TAFP HEART OF TEXAS CHAPTER GRANT REPORT�

PARTICIPANTS AND EXPENSES IN THE $5000 GRANT

• Katie Goodfellow – now a resident pediatrics U of Cincinnati - $2000 scholarship
• Perry Blough – 4^th year medical student Dell - $1000 travel scholarship to present at AAFP student and resident conference
• Joe Ngo – instructor – Anderson High School Manufacturing Engineering program
• Steve Mendoza – instructor – practicing civil engineer in Austin community
• Senior Design Capstone Project $1000 – UT Cockrell School of Engineering Biomedical Engineering Department students – Ismene, Neil, Evan, Manini, Will, William
• (miscellaneous fabrication expenses - $1000)

SHORT ABSTRACT

�Approximately 12.1% of Americans are mobility-impaired, making it difficult for them to raise themselves onto a standard 32” medical office exam table. This process leads to patient discomfort, embarrassment, longer examination times, and risk of injuries.  Often, examination elements are not completed, and healthcare quality is compromised.

​

Adjustable exam tables offer a comprehensive solution; however, their average cost is $8000, and only 9% of U.S. clinics are so equipped. Therefore, a device to facilitate mobility-impaired patients to independently position themselves on a standard 32” exam table is needed. 

​

Through a grant from the Heart of Texas Chapter of the Texas Academy of Family Practice, a team of biomedical engineering and medical students were challenged to design a practical device to assist mobility impaired patients onto a standard exam table.  The device had to be compact enough to fit in an exam room, be mobile, safely handle loads up to 400 lbs, and be safe from risk of falls. The final product met FDA medical device standards and could be built from easily obtained low cost commercially available materials and reached the stage of readiness to move to a step of practical production, marketability, and human testing.

��

JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION - AUG 27, 2024

“The third viewpoint by doctors Iazoni and Stein is titled New Rules Requiring Accessible Medical Diagnostic Equipment, and it is the first update to Section 504, Disability Civil Rights Regulations. The authors discuss how patients with substantial mobility disability often do not receive routine services such as vital signs and weight due to inaccessible medical diagnostic equipment.��In September 2023, the Office for Civil Rights, US. Department of Health and Human Services announced its intentions to update regulations relating to Section 504 to prohibit disability discrimination in specific health care settings, child welfare, and other human services. Although new Section 504 regulations may impose upfront costs, potential long-term savings might result from reducing staff injuries, and persons with mobility disability will finally have accurate weight measurements and safe transfers onto examination tables or chairs, thus improving their experiences and quality of care.”��From JAMA Editors' Summary: Continuous Antibiotic Infusions for Sepsis, Obstetric Ultrasound with AI, Firearm Policy in Hospitals, and more, Aug 27, 2024�https://podcasts.apple.com/us/podcast/jama-editors-summary/id128978076?i=1000666803624�This material may be protected by copyright.

DAY 1

DAY 30

TEAMING UP WITH ANDERSON HIGH SCHOOL

THE “MAKER” COMMUNITY

COMPUTER ASSISTED LASER METAL CUTTER

WELDING AND CNC MACHINING

AND THERE YOU HAVE IT

A COMPLETED PROTOTYPE

ITERATION 1.0

SELECTED TO BE A POSTER PRESENTATION AT THE UT BIODESIGN INNOVATION SHOWCASE

SELECTED AS ONE OF 50 �PRIMARY RESEARCH POSTERS

The American Academy of Family Physicians (AAFP) National Conference for Family Medicine Residents and Medical Students August 1–3, 2024 in Kansas City, MO.

FUTURE DIRECTIONS

• Conclusions and Future Directions

​

This project addresses a major barrier to care identified both nationally as well as within our local community. Through multidisciplinary collaboration, we were able to develop a novel medical device to address patient mobility impairment that prioritizes safety, ease of use, and affordability. This device incorporates a scissor lift as a means of lifting a patient from the ground to a height of 32”, equivalent to the height of a standard patient exam table. Through extensive testing and refinement, the design was determined to be safe, posing minimal risk to the patient or healthcare provider; portable; and affordable, meeting the project budget of $1000.   

​

​

Future plans include human testing with IRB approval. Production feasibility and marketing projections have been created.

​

Future work will address designing our device to accommodate a wheelchair. One potential solution for this challenge is designing a collapsible and expandable base that can more readily navigate the clinic environment. This design is being prepared for future prototyping. 

• An additional consideration for future work is developing solutions for addressing the transfer of patients from their vehicle to the clinic.
• ��

REFERENCES

• References
• �[1] CDC. Disability Impacts All of Us Infographic. Centers for Disease Control and Prevention. Published May 15, 2023. Accessed November 21, 2023. https://www.cdc.gov/ncbddd/disabilityandhealth/infographic-disability-impacts-all.html
• �[2] Maragh-Bass AC, Griffin JM, Phelan S, Finney LJ, Morris MA. Healthcare provider perceptions of accessible exam tables in primary care: Implementation and benefits to patients with and without disabilities. Disability and Health Journal. 2018;11(1):155-160. doi:https://doi.org/10.1016/j.dhjo.2017.04.005
• �[3] Iezzoni LI, McCarthy EP, Davis RB, Siebens H. Mobility impairments and use of screening and preventive services. American Journal of Public Health. 2000;90(6):955-961. doi:https://doi.org/10.2105/ajph.90.6.955
• �[4] Molly Follette Story, Schwier E, June Isaacson Kailes. Perspectives of patients with disabilities on the accessibility of medical equipment: Examination tables, imaging equipment, medical chairs, and weight scales. Disability and Health Journal. 2009;2(4):169-179.e1. doi:https://doi.org/10.1016/j.dhjo.2009.05.003
• �[5] Morris MA, Maragh-Bass AC, Griffin JM, Finney LJ, Lagu T, Phelan S. Use of Accessible Examination Tables in the Primary Care Setting: A Survey of Physical Evaluations and Patient Attitudes. Journal of General Internal Medicine. 2017;32(12):1342-1348. doi:https://doi.org/10.1007/s11606-017-4155-2
• �[6] Hughes RG. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Published 2020. Accessed November 21, 2023. https://pubmed.ncbi.nlm.nih.gov/21328752/
• �[7] Fragala G. Benefits Achieved for Patients Through Application of Height-Adjustable Examination Tables - Guy Fragala, Manon Labreche, Patti Wawzynieki, 2017. Journal of Patient Experience. Published 2017. Accessed November 21, 2023. https://journals.sagepub.com/doi/10.1177/2374373517706835
• �[8] Access to Subspecialty Care for Patients With Mobility Impairment: A Survey: Annals of Internal Medicine: Vol 158, No 6. Annals of Internal Medicine. Published 2013. Accessed November 21, 2023. https://www.acpjournals.org/doi/10.7326/0003-4819-158-6-201303190-00003
• �[9] Americans with Disabilities Act Title III Regulations. ADA.gov. Published March 8, 2012. Accessed November 21, 2023. https://www.ada.gov/law-and-regs/title-iii-regulations/

DETAILS

• Community Project
• Project/program description
• According to the CDC, mobility impairment results in challenges such as difficulty walking or climbing stairs for approximately 12.1% of the U.S. population [1]. Consequently, within the clinical environment, the impact of mobility impairment extends to creating barriers that affect the quality of care. These barriers manifest in various ways, including the presence of less accessible medical equipment, a potential decrease in the frequency of patient visits, and a reduction in preventative examinations [2]. This limited accessibility contributes to a concerning trend where individuals with mobility impairments receive comparatively fewer preventive care services than their counterparts without mobility limitations [3].
• �A significant, but unacknowledged, barrier to adequate care stems from the inaccessibility of the standard patient medical office examination table to mobility impaired patients, leading to an increase in costs, risks, and efforts of medical staff involved in transferring patients onto the exam table. These barriers significantly impede the ability to conduct thorough physical examinations on these patients. For instance, a primary focus of research regarding the impact of patient mobility impairment is the accessibility of breast screening where studies show that non-ambulatory patients were 3.24 times less likely to receive a mammography examination in comparison to ambulatory patients [4]. Similarly, within the primary care setting, a study of physical examinations showed that patients reporting a disability were 27% less likely to be examined on the patient exam table [5]. The mobility-impaired patient becomes an “untouchable” in the hurried physician’s office, excluded from all the intangible benefits of the healing touch of the physician’s exam, the respect of level eye contact from the height of the exam table, and the security that a thorough evaluation took place in their care.  
• �In addition to inadequate examination, mobility-impaired patients are at risk for falls and subsequent injury in the clinical environment when transferring to the exam table. Specifically, fractures and head trauma are a common result of falls within the clinical environment. While medical professionals are prepared to provide assistance, risk of patient or staff injury due to falls, which affect 700,000 - 1 million patients in U.S. hospitals every year, can result in questions of malpractice [6]. As a result, to mitigate liability and decrease the risk of falls, over 50% of medical practices in one survey recommended that mobility-impaired patients bring someone along to assist them during their appointments [7]. However, this reduction of patient independence subsequently affects the ability of mobility impaired patients to visit clinics and receive adequate healthcare.
• �While various solutions with varying efficacy exist to improve healthcare accessibility, the prevalence of these solutions is questionable. Adjustable height exam tables or patient lifts, for instance, were reported in only 9% of clinics in a study of endocrinology, gynecology, orthopedic surgery, and other specialty clinics throughout the U.S. [8]. This illustrates the limitations of the capabilities of clinics to serve the patient population, and the failure to meet the criteria of the Americans with Disabilities Act (ADA). These clinics, classified as public accommodations, are required to adhere to Title III of the ADA mandating accommodations for disabled individuals to provide equal access to services [9]. As part of these obligations, equal access to physical examinations and accommodations to reduce risk of patient falls must be implemented. Unfortunately, clinics are falling short of both their ADA obligations and the needs of their patients. Adjustable height examination tables offer a comprehensive solution, but their average cost of $8000 reflects a burden most clinics are unable to bear [8]. Therefore, there is a need for a device aiding mobility-impaired patients to independently position themselves on a standard 32” exam table, alleviating the discomfort, duration, and effort of this process.
• �In order to assess whether patient mobility is recognized as a barrier to care in our local community, we additionally surveyed local primary care physicians regarding their experiences with patient mobility impairment. Of physicians surveyed, over 60% stated that they almost never transfer wheelchair-bound patients onto an exam table during their visit. Additionally, just over 10% of physicians reported having an adjustable height examination table available for patient use in their clinic, and nearly 90% of physicians stated they limit their physical examination of patients at least once a week due to mobility constraints.
• ��

MORE DETAILS

• Objectives/purpose
• In our project, we are seeking to address the transfer of mobility-impaired patients onto exam tables through the development of a lift system. In collaboration with a team of undergraduate biomedical engineering students at The University of Texas at Austin and with funding through a grant by the Heart of Texas Chapter of the Texas Academy of Family Practice, we developed a novel patient transfer device. Our proposed device aims to facilitate safe and efficient patient movement onto exam tables at an affordable cost while considering patient and physician needs. 
• �Methodology
• Prior to development of a prototype design, a needs assessment was conducted in which healthcare professionals within a community medical group were surveyed regarding their experiences assisting patients onto exam tables and estimated percentage of examinations deferred due to inability to transfer a patient onto an exam table. Criteria regarding device cost, duration of operation, portability, and storage size were included to further assess user needs.
• Following the needs assessment, a Pugh Matrix was developed comparing 5 conceptual designs and a standard bariatric patient lift against a set of criteria of engineering requirements determined in collaboration with the engineering students. Potential conceptual solutions were distinguished through consideration of their ability to resolve the following questions: (1) how might we raise and lower patients from the floor to the exam table, and vice versa; (2) how might we ensure safety and stability during this process; and (3) how might we accommodate patients with limited mobility, bariatric patients, and patients in wheelchairs? 
• Following selection of a prototype design, technical specifications for construction of a model were selected based on predetermined engineering requirements and tested within computer-aided-design (CAD) programs Autodesk and Solidworks. Once a technically sound design was finalized, construction was initiated by the team of engineering students with a goal of maintaining a production cost of less than $1000. The final design underwent numerous iterations to address limitations identified in testing, such as stability concerns. 
• ��

EVEN MORE DETAILS

• Applicants Role in Project
• Perry Blough, the primary author, is a third-year medical student at Dell Medical School at the University of Texas-Austin pursuing a career in internal medicine. He is interested in making healthcare more accessible for all patients, particularly within the primary care environment, as well emphasizing proactive healthcare as a means of improving patient wellbeing, resilience, and overall quality of care. He is simultaneously pursuing a masters degree in educational psychology at the University of Texas-Austin in order to address gaps in both patient and medical trainee learning. Perry served as a consultant to the team of engineering students, assisting with needs assessment, patient and provider outreach, and design evaluation.
• Katherine Goodfellow is a graduating fourth-year medical student at Dell Medical School. She has a B.S. in Biomechanical Engineering from the Cockrell School of Engineering at the University of Texas at Austin.  She is also finalizing a masters degree in education at the University of Texas.
• Will Hurley is a senior completing his undergraduate degree in biomedical engineering at the University of Texas-Austin. He is enrolled in medical school to begin in July, 2024. He assisted with this project as part of his Senior Capstone project. He assisted in technical calculations, mathematical modeling, conceptual design, and model construction and testing. 
• Dr. Larry Kravitz is a board-certified family physician and Affiliate Faculty in the Department of Population Health at Dell Medical School. He is the recipient of the Heart of Texas Chapter of the Texas Academy of Family Practice grant to create the proposed medical device for mobility-impaired patients. He serves as faculty sponsor for the University of Texas Cockrell School of Engineering Capstone Senior Design Project.
• ��

EVEN ADDITIONAL MORE DETAILS

• Results
• The initial needs assessment identified five “must-have” and five “nice-to-have” criteria for consideration as part of the conceptual product design. The “must-have” criteria included (1) device cost <$1000, (2) a load capacity of at least 400 pounds, (3) a maximum height of 12 inches for transfer to an exam bed, (4) meet sufficient safety criteria such as employing guardrails and safety locks, and (5) be portable and easily transferable between exam rooms. The “nice-to-have” criteria included wheelchair accessibility, (2) prompt assembly/disassembly, (3) ability to facilitate patient transfer in under 2 minutes, (4) integrate remote control functionality, and (5) be designed for easy cleaning and maintenance.
• Initial modeling yielded a Pugh Matrix comparing 5 potential design concepts, and a standard bariatric patient lift, against numerous criteria, including compliance with the previously listed “must-have” and “nice-to-have” criteria. The concept that received the highest score in the Pugh Matrix was a standing platform with a scissor lift. Other concepts, such as the use of a hydraulic or pneumatic lift, were considered overly expensive and unable to meet accessibility and ease of use criteria. The most significant shortcoming of the scissor lift was an inability to accommodate a wheelchair. However, all conceptual proposals were determined to be unable to accommodate a wheelchair due to excessive size requirements that would hinder its portability and ease of use in the usual 10’ x 10’ exam room with a 32” wide doorway. 
• Early prototypes revealed concerns regarding stability of the device associated with the scissor lift component. The final design overcame these challenges by addition of a 1/2 diamond to the bottom of the scissor lift and establishing a four-point contact system to distribute weight evenly. Furthermore, introduction of a bolt-and-rail sliding mechanism facilitated increased stability of the platform as the scissor lift constricts. For uniform lifting, a gear belt was installed that connects to the screws for synchronized movement. All stability and load testing was conducted through CAD simulations and testing via small-scale bridge shake tests and Instron tensile testing, respectively. The final design’s power train is driven by a simple commercial portable rotary hand drill holstered along the device handrail. Rechargeable batteries allow operation free from an electrical cord, device portability and easy maintenance. Transport wheels were additionally included that lock as patients are lifted to exam table height.
• We were unable to design our device to accommodate a wheelchair. However, this was not a problem of device design as much as a problem with medical facility design.  The average exam room is less than 10’x10’ in size, and the door entry is usually 32” wide per minimal ADA requirement.  The average wheelchair is 25” wide and 42” in depth. If our device were to be sized to incorporate these dimensions, it would have difficulty entering an exam room and maneuvering once it entered the room, compromising portability considerations. 
• ��

THANK YOU �FOR YOUR GENEROUS GRANT

• We hope you consider it a good return on investment.
• Presentation at AAFP National Meeting
• Presentation at UT Biodesign Showcase
• Education requirements for UT BME students
• Scholarship for Dell student to pay medical school costs
• National Conference travel and presentation scholarship for Dell student
• Creation of a novel medical care device
• Collaboration with a local high school STEM program
• Leading to future work creating relevant advance in medical care