42 minutes and within the unit,
11 minutes. Nurses at the site spent over 1700 hours eachmonth on transporting patients and activities related to thistask, resulting in less time to care for patients.38 Bed transportation technologies, may help facilitate reduction in timespent transporting patients and, in doing so, improve staff
efficiency by eliminating the need for lateral transfers onto
stretchers for patient transport and requiring fewer staff tobe involved in patient transportation.

Weight of Patient. The obesity rate among U.S. adults in 2015
climbed to a new high of 28.0%, up 2.5 percentage points
since 2008.31 Unfortunately, this trend continues and alreadyhigh risk patient handling tasks are greatly increased in risk
when moving heavier patients. The tasks associated with bariatric populations are more complex because of excess patient
weight and weight distribution, decreased mobility, and themany co-morbid conditions found in bariatric patients.32 In
relation to patient transport, the heavier the load, the greater
the push forces required to initiate the move and sustain it.
Additionally, the weight distribution of a heavier patient may
impact their placement and stability on a bed or other rollingdevice. Finally, with less mobility and functionality, and higher
acuity levels, bariatric patients rely more on caregiver assistance, thus increase a caregiver’s risk of injury.
Wheel/Caster design and condition. Wheel size, diameter, andcondition will affect the ease of rolling a patient bed.33, 34
Space and Clearances. Inadequate space and clearances
for performing patient handling activities such as pushinghospitals beds makes challenging tasks even more difficultand increases the risk of caregiver injury. Pushing beds is
impacted by space allowances and clearances in hallways.
For instance, if there is inadequate room to turn into apatient room, push forces are elevated. Doorway widths also
impact the ease in which beds are moved in and out of anarea. It is essential to have adequate room clearances for

Indigo Drive Assist Fitted to A Citadel Bed

Excessive Push Forces. Push forces are impacted by the above
factors. When they become excessive and exceed the maximum allowable forces found in the AORN Guidance Statement (2007), the recommendations are to reduce the weightof the load and use two or more caregivers to push the pieceof rolling equipment, or, utilize a powered transport device.36 Though good advice, few are aware of these maximum
allowable forces. An easier rule-of-thumb is that caregivers
should avoid push/pull forces greater than 20% of their own
weight.37

Bed Moving/Patient Transportation Technologies

incline and reduce acceleration when going down. However,when a bed mover is attached to a patient bed, the bed cannot
fit into most standard elevators. The device needs to be removed prior to inserting the bed into an elevator or one should
be available near the elevator on each floor.46 Storage of thisdevice can be problematic.

To reduce the excessive ergonomic effort and risk of injury
when transporting patients, adaptations have been madeto standard beds adding power features and fifth wheels.
Battery-powered bed pushing devices have also been
designed to assist in bed transport.39-44 Each has theirbenefits and challenges. Such technology, especially beds
with power drive features, are available and frequently
used with critical care and bariatric beds. However, few
medical/surgical units, although they have frequent ‘road
trips’, have beds with this power technology. Summaries ofstudies exhibiting the positive benefits of power technology are found below.

Steering assistance features such as a 5th wheel design areperceived to improved caregiver productivity during patienttransportation tasks within a patient room and when moving
down a corridor.48

When a powered hospital bed mover was trialed against
manual transport, and muscle activation was captured, nearly
all muscles tested showed lower muscle activation levels withthe bed mover. Additionally, users maintained a more upright
posture. The authors surmised that lower levels of muscle
activation may result in decreased incidence of lower backinjury.45 These bed movers facilitate pushing patients up an

Power drives, are used to facilitate movement of hospital
beds. Wiggermann (2017) conducted a study that measured
hand forces on 10 caregivers while they moved a bariatricbed manually and while using a powered drive. The powered
drive decreased peak forces between 38% (while maneuvering into an elevator) and 94% (while going down a ramp).
The powered drive also reduced stopping distance by 55%.

A robotic hospital bed mover with omni-directional mobility
demonstrated better performance than use of a manual transport stretcher. It was estimated that the robotic device halved
the force required to push hospital beds, reducing physicaldemands, requiring less manpower, and reducing back muscle
activities.47

During straight-line pushing, average hand forces did not vary
between bed designs but when maneuvering the bed, theforce was reduced by 34% when using powered drive beds.49
Insufficient numbers of beds with motorization capabilities
place staff who transport patients at a higher risk of injury
than necessary. When staff are working injured, patient
safety and quality of care are impacted. Introduction of thesedevices should be a priority for healthcare organizations.
A new power transport design, IndiGo drive assist from
Arjo, reduces work required to transport patients on their
bed to help reduce the risk of staff injury. Unlike power drive
systems the innovative design does not change the userinterface of the bed. Users push or pull the bed as usual fromany touch point and IndiGo assists movement in the direction the user wants to move. It provides drive and braking
assistance based on caregiver input as well as automatic
slope detection. Blue lights project onto the floor when thedevice is activated, letting users know the power device isoperational. Indigo is compatible with most Arjo patient bed
frame systems and attaches underneath the bed so it does
not impact any of the bed’s existing functionality. It requires
less work to move a bed with IndiGo installed and has thepotential to improve the bed transport process and improvesafety for those involved.

Testing of the IndiGo power drive system produced very positive results.
The following describes the testing protocol and outcomes.

IndiGo Testing
Protocol and Outcomes

Figure 1: Test Setup
Figure 2: Encoder System
Test Setup
Four different Arjo beds were used to evaluate the IndiGo drive
assist. The beds used were CitadelTM Bed Frame System, Enterprise™
5000X, Enterprise™ 8000X, and Enterprise™ 9000X. Each bed wasconfigured with 150mm casters and had a simulated patient load of
112 kg with a mattress and an additional accessory load of 20kg.
The bed frame was configured with a set of calibrated loadcells to record user input force into the system. A calibrated
encoder system was used to measure the speed and distancetraveled for each trial. An external trigger was fitted to the bed
to assist with start and stop of data analysis. A calibrated datalogger (GL240) was used as the interface. This test set up was
first verified using internal Standard operating procedure, SOP
requirements before being used to execute formal testing. The
same test setup up was used on each bed for all tests.

Table 1: Test Requirements and Acceptance Criteria
The initial work to accelerate a bed with a Power Assist Module (PAM) installed to a speed above 0.8m/s
1±0.15m/s within 2 ±0.2m with a load of 112 ±2kg patient weight and 20 ±2kg accessory on a hard and flathorizontal surface, shall be 15% less than a bed without PA module tested at the same parameters.
The work to decelerated a bed with a PAM installed from 1.2m/s ±0.15 to a stop within a 4.0 +0.4m distance2with a load of 112 ±2kg patient weight and 20 ±2kg accessory on a hard and flat horizontal surface, shall be
15% less than a bed without a PA module tested at the same parameters.

TRIGGERDATA LOGGER

The work to move a bed with a PAM installed with a load of 112 ±2kg patient weight and 20 ±2kg accessory
3

a distance of 4.0 +0.4m up a 3.5° +0.5° slope at a speed of 0.8m/s ±0.15m/s on a hard floor shall be <40%of a bed without PA module installed.
The work to control the speed of a bed with a PAM installed at a speed <1.4m/s at a load of 112 ±2kg and4

20 ±2kg down a 3.5° +0.5° slope a distance of 4.0m +0.4m on a hard floor shall be <40% of a bed without
PA module installed.

LOAD CELLS

Test Procedure:
Each bed was fitted with the test set up noted in Figures 1 and 2. The four requirements evaluated are listed in Table 1.
The same bed was used for both Power Assist Module (PAM) and bed without Power Assist (PA) module.
The PA module was simply deactivated to obtain “without PA module” configuration.

The figures below illustrate the procedure for each test scenario.
Figure 3: Test 1 Illustration

BACK = 45%
PATIENTLOADSEAT = 25%
PATIENTLOADLEGS = 30%
PATIENTLOAD

Figure 6 : Test 4 Illustration
PATIENT LOAD = 112 ± 2kg
ACCESSORIES LOADED = 20 ± 2kg

20kg
Acc.

WORK TO ACCELERATEWORK BED WITH INERTIA ≤ 85% x WORK BED

BACK = 45%
PATIENTLOADSEAT = 25%
PATIENTLOADLEGS = 30%
PATIENTLOAD

PATIENT LOAD = 112 ± 2kg
ACCESSORIES LOADED = 20 ± 2kg

20kg
Acc.

WORK TO DECELERATEWORK BED WITH INERTIA ≤ 60% x WORK BED

0.8 m/s≤ 1.4 m/s

2M (6.56F T)

4.0 O

Figure 4: Test 2 Illustration

BACK = 45%
PATIENTLOADSEAT = 25%
PATIENTLOADLEGS = 30%
PATIENTLOAD

Figure 7: Additional details for Test 3
PATIENT LOAD = 112 ± 2kg
ACCESSORIES LOADED = 20 ± 2kg

20kg
Acc.

PATIENT LOAD = 112 ± 2kg
ACCESSORIES LOADED = 20 ± 2kg

BACK = 45% PATIENT LOAD
LEGS = 30% PATIENT LOAD
20kg Acc.

WORK TO DECELERATEWORK BED WITH INERTIA ≤ 60% x WORK BED

WORK TO ACCELERATEWORK BED WITH INERTIA ≤ 60% x WORK BED

m/s
1.2 m/s

5f t)
4 .3 4 3m (14 .2
17 1.0 0

4M (13.12F T)

4.0 O
R AMP
ENGAG ED

Figure 5: Test 3 Illustration
BACK = 45%
PATIENTLOADSEAT = 25%
PATIENTLOADLEGS = 30%
PATIENT
LOAD

62 .00PATIENT LOAD = 112 ± 2kg
ACCESSORIES LOADED = 20 ± 2kg

20kg
Acc.

COMPLETELYON R AMP

WORK TO ACCELERATEWORK BED WITH INERTIA ≤ 60% x WORK BED

0.8 m/s

4.0 O

START

48 .0028 8.0 2 (24 f t)

178 .00

FINISH

0.508m (20in)
HEIG HT x 2 .4 384 m(96in) LONG

Data Analysis

The final percent Work reduction calculationis the mean percent Work reduction of 3 trials.

The data collected was force to move the bed, speed, distanceand time. This data was used to calculate Work (force x distance)and evaluated against other internal acceptance criteria.
Work was chosen as the baseline factor to evaluate as it is thetrue measure of how much energy is transferred from one entity
to another. Each bed ran through the testing procedure threetimes. Figures 8-11 below break the data down for each test
description.

Figure 8: Test 1 Summary Results

Table 2: Work Reduction Summary% Work Reduction

Figure 9: Test 3 Summary Results

Test

Test
Description

1

Accelerate the bedon flat surface

CitadelEnterprise
9000X

Enterprise
8000X

Enterprise
5000X

30.1%

20.5%

16.6%

29.5%

2

Decelerate the bedon flat surface

55.8%

53.6%

54.6%

50.2%

3

Accelerate the bed
up slope

60.1%

50.7%

43.1%

49.5%

4

Decelerate the bed
down slope

72.7%

64.4%

59.4%

66.9%

Target>15%
WORK REDUC TION OF BED IT SELF
VERSUS BED WITH INDIGO (PAM) - MEAN OF 3 TRIAL S

WORK REDUC TION OF BED IT SELF
VERSUS BED WITH INDIGO (PAM) - MEAN OF 3 TRIAL S
100%

(lb)

80%

1300

(lb)

30.1%

40%

29.5%
16.6%

300
246

172

199.8

140.9

176.1

146.8

20.5%
222.9

177.3

-200

20%

60.1%

1,274.3

49.5%

800
651.8

80%

1,387.9

1,257.5

50.7%

43.1%
715.3

643.4

684.2

-40%

-80%
-100%

-1700
CITADELENTERPRISE
5000

ENTERPRISE
8000

-40%

-700

-60%
-1200

-80%
-100%

-1700
CITADELENTERPRISE
9000

ENTERPRISE
5000

ENTERPRISE
8000

ENTERPRISE
9000

ACCELERATE INCLINE (4O)

PAM_WORK MEAN RUNS 1-3% WORK REDUCTION

>40%

-20%

ACCELERATE FLAT
BED_WORK MEAN RUNS 1-3

40%

0%
-200

-60%
-1200

60%

20%

300

0%
-20%

-700

1,633.1

1300

60%
800

100%

BED_WORK MEAN RUNS 1-3

PAM_WORK MEAN RUNS 1-3% WORK REDUCTION

Test Summary
When evaluating the Work reduction data of the IndiGo drive
assist on the heaviest bed frame, Citadel, it shows that it can
provide up to:• 72% work reduction when decelerating down 4 degree slopes

Figure 10: Test 2 Summary Results

Figure 11: Test 4 Summary Results• Up to 60% work reduction when accelerating up 4 degree slopes• Up to 55% work reduction when decelerating on a flat surface

WORK REDUC TION OF BED IT SELF
VERSUS BED WITH INDIGO (PAM) - MEAN OF 3 TRIAL S
100%

(lb)

80%

1300
55.8%

50.2%

54.6%

53.6%

800

20%

-128.1

100%

(lb)
1300

72.7%

66.9%

60%
40%

300

-200

WORK REDUC TION OF BED IT SELF
VERSUS BED WITH INDIGO (PAM) - MEAN OF 3 TRIAL S

64.4%-202.8-101.0-179.4-81.5-187.2

-86.9

-20%
-40%

-700

800

40%
20%

300

0%
-200

-20%

-350.5-413.0

-700

-60%
-1200

-80%
-100%

-1700
ENTERPRISE
5000

ENTERPRISE
8000

ENTERPRISE
9000

PAM_WORK MEAN RUNS 1-3-420.4-453.3-1,282.9-1,248.2

-40%
-60%

-1,035.5-1200-1,274.5

-80%
-100%

-1700
CITADELENTERPRISE
5000

ENTERPRISE
8000

ENTERPRISE
9000

DECELERATE INCLINE (4O)

DECELERATE FLAT
BED_WORK MEAN RUNS 1-3

80%
60%

0%

-56.6

CITADEL

59.4%% WORK REDUCTION

BED_WORK MEAN RUNS 1-3

PAM_WORK MEAN RUNS 1-3% WORK REDUCTION• Up to 30% work reduction when accelerating on a flat surface

Conclusion
Use of power transport devices has a tremendous impact on thesafety and efficiency of hospital work environments. Ergonomicrisk and caregiver potential for injuries are directly affectedby the decrease in push forces and the elimination of high risklateral transfer tasks associated with patient transport. Whentransporting patients on their beds, work reduction is evidenced
by fewer staff that may be required to transport patients as wellas the elimination of transport lateral transfer tasks.
The introduction of IndiGo drive assist adds to existing technology - a ‘grab anywhere’ interface that allows caregivers to movethe bed and push in any direction, delivering significant work/force reduction when accelerating,decelerating and moving up
and down slopes. Work reduction helps improve safety for caregivers during high risk bed transport and provides the possibilityof reducing the number of staff required to complete this task.
Unlike bed power drive systems used in specialist critical careand bariatric beds the introduction of new technologies such as
Indigo drive assist brings work reduction benefits to many otherdepartments in the hospital that account for the majority of a
hospital’s bed transport activities.

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manoeuvring of ceiling-based and ﬂoor-based patient transfer devices. Ergonomics.
Vol. 52, No. 3, March 2009, 384–397.
[28] Matz, M. (2010). Rationale for Including the PHAMA in the 2010 Guidelines
for Design and Construction of Health Care Facilities. In Borden, C.(Ed), Patient
Handling and Movement Assessments: A White Paper. Dallas:The Facilities
Guidelines Institute.
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between floor-based and overhead-mounted patient lifting devices. Ergonomics.
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The case for powered bed transport - Whitepaper. March 2018. Only Arjo designed parts, which are designed specifically for the purpose, should be used on the equipment
and products supplied by Arjo. As our policy is one of continuous development we reserve the right to modify designs and specifications without prior notice.
At Arjo, we are committed to improving the everyday lives of people affected by reduced mobility and age-related health challenges. With products and solutions that ensureergonomic patient handling, personal hygiene, disinfection, diagnostics, and the effective prevention of pressure ulcers and venous thromboembolism, we help professionals
across care environments to continually raise the standard of safe and dignified care. Everything we do, we do with people in mind.
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