How you can make your exam room more accessible

Gone are the days when physicians had no other option than to force their patients to climb up onto an uncomfortable fixed height, 32-inch-high examination table - a setting that often limits accessibility, hinders the clinical exam and contributes to white coat syndrome. Think about how intimidating and undignified that experience might be.

Changes in the healthcare industry (e.g., shifting demographics, technology advances, value-based reimbursement) are helping evolve and redefine the examination table as a clinical hub where diagnostics, patient engagement and treatment intersect to help improve the quality of care delivered.

In many ambulatory settings, there is no longer even an exam table but rather a comfortable exam chair that blends the requirements of a clinical device and the design elements of a piece of furniture. Exam chairs are designed to be patient centered, enhancing patient comfort while allowing caregivers to remain in the proper working position throughout exams and procedures.

Having a height adjustable examination chair, particularly one that combines the functionality of a clinical device with various comfort design elements of a chair, can make a huge difference in keeping physicians safe while providing a high quality of care for patients, especially those with mobility limitations.

Impact on the patient

Traditionally, fixed-height, box-type tables were used in exam rooms. The standard height of tables is about 32 inches while the height of a common wheelchair seat is approximately 18 inches. That 14-inch difference means wheelchair users and patients with other mobility limitations often are not able to transfer onto the table without assistance. That can create an obstacle to care.  

In a 2013 survey published in the Annals of Internal Medicine, 54 percent of practice administrators acknowledged that when providers examined patients with disabilities, they skipped parts of an exam when they encountered a barrier. Further, 76 percent of practice administrators indicated that patients were examined in their wheelchairs when they could not transfer onto an exam table.

When physicians are unable to perform an appropriate examination because patients cannot transfer onto an examination or procedural table or chair, patients may be misdiagnosed because the physician may not have enough information. Alternatively, patients might miss the benefit of early detection of a serious developing condition. By providing accessible-friendly seating that allows for a more comprehensive examination, physicians can also reduce their exposure to professional liability.

I recently worked with colleagues to measure the exertion required to get up onto a fixed height examination table. We also measured patients’ risk of falling and the difficulty patients encountered when mounting the tables. Our research found all patients use less exertion with height adjustable examination chairs. This benefit was even greater for patients who have mobility limitations. In fact, patients reported feeling safer when attempting to mount a height adjustable examination chair versus a fixed height table.

Impact on the physician

In addition to the difficulty encountered by patients, fixed height examination tables can present further problems for physicians and other providers. Assisting a dependent patient, whether in a wheelchair or from a standing position, up onto a fixed height examination table is a difficult and demanding task. It also places physicians, family and staff at risk of suffering a back injury or musculoskeletal disorder.

Results from another study I conducted indicated that through application of height-adjustable examination chairs, the difficult and high occupational risk activity of assisting patients up onto an examination table can be made safer and easier for caregivers to perform. Caregivers, using a subjective Borg scale, reported that significantly lower perceived physical exertion was required to perform the task with a height adjustable examination chair.

As a result of facilitating the task of assisting patients up onto an examination table or chair, physicians may be more likely to comply with protocols for examinations in ambulatory care settings as they can have better access to patients. Physicians are also less likely to become fatigued over the course of the day if they can be comfortable and maintain a good posture while examining or treating patients. This could result in improved quality of care and better outcomes for patients.

Employing the concepts of safe patient handling and adding adjustable exam chairs, that can be lowered to the average high of a wheelchair, results in better experience for everyone.

Guy Fragala, PhD, PE, has more than 45 years of experience as a healthcare professional and is a recognized international expert in the application of ergonomics to the healthcare setting.  He has been one of the pioneers for safe patient handling and mobility in this country. Fragala's study was sponsored by Midmark.