Article: Leaving Slings and Other Transfer Devices Under Patients: A Clinical Decision Support Quality Improvement Project
Year Published: January 2025
Please click the link below:
If not automatically directed on the PDF file just click Download PDF file on the Headings tab.
For documents located in SharePoint Site (CA SJ Wound and Ostomy) look for the article and click it to open. March 2026 - Leaving Slings and Other Transfer Devices Under Patients.
Don't forget to write your name with each posting.
What are the advantages to the proposed recommendations in the article?
ReplyDelete- Healthcare staff considers multiple factors when making decision whether to leave the slings or transfer devices under the patient. Considerations include patient’s characteristics such as medical history, current condition, skin integrity and mobility level and patient’s preference. Also in consideration is the material characteristics such as breathabililty, thickness and manufacturer’s guidelines. These findings show that there is no universal guidance for and against leaving sling and transfer device under the patient. Different opinions regarding the risk versus the benefit led to the recommendation of the importance of further research and quality improvement. Another recommendation is further research to determine how staff understanding and opinions related to leaving sling and transfer devices under patient might differ by discipline or role type and how that affect patients pressure injury rates. Greater understandings and communication of the risk for pressure injury by leaving slings and transfer devices under under patient could lead to better clinical practice and decrease in hospital acquired pressure injury.
Discuss the limitations of the article.
-Findings of sling and transfer device practices were evaluated at facility level rather than unit level. Variations in actual unit practice may have led to different observations. The lack of information for specific patients and specific body location did not provide analysis for specific sling or transfer device and pressure injury body site location.
Method: The purpose of this quality improvement project was to develop guidance for safe patient handling and mobility efforts to prevent pressure injuries with the Veterans Health Administration when slings and other transfer devices are left under patients. To accomplish this, activities were conducted between Oct 2019-Sept 2021 using a mixed methods rapid assessment approach. Objectives were to 1) collect data about common practices at VHA facilities related to leaving slings under patients, 2) examine reported patient transfer practices and associations with rates of inpatient pressure injuries, and 3) evaluate current practices against best available evidence to develop guidance about safely using slings to reduce PI and skin injury risk. Data collection techniques were cross-sectional surveys, EHR review and qualitative interviews. The goals of the qualitative interview guide were to identify 1) how slings are used in the interviewees facility and 2) perceptions of safe sling and transfer device use and how these practices influence skin health and PI risk. These interviews were co-facilitated virtually by 2 trained qualitative evaluators and lasted for up to 1 hour with audio and video recordings with interviewee consent.
ReplyDeleteLimitations: While selection of unit-specific outcomes allowed for a more precise examination of PI outcomes, patient transfer practices were evaluated at the facility level. Variations in actual unit practice may have led to slight differences in observed associations. Most unit-level PI outcomes were non-normally distributed, which limited the ability to observe significant effects. Pressure Injury outcomes were aggregated at either unit or facility level and did not specify body site location for observed PIs, which prohibited any analyses for specific sling/ transfer device type and pressure injury body location. Within the scope of this project, qualitative data were minimally analyzed by role type, however date suggests that role type ,ay influence staff perceptions of the risks and benefits, and decision—making processes associated with leaving slings and other transfer devices under patients.
what are the advantages and disadvantages to the proposed recommendations in the article?
ReplyDeleteSome advantages of the proposed recommendation include improved patient safety, more consistent and standardized transfer practices, reduced risk of staff injury, and better clinical decision-making through guided use of appropriate transfer devices. However, disadvantages include reliance on adequate staffing and availability of equipment, the need for additional training, potential workflow disruptions, and difficulty consistently following recommendations in busy or understaffed clinical settings.
Discuss the sample size used in the study.
The study used a relatively small, unit-based sample typical of a quality improvement project, which limits how generalizable the findings are to other settings or larger populations. While the sample size was sufficient to evaluate changes within the specific unit and demonstrate improvements in practice, it may not fully represent diverse patient populations or different hospital environments, and results should be interpreted with this limitation in mind.
How does this research article compare to our practice, policy, and procedure? On my floor slings and other transfer devices like slide sheets are never left under the patient. As soon as a patient is transferred or repositioned the sling or transfer device is promptly removed. I prefer this method because it only takes a few moments to position the sling or slide sheets and then there is no worry of complication or pressure injury in between uses. In the research article it seems that a lot of subjective reasoning is used instead of a concrete flow sheet or algorithm and I don’t believe this is the best evidence based practice.
ReplyDeleteWhat are the advantages and disadvantages to the proposed recommendations in the article? In this article it seems that a lot of the decision making is left to the caregivers subjective reasoning without hard guidelines. I believe this is a disadvantage as it could lead to a caregiver prioritizing their own convenience over optimal patient outcomes. I feel that preventing a pressure injury saves a lot more time in the long run than a few moments of properly placing a sling. The advantage however is that for some patients excessive movement to place and remove a sling could present a danger if they were clinically unstable it might be best to limit unnecessary position changes.
ReplyDeleteMarch article: Leaving Slings and Other Transfer Devices Under Patients: A Clinical Decision Support Quality Improvement Project
ReplyDeleteQuestion # 1: Discuss the research question or main problem discussed in the study?
The article's evidence suggested that sling and transfer device use is a cause of hospital-acquired pressure injuries, and therefore skin protection must be considered when using these devices. The Veterans Health Administration facilities utilize fabric slings with safe patient handling and mobility equipment for patient transfers. Knowledge or best practice regarding the safety of leaving slings under patients' skin has not been established. To address this evidence gap, the Veterans Integrated Services Network (VISN) Patient Safety Center of Inquiry (PSCI) conducted a quality improvement project to develop guidance regarding leaving slings and other transfer devices under patients and
potential for skin or pressure injury risk. The purpose of this report is to describe current use of slings and transfer devices at VHA facilities and introduce a guidance document that may be used to facilitate best practices in use of transfer equipment
Question #2: Describe the method used by the author of the study
Quality improvement project activities were conducted from October 2019 to September 2021 using a mixed-methods rapid assessment approach. The objectives were to collect data about common practices at VHA facilities related to leaving slings under patients, examine reported patient transfer practices and associations with rates of inpatient pressure
injuries, and evaluate current practices against best available evidence to develop guidance about safely using slings to reduce pressure injury and skin injury risk. The data collection techniques were cross-sectional surveys, electronic health record review, and qualitative interviews. This project was determined to be quality improvement (QI) by the James A. Haley Veterans’ Hospital Research and Development Committee and therefore exempt from additional Institutional Review Board.
The feedback on practices and perceptions related to leaving slings and other transfer devices was evaluated using online cross-sectional surveys and interviews with VHA staff. Secondary data for VHA inpatient rates of pressure injury were used to examine associations with staff-reported sling and other transfer device practices.
Bethany Sobesto
ReplyDeleteDiscuss the research question or main problem discussed in the study?
The question in this study was whether or not slings and transfer devices should he removed from beneath patients after use and within what time frame these items should be removed. This quality improvement project was done in order to decrease pressure ulcers and skin injuries from the devices mentioned. Surveys and interviews were done with staff in order to find out their opinions on the matter, to find out their current practices, and to compare their practices to evidence based practice on this safety issue.
what are the advantages and disadvantages to the proposed recommendations in the article?
The advantages of leaving the sling or other transfer device beneath a patient are time efficiency and less annoyance for the patient. Leaving the device under them saves the staff time because they do not have to turn the patient to properly position the sling or device each time. It there was an emergency were the patient needed to be returned from the chair to their bed urgently, then it would save time not if the device was already under the patient. Also, sometimes the patient does not want the hassle of having to be turned each time they need to be transferred. If the device is already under them, then it saves the patient from the hassle of having to be turned to put the device under them again. The disadvantages of leaving the sling or device under the patient are the possibility of acquiring a pressure ulcer or another skin injury. Plastic or other material on the devices could cause these.
Discuss the research question or main problem discussed in the study?
ReplyDeleteThe purpose of this quality improvement project was to develop guidance for safe patient handling and mobility efforts to prevent pressure injuries within the Veterans Health Administration when slings and other transfer devices are left under patients.Leaving patient transfer slings or devices (like hoer lift slings or lateral transfer sheets )underneath a patient posses risks primarily by contributing to friction, shear and pressure injuries .However the approach depends directly on the specific device type ,manufacturer guidelines and a clinical risk assessment .Leaving devices unattended under patients increases the risk of pressure injuries .The wrinkled fabric or the device itself alters how body weight is distributed ,disrupting the microclimate of the skin (temperature and moisture)and creating stress concentrations .
What are the advantages and disadvantages to the proposed recommendations in the article?
ReplyDeleteLeaving slings and other transfer devices under patients involves a critical trade off between caregiver safety and patient skin integrity .While it eliminates physically strenuous manual lifting keeping devices in situ can significantly elevate interface pressures ,reduce the efficacy of therapeutic support mattresses and increase the risk of Pressure Injuries
Advantages
Caregiver Efficiency and Safety allows for rapid mechanical transfers without the physical strain and risk of back injuries associated with constantly repositioning and rolling patients to place slings
Patient Comfort minimizes the need for frequent turning or sliding which can be painful for patients with severe pain, fractures or extreme sensitivities .
Specialized Design Certain all day or in situ slings are designed with breathable low friction materials meant to stay under a patient for extended periods without excessive bunching
Disadvantages
Pressure Injury Risks where slings can create high interface pressures ,particularly along seams and edges ,which obstruction blood flow
Mattress interference shows leaving a sling (especially non mesh or padded types )underneath a patient interferes with the function of pressure relieving air mattresses or therapeutic support surfaces
Friction and shear which shows wrinkles bunching ,or moisture trapped beneath the device can increase friction against the skin, leading to rapid skin breakdown .
Discuss the research question or main problem discussed in the study?
ReplyDeleteSkin tears are a prevalent but often under recognized type of injury in clinical settings ,particularly affecting vulnerable patients in intensive care and surgical environment.The Descriptive study was conducted between December 2024 and April 2025with 81 Intensive care and 76 operating room nurses at a training and research hospital .The Study Data were collected face o face using a descriptive characteristics form ,the Skin Tear Knowledge Assessment Instrument (OASES). The data were analyzed using SPSS software .Descriptive statistics ,including frequency ,percentage ,mean and standard deviation, were calculated .Additionally ,independent samples t tests, one way ANOVA and regression analysis were performed .Skin Tears are traumatic common wounds often under recognized by healthcare professionals .For high acuity patients in Intensive Care Units (ICU) and Operating Rooms (OR),recognizing the causes ,classifications and proper management of skin tears is essential to preventing chronic complications and prolonged hospital stays .
1. Discuss the research questions or main problem discussed in the study.
ReplyDeleteHospitalized patients who endure pressure injuries (PIs) can experience more pain, slower recovery and therefore longer hospitalizations, as well as increased risk of sepsis and mortality. PIs are preventable one of the benchmarks of quality of care for nursing, and thus an important goal of patient safety for the Veterans Health Administration (VHA). More specifically, slings and transfer devices left for a prolonged period of time underneath patients may be a cause of hospital-acquired PI and are utilized by VHA hospitals, however there are no specific best practice protocols to govern their use. For this study, a quality improvement project is performed to try to develop specific guidance regarding proper use of these devices for the prevention of skin breakdown.
2. Discuss the limitations of the article: limited sample size, design flaws, and/or author bias.
One limitation of the study is that the PI outcomes were aggregated and not separated to differentiate which part of the body had the injury or which patient had it, making it more difficult to determine which PIs were more prevalent and which device caused more injury. Another issue is that qualitative data was collected in only 9 VHA facilities of many, limiting the ability of the study to be generalized to the larger patient population. In addition, facility-level rather than unit-level outcomes were used, and therefore more detailed data of PI outcomes was sacrificed in favor or more normal distributions which would better highlight significant effects. One last thing to consider is that survey respondents and interviewees were unable to come to a consensus on how long slings and other transfer devices could safely be left under patients to prevent pressure injuries.
Discuss the research question or main problem discussed in the study?
ReplyDeleteThe main purpose of this quality improvement project was to develop guidance for safe patient handling and mobility efforts to prevent pressure injuries within the Veterans Health Administration when slings and other transfer devices are left under patients. Pressure injuries among hospitalized patients have clinical and emotional impacts including increased pain, slower recovery, prolonged hospitalization, and increased risk for sepsis and patient mortality. Pressure injuries are considered preventable adverse events, and their prevention is an indicator of quality of care.
Discuss the sample size used in the study.
The sample size used in this study included 112 health care staff members in patient safety. The members were across 77 unique VHA facilities that responded to surveys between November and December 2019. 24 interviews were conducted using purposive sampling with VHA staff at facilities with highest and lowest PI rates between January and March 2021.
1. What are the advantages and disadvantages to the proposed recommendations in the article?
ReplyDeleteThe article recommends using clinical judgment instead of a universal policy when deciding whether to leave slings and other transfer devices under patients. One advantage of this recommendation is that it allows healthcare providers to consider each patient's individual needs, including skin condition, mobility, comfort, and overall safety. It may also reduce pain from repeated sling removal, improve staff safety during patient transfers, and make repositioning patients more efficient. However, a disadvantage is that relying on individual judgment can lead to inconsistent practices between healthcare providers and facilities. In addition, because there is limited evidence on best practices, leaving slings under patients without proper precautions may increase the risk of pressure injuries, skin breakdown, moisture buildup, and pressure caused by wrinkles or seams in the sling.
2. Describe the method used by the author of the study.
The authors used a mixed-methods quality improvement approach to examine the safety of leaving slings and transfer devices under patients. They collected data through cross-sectional online surveys completed by healthcare staff from Veterans Health Administration facilities, conducted semi-structured interviews with staff from facilities that had both high and low rates of pressure injuries, and reviewed electronic health record data from several Veterans Health Administration databases. The survey and interview data were analyzed to understand current practices and staff opinions, while statistical analyses were used to determine whether leaving slings under patients was associated with higher rates of pressure injuries.
Describe the method used by the author of the study.
ReplyDeleteA mixed methods rapid assessment approach was used for this study by using quality improvement project activities from October 2019 to September 2021. The quality improvement activities focused one several key objectives including: data collection about common practices at VHA facilities related to leaving slings under patients, examine reported patient transfer practices, and evaluate current practices against best available evidence about the use of slings preventing PIs. The data techniques used to evaluate these objectives were cross sectional surveys, electronic health record reviews and qualitative interviews with active participants within the study.
Discuss the limitations of the article: limited sample size, design flaws, and/or author bias.
The main limitation of the research article was examining sling and transfer device outcomes at the facility level rather than unit level. Not all results were evaluated at the same level and therefore can result in different results produced. The results also did not specify body site location for observed pressure injuries. This prohibited further analysis and understanding of location of pressure related injuries. All results were also only concluded at VHA facilities, rather than comparing outcomes amongst different healthcare organizations.
by Cindy Wein RN
ReplyDeleteDescribe the method used by the author of the study.
This article uses a couple of different methods. Predominantly it is a quality improvement project within the Veterans Health Administration as a patient safety initiative for the prevention of pressure injuries in patients with a transfer device equipment that is left under them throughout their hospitalization. The researchers used three methods for this study including surveys, reviews of medical records and interviews.
How does this research article compare to our practice, policy and/or procedure?
On my unit we recently concluded a trial of a new transfer device that is also left under the patients. The device was intended to assist with turning and therefore increase skin safety and prevent pressure ulcers while assisting staff with transfers and mobility in bed. This device was rolled out to the staff based on specific criteria that was in the chart and gathered upon assessment. Like all studies and trials, there are always advantages and disadvantages and more importantly limitations to the study. Without going into details about my unit’s trial and the outcome, there is always a concern that the transfer device can cause pressure ulcers unintentionally in patients.
1. Describe the method used by the author of the study
ReplyDeleteThe quality improvement project used a mixed‑methods approach, combining surveys, interviews, and existing data to understand sling‑removal practices across the VHA. The first survey had 93 staff members from 66 facilities with a follow‑up survey including 112 staff members from 77 facilities. They interviewed 27 staff members, mostly nurses and therapists, from 9 facilities chosen deliberately as they had either very high or very low pressure injury rates which helped the researchers compare different practices. The study also looked at facility level data from 132 VHA facilities to see how reported sling practices were related to actual patient outcomes.
2. what are the advantages and disadvantages to the proposed recommendations in the article?
A major advantage of using the recommended decision support tool is that it allows for a more individualized approach to patient care by considering medical histories, skin condition, and mobility. For patients who are bariatric or clinically unstable, leaving a sling in place can minimize the pain and discomfort of frequent turning while also reducing the risk of skin shearing. This practice also promotes nurse safety and efficiency because it makes it easier for staff to use handling equipment for regular repositioning.
But a significant disadvantage is the increased risk of pressure injuries, since the study showed a higher rate in both ICU and medsurg units where slings were left under patients. Relying on subjective clinical reasoning without a formal policy or protocol could lead to inconsistent practices where staff might prioritize their own convenience. There are also technical disadvantages because leaving devices under a patient can trap moisture and create high skin pressures at seams or wrinkles, which can even interfere with the performance of therapeutic air mattresses. Successful implementation of these recommendations would also require additional training and a significant focus on communication to ensure that skin risk is monitored across the care continuum.
1. What are the advantages and disadvantages of the proposed recommendations in the article?
ReplyDeleteThe recommendations encourage individualized clinical decision-making, improve patient and staff safety, and promote better communication to help prevent pressure injuries. However, they rely heavily on staff judgment, which may lead to inconsistent practices, and there is still limited research proving the safest way or length of time to leave slings under patients.
2. Discuss the research question or main problem discussed in the study.
The main problem was the lack of clear evidence and consistent guidelines about whether it is safe to leave slings and other transfer devices under patients without increasing the risk of pressure injuries. The study sought to examine current practices, staff perceptions, and the relationship between sling use and pressure injury rates to develop guidance for safer patient handling.
1. What are the advantages and disadvantages of the proposed recommendations in the article?
DeleteThe recommendations encourage individualized clinical decision-making, improve patient and staff safety, and promote better communication to help prevent pressure injuries. However, they rely heavily on staff judgment, which may lead to inconsistent practices, and there is still limited research proving the safest way or length of time to leave slings under patients. The recommendations also support a patient-centered approach by considering each patient’s mobility, skin condition, and overall health status. As additional research becomes available, these recommendations can be refined to provide more standardized and evidence-based guidance for clinical practice.
2. Discuss the research question or main problem discussed in the study.
The main problem was the lack of clear evidence and consistent guidelines about whether it is safe to leave slings and other transfer devices under patients without increasing the risk of pressure injuries. The study sought to examine current practices, staff perceptions, and the relationship between sling use and pressure injury rates to develop guidance for safer patient handling. The researchers recognized that differences in clinical practice may contribute to inconsistent patient outcomes and uncertainty among healthcare providers. Their goal was to identify best practices that balance patient comfort, safety, and the prevention of pressure injuries while supporting safe patient handling.
1. Describe the method used by the autor for the study.
ReplyDeleteA mixed-methods fast assessment methodology was employed in this quality improvement (QI) project. Information gathered between October 2019 and September 2021. The project aimed to evaluate current practices for leaving patient transfer slings under patients, look into the connection between transfer procedures and inpatient pressure injury rates, and compare current practices with the best available data in order to develop evidence-based recommendations for reducing pressure injuries and skin damage. Both quantitative and qualitative data were obtained through the use of cross-sectional surveys, electronic health record (EHR) reviews, and qualitative interviews. When the James A. Haley Veterans' Hospital Research and Development Committee determined that the trial constituted a quality improvement effort, it was exempt from Institutional Approval Board (IRB) approval.
2. Discuss the research question or main problem discussed in the study?
Preventing hospital-acquired pressure injuries (PIs) linked to the use of patient transfer slings and safe patient handling equipment was the primary issue addressed in this quality improvement effort. There was no data on the safety of leaving transfer slings under patients in between transfers, despite the fact that pressure injuries are regarded as avoidable adverse events and a crucial measure of healthcare quality. The study aimed to identify current procedures in Veterans Health Administration (VHA) hospitals, investigate the connection between the usage of sling and the risk of pressure injuries, and create evidence-based recommendations to lessen skin injuries and enhance patient safety. In the end, the initiative sought to support the VHA's objective of eradicating avoidable hospital-acquired pressure injuries while addressing the absence of defined best practices for sling use.
Ronit Malamud
Discuss the sample size used in the study.
ReplyDeleteThis study focused on making guidance for preventing pressure injuries in patients with patient transfer slings left under them. This study surveyed 112 healthcare staff across 77 VHA hospitals. They then interviewed 24 staff at VHA facilities with the highest and lowest rates of pressure injuries.
Discuss the limitations of the article: limited sample size, design flaws, and/or author bias.
Limitations of this study include variations of unit based practices which may have lead to differences in outcomes. Another limitation noted was the lack of specification of body location for pressure injuries that were observed. Finally, data was only collected from 9 facilities, greatly limiting the findings across facilities.