Creating a Barrier-Free Practice

According to the 2000 Census, the number of people in the United States with some form of disability is about 54 million, and the number with a severe disability is close to 27 million. The percentage of older adults is also increasing. Aging adults represented 12 percent of the population in 1997; they will represent 20 percent of the population by 2030. The obesity percentage among U.S. adults also continues to rise and is currently at 30 percent.

For many of these people, a visit to the doctor’s office can be very stressful. Many also fail to receive adequate care because of accessibility issues. As this issue draws increased attention within the industry and at a national level, physicians are starting to understand that they can measure up to the needs of their patients and provide them with accessibility, dignity, safety and comfort by creating a barrier-free practice.

Breaking Down the Barriers

The growing importance of accessibility and its effect on quality of care is fueling an industry drive to break down barriers in the exam and procedure room, allowing for an equality in healthcare that has been non-existent in the past.

As part of this drive, healthcare organizations and patient and advocacy groups around the country have come together in recent years to bring attention to this issue and help physicians and patients understand the importance of a barrier-free practice. One such effort is the annual National Patient Accessibility Week (NPAW), which is celebrated annually Nov. 1-7.

Supported by agencies such as the Department of Veterans Affairs (VA), the Disability Rights Education and Defense Fund (DREDF), the American Council of the Blind (ACB), the Breast Health Access for Women with Disabilities (BHAWD) and Midmark Corp., the focus of this national education campaign is to increase the awareness that healthcare providers need and are obligated by law to have accessible, barrier-free facilities for patients who have disabilities, as well as patients with other mobility concerns, including the elderly and obese populations.

The VA, in particular, is leading the charge in providing accessible healthcare facilities. With 155 medical centers in the United States, 400-plus sites of care and more than 5 million people receiving healthcare in VA facilities each year, the VA is funding a major initiative to improve the quality and access of healthcare for its patients.

“The VA is taking a very proactive approach to accessible healthcare,” says Audrey Nelson, PhD, director of patient safety for the VA. “For example, last year we funded a $205 million initiative to upgrade our ambulatory care clinics with height-adjustable exam tables, ceiling mounted lifts, bariatric equipment and other devices to create equal access to care for all patients.”

The Benefits of a Barrier-Free Practice

By providing an accessible healthcare environment that works for everyone, healthcare providers improve the quality of patient care as well as the quality of their patients’ lives. Full accessibility also greatly improves patient safety and patient outcomes, as well as productivity and profitability for the medical practice.

An accessible environment can often mean the difference between a very successful and growing practice and one that is barely surviving. This is why it should be an important component during the design and layout of any examination or procedure room and office. It should also be a consideration during any equipment purchases and staff training.

The foundation for any efficient and successful practice is the level of comfort and safety provided by the facility, especially its exam and procedure rooms. For patients, the level of comfort can directly influence their level of anxiety and help ease “white-coat syndrome.”

From a business standpoint, the perception of the patient and the reputation of the healthcare practice are very important. The more pleasant the patient experience, the more likely it is that they will not only return for other procedures; they may even recommend these services to a friend or family member.

The Procedure Table/Chair

The procedure table or chair is the one piece of equipment in a practice that touches nearly every patient. For this reason, it plays a very important role in the accessibility of the practice.

With the average age of patients on the rise, it is more likely that patients may need assistance in accessing an exam or procedure table. In many facilities, the burden falls on staff to lift or assist the patient. This sort of patient/staff interaction has a high potential for serious injury to one or both of the parties involved.

The most important feature of a barrier-free table is that it should be able to lower to a height of less than 20 inches so patients are able to get on it with little or no assistance. Being able to easily get onto a procedure table can increase a patient’s comfort, help the physician conduct a more thorough and accurate exam or procedure, decrease potential for staff back injuries and increase the satisfaction level of the overall patient experience.

Barrier-free tables also reduce the likelihood of distress and injury to patients who are elderly, disabled, obese or even pregnant who may have difficulty in accessing a standard procedure table.

A Barrier-Free Checklist

Other areas to keep in mind when assessing whether a facility is accessible include the following:

1. Parking lot and building entrance: The facility should have designated handicap parking spaces that are fully accessible with easy access to the building. There should also be ramps in the parking lot to access walkways and ramps for level building entrances.
2. Signage: In addition to the already required ADA accessible signage, all public, commercial and private parking lots should have a “Van Accessible” sign. One of every eight spaces should ideally have an eight-foot aisle to accommodate van users. There now are even signs that designate a facility as “barrier-free.”
3. Doorways and hallways: The doorways and hallways should be wide enough to allow for access and easy maneuvering by those in wheelchairs or utilizing mobility devices. Handrails can also provide assistance for the mobility impaired in hallways and ramped areas.
4. Waiting areas and reception desk counters: Waiting areas should allow plenty of space for easy maneuvering of those in wheelchairs or those who use other mobility devices. Reception counters should also be accessible for those in wheelchairs. This may require the counter to be at a lower height.
5. Drinking fountains and water coolers: Drinking fountains should be at wheelchair height and easily accessible to the mobility impaired.
6. Restrooms: The facility should have accessible restrooms and dressing rooms large enough for a person using a wheelchair to easily navigate.
7. Examination/procedure rooms: The layout of the room should provide sufficient turning radius for those using wheelchairs or other mobility devices.
8. Elevators: Accessible elevators should be on an accessible route.
9. Patient materials and appointment procedures: All patient materials should be available in accessible formats for blind or visually impaired patients, and the facility should have inclusive appointment policies and procedures that provide for all types of physical and communication needs. Another consideration is the provision for the presence of sign language interpreters to enable full communication with hearing-impaired patients who use sign language
10. Staff training: Facility staff should be trained to understand and respond with respect to people with different types of disabilities and those who are mobility-impaired. Medical staff should be properly trained on how to safely assist or maneuver patients with disabilities or those who are mobility impaired.

Kurt Forsthoefel is senior product manager of medical exam products for Midmark Corp.

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