Title: Research A general purpose bedstead for hospitals
Pages: 52 - 57
Author: James Cousins
These photographs show the prototype hospital bedstead designed and made at the Royal College of Art and based on a new specification which is discussed in this article. The prototype is shown here without backrest, safety sides or bedstripper. The design and construction of the bedstead are described in detail on pages 56 and 57.
A general purpose bedstead for hospitals
by James Cousins
Hospital beds crude devices of tubular steel and wire to elaborate pieces of power operated machinery controlled by push buttons. None, it seems, fulfils ideal requirements. The following article, by the ColD's purchasing liaison officer, describes a new attack on the problem carried out by a team at the Royal College of Art as part of an extensive research programme for King Edward Hospital Fund London.
In 1961 DESIGN discussed the problem of non-surgical hospital furniture and equipment design in a series of articles by Archie McNab (issues 152,154,157,160). The articles drew attention to the need for co-ordinated research to investigate the specific requirements for equipment with a view to rationalisation and one of the articles discussed particularly the problem of the general purpose hospital bedstead.
Some 300 variations of hospital bedsteads are said to exist in this country alone. Like most of the other furniture and equipment used in hospitals they are often designed to meet local requirements and are manufactured in small quantities in materials, and by production methods, that are available to the small manufacturer - and this tends to make economic production difficult.. It has been estimated that the total number of hospital bedsteads required each year is in the region of 20,000, of which general purpose bedsteads account for about 12,000. Rationalisation of design should offer substantial improvements in value for money.
It is unlikely that any one organisation, or hospital authority, will ever be able to say about a new bed that "this is the final solution". But the work currently being carried out by King Edward's Hospital Fund for London (of which the studies by the Royal College of Art hospital equipment group form an important part) represents the most determined and extensive effort so far made in this country to find a single specification for a general purpose bedstead that will best meet present day requiremeets in all hospitals. Before discussing the results of this work it is necessary to say something about the origins of the RCA group and its association with the King's Fund.
Establishing the research team
While the bed is the foundation of hospital treatment, it cannot be considered in complete isolation from other furniture, equipment and services, and it was the need for more information and active research in the field of nonsurgical hospital equipment that led, in 1961, to the establishment of the RCA group supported by the Nufffeld Foundation. The group was set up under the direction of Misha Black, professor of industrial design (engineering) at the college, and L. Bruce Archer was appointed research fellow. Subsequently, at varying times, others have been added to complete the full time team - Doreen Norton, nursing research, Kenneth Agnew, design research, Gillian Patterson, information research, and Gordon Cork, technician. A number of outside consultants on both the engineering and medical sides have been engaged from time to time.
From the start Mr Archer set about the task using the rigorous design methods which he has described in a series of articles for DESIGN., He was concerned first with the gathering and evaluation of information from sources all over the world, with the design of an efficient system for classification, storage and retrieval of information, and with the planning of a research programme covering a wide range of non-surgical hospital equipment. One early outcome of this programme was a new design for a ward trolley which has already been described and illustrated in the magazine (DESIGN 179/72).
This preliminary investigation was followed, early in 1963, by a study sponsored by the King's Fund, the end products of which are intended to be:
Aims of investigation
1 A report describing how equipment schedules and specifications are prepared, how the selection of equipment is made, where equipment deficiencies are, and where future research and development effort would best be directed.
2 The classification and preliminary evaluation of types of equipment as part of the procedure for the selection of equipment for a new hospital.
3 Some new equipment designs offered as better solutions to some of the more pressing needs.
The new development at West Middlesex Hospital was chosen as an experiment alcentre forthe investigations, and the RCA team has co-operated closely in its work with the architects (Robert Matthew, Johnson Marshall & Partners), with the hospital staff and with The Hospital Centre-the focal point of the research information and enquiry services of the King's Fund.
Concurrently with these developments the King's Fund, in association with the Ministry of Health, set up a working party specifically to consider the design of hospital bedsteads. The members of this working party, under the chairmanship of the Hon Mrs R. M. T. Campbell-Preston, and including the controller of the Supply Division, Ministry of Health, first met early in 1963 to try to establish what is needed to meet the requirements of a bedstead suitable for the majority of patients in a general ward. Since the RCA group was already set up to tackle problems of this type, the working party arranged for the bedstead to be chosen as one of the urgent items for the college group to study.
(1)'Systematic Method [or Designers, DESIGN 172,174,176,179,181 ,185,188
Meanwhile, the working party itself had completed its preliminary inquiries, in which information was gathered from hospital authorities and other likely sources in this country and abroad, and the ground prepared for a continuous exchange of information among all those interested in thesubject throughout the world. A list of sources of information was prepared and widely distributed early in 1963(2) and a similar list, bringing information of this kind up to date, was issued by the RCA group last July(3).
The working party also made its own analysis of the problem, a report of which appeared in November 1963.(4) Thecriteriafor judging the bedstead in this analysis were examined from the patients', purses' end doctors' points of view, but the evaluation of requirements was made in general terms without reference to dimensions or technical recommendations on construction and finishes. Requirements included comfort, convenience, safety, quietness, mobility, cleanliness, ease of maintenance, prevention of cross-infection, facilities for teaching and good appearance. It was pointed out that the bedstead is a place for diagnosis, therapeutic treatment and rehabilitation, which entails access for the bedstead to various parts of the ward and elsewhere in the hospital.
At this point, the working party tackled the problem of producing a more detailed design specification, with recommended dimensions, that would be of direct use to designers and manufacturers, including firms outside the traditional hospital equipment industry. The aim was to describe a bedstead which would be suitable for the majority (say 60 per cent) of patients being nursed in the ordinary wards of general hospitals.
New ways of gathering information
It was clear that a great deal more research was needed before a number of outstanding problems could be resolved. At the working party's request, work study officers conducted trials of bedsteads at five hospitals under ward conditions. Consultation with the medical profession and further research among published documents was carried out on an extensive scale by both the RCA team and the working party. A discussion group of the Royal College of Nursing helped with professional advice. Individual sources of information were followed up by correspondence, telephone and visits.
When these studies had been completed, it was still necessary, however, to obtain the opinion of the hospital service at large on certain questions which appeared to be incapable of resolution by other means. It was decided that the most effective way of carrying out this type of mass user research would be through the medium of television. With the co-operation of the BBC, it was agreed to try out this novel form of information gathering on a Panorama programme n February 1964. Opinions on a number of problems, which were to be demonstrated in the programme, were sought from a large sample of people in the hospital service who had been invited to watch. Some 20,000 people in 1,000 hospitals were involved, and it was hoped that "heir replies to specific questions would make it possible to present a ed specification reflecting much more general agreement about user requirements than had been possible hitherto.
In the event, the effectiveness of the idea was reduced by drastic ast minute cuts made by the BBC. The hospital staffs co-operating did, however, return much useful information, and the results of this inquiry have been published by the RCA team.(5) With a wealth of information and most of the problems sorted out, the new specification for a general purpose hospital bedstead was produced by the RCA team and published by the King's Fund in July 1964.(6)An amendment referring to the mattress length was added in October.
Major advances specified
For the first time, a design specification existed resulting from a detailed, nation-wide analysis of requirements conducted with the help of a professional design research team - a specification modestly described in its introduction as "essentially an hypothesis extensively but not entirely validated by enquiry". The specification is described in detail on the following pages, and it is sufficient here to refer only to some of the major advances over current practice.
1 Height adjustment through an unusually large range
2 Fast, hazard free and robust foot elevating facility
3 Good stability when immobilised
4 Electrostatic safety
5 Improved patient support characteristics
6 Improved cleaning characteristics
The specification is, of course, available to any firm that wishes to submit prototypes for evaluation by the King's Fund, and it is expected that when this article is published, several manufacturers' designs will have been inspected. It was always the intention, however, that the RCA team should design and build its own prototype, since it was felt that certain problems could only be resolved in the actual design of the hardware and by further study of a prototype during subsequent validation trials. This prototype has now been built and is illustrated in this article. Its construction is primarily of sheet metal, folded and welded, and this would allow production by a wide range of industries. Domestic appliance firms wishing to diversify, for example, would have all the necessary facilities, as would many other firms using sheet metal fabrication processes. The cost of the bed has not been a predominant consideration for the RCA team at this stage, since it was felt that the first priority was to arrive at a design which was an optimum interpretation of the user requirements set out in the specification. It could thus be used as a basis for comparison with other designs submitted, though it should tee pointed out that the high cost of such things as power operation for the lift and tilt mechanisms have been avoided.
Designs submitted by manufacturers, together with the RCA's own design, will initially be assessed against a check list based on the design specification. Those considered likely to be satisfactory will be chosen for validation trials under ward conditions. The trials will begin this month and after a suitable period, probably six months, a final selection will be made of designs qualifying for approval. The ultimate criteria will be based on the cost of the bedstead in relation to its effectiveness in meeting the ideal specification.
(2) inquiry into the Design of Hospital Bedsteads: List of Known Studies, The Hospital Centre, King Edward's Hospital Fund for London, March 1963
(3) Report no 16, General Purpose Hospital Bedstead: List of Sources of Information, Royal College of Art, July 1964
(4) Notes on Characteristics of a Hospital Bedstead Suitable for the Majority of Patients in a General Ward, The Hospital Centre, King Edward's Hospital Fund for London November 1963
(5) Report no 10, Results of a Television Enquiry on Certain Features of the Hospital Bedstead, Royal College of Art, June 1964
(6) Report no 15, General Purpose Hospital Bedstead; User Requirements, Royal College of Art, published by the working party on the design of the hospital bedstead, The Hospital Centre, King Edward's Hospital Fund for London, July 1964
However interesting this project may be as an exercise in the application of advanced techniques to design research, the proof of the pudding will be in the eating. The validation trials will reveal any weaknesses in the specification and any shortcomings in its terpretation. The final verdict must therefore await the completion of the trials,when we hope to publish a further report.
If the result is a success, then it will count for more than a useful step forward in the modernisation of Britain's hospitals. It will point e way to rationalisation in many other activities which serve the national interest- in building, in transport, in corporate buying over a ide area. It will prove the value of rigorous design methods in approaching problems that have been obscured by prejudice or have seemed too big or complex to be worth tackling. It will have hammered one more substantial nail into the coffin of those whose idea of industrial design begins and ends with appearance. It will demonstrate convincingly the new role which colleges of art can play in creative research of all kinds. But perhaps most important of all, it will show how investment in research can result in substantial gains in value for money, particularly where large sums of public money are involved. As such it should provide a case study for ministerial and other purchasing authorities.
THE GENERAL PURPOSE HOSPITAL BEDSTEAD: USER REQUIREMENTS
The following list of requirements is abstracted from Report No 15, prepared by the Royal College of Art research team and adopted and published by the King's Fund working party at the Hospital Centre.
This specification is set out on the basis of the following list of bed elements:
1 mattress or pad
2 mattress support
7 safety sides
9 other features
In any particular design the functions of one element may be shared. The list of elements is thererefore provided for convenience in describing the user amenities required and does not imply that the bed must be constructed from exactly these sub-assemblies.
Mattress or pad element
The design of the mattress is not in the brief. For the purposes of the bedstead specification, therefore, no radical departures from conventional practice in mattress construction are envisaged. Nevertheless, serious consideration of the mattress specification is necessary in order lo determine the most suitable base. The function of the mattress or pad is to contribute to a posturally correct, comfortable and hygienic surface for the patient to lie or sit on. The length of the mattress should be 6 ft 5 inches. The width of the mattress should be 2ft 10inches - 3 ft. The uncompressed mattress should not materially exceed 4 inches in thickness. The mattress must be suitable for use on the mattress support element.
Mattress support element
The function of the mattress support is to carry the mattress, retain it in position, and contribute to good posture. It must also provide a 'tucking in' surface for the bedclothes The length of the mattress support (defined as the in-bed clearance between head and foot) should be 6 ft 7 inches. It should be capable of occasional extension to 7 ft 2 inches. The mattress support should be as narrow as possible, but should not be less than the width of the mattress. There should be a minimum structural depth below the side edges of the mattress. There should also be a similar clearance under the mattress support at the head end. The mattress support should be flat and rigid, with minimum interruption consistent with ventilation of the mattress and drainage.
The function of the frame is to position and retain the mattress support in space, and relate to it most of the amenities of the bed. It should provide means of positioning the mattress (with support) horizontally, between two limits. These limits should be: a low position from floor to top of mattress of 18 inches, and a high position from floor to top of mattress of up to 36 inches. The feasibility of using pedal-drive to obtain this adjustment should be considered. Height adjustment movement that increases the overall length of the bed should be avoided. The frame element must provide a foot-high tilt of 12ø, with not less than two intermediate positions. The effect of the tilt should not bring the height of the mattress top at the head to less than 24 inches from the floor. Head-high tilt is not essential but should be provided where this does not add to the total cost. Tilt and height adjustment should be independent and mutually compatible over their respective fulI ranges. The frame must embody means for smooth mobility of the bed at least within ward areas. The bed should be readily immobilised, and when immobile it must be rigidly stable. It should inhibit transmission of vibration and mild collision shock to the patient. It should provide clearance for the feet and legs of people working at the bed or propelling it. It should provide floor clearance for cleaning and passage over small articles on the floor when being propelled. It should have stowing space for safety sides. It should be capable of receiving a variety of attachable auxiliaries.
The function of the headpiece is to protect the patient's head and retain the pillows. It also acts as a handrail. It must permit rapid unobstructed access to the patient, from the head end of the bed. It should be a continuous surface.
The function of the footpiece is to protect the patient's feet. It also acts as a handrail. When dismounted, it must leave no obstruction to the use of a stretcher or to bedmaking. It could be a continuous surface.
The function of the backrest is to support the upper part of the patient's body and head at angles from the horizontal.
It must permit rapied unobstructed access to the patient from the head end of the bed. It should be capable of providing support for postures from the semi-recumbent to the fully upright. The adjustment of the back support must be compatible with foot-high tilt over the full ranges of these movements. It should provide means for retaining any padding necessary for the patient's comfort. It should allow for the possible presence of drainage tubes etc. Its use should cause the minimum disturbance for the patient and effort for the attendant. It should not push the patient away from the head end of the bed. It should be capable of operation from both sides.
The function of the safety sides is to prevent the patient from accidentally rolling or sliding off his mattress. The height above the level of the top of the mattress should be 10 inches-12 inches. The safety sides should be three quarters of the length of the mattress, readily attached and detached, readily hinged or slid away, stowable within the bed structure but not forming an obstruction to the attendant.
The function of the bed stripper is to provide a temporary resting place for bedclothes when the bed is being remade. It should be provided as part of the bed structure and it should be capable of holding all the bed clothes clear of the floor.
There must be adequate protection, on the bed, against impact or abrasion damage to the bed itself or to other objects.
Special overall characteristics
Anti-static: it must not be possible for static electric charges to accumulate anywhere on the bed. Cleaning and disinfection: the number of surfaces should be kept to a minimum. Crevices, sharp internal corners, and areas where moisture can accumulate or stand should be avoided. Materials and methods of construction which can inhale and exhale airborne particles should be avoided. Materials which could support micro-organic life should be avoided. Materials and methods of construction should permit the use of liquid or vaporous disinfectants.
THE GENERAL PURPOSE HOSPITAL BEDSTEAD: DESCRIPTION OF RCA DESIGN
The RCA design is built mainly from sheet metal, folded and welded. The mattress platform is a plain metal sheet, pierced with 14 one-inch diameter holes for ventilation of he mattress. This platform is stiffened by an dge frame and cross-members. There is a rim to retain the mattress. The platform is upported by a pair of arms which provide a ertical height adjustment of 18 inches. Both rms are simultaneously moved by a single ydraulic jack, pedal operated. The pedal aids aside when not in use.
In addition, the foot end of the mattress latform can be raised through 12ø. This is independent of the height adjustment. When raised the foot end carries one of the main rms with it, the relative movement being controlled by a non-return extensible prop. A trigger device beneath the bed foot releases the automatic locking gear on the rop when the tilt is to be reduced or the bed returned to level. The bottom pivot points of he arms and the hydraulic jack are carried by a chassis borne on four castors.
The castors are a new design, based on the Sheppard castor, specially developed by Archibald Kenrick and Sons Ltd to the RCA specification.. The castors are sprung, but operation of the brake lever locks the vertical springing, as well as rolling and castoring, actions.
At the foot end of the mattress platform is a demountable footpiece with handrail. The footpiece lifts and hinges outwards to form a temporary resting place for bedclothes when the bed is being re-made.
At the head end of the mattress platform is a demountable headpiece. This consists of a handrail and an adjustable angle backrest.
The backrest is a plain surface with spring-clamp fixings for straps to hold pillows in position. Any strip material can be used. Alternatively, slots in the backrest will retain pillows if the ends are tucked in. The backrest is locked in position against the mattress by a non-return extensible prop. The backrest can be pulled out to any angle up to, say, 30ø from vertical without effort, locking automatically. A trigger device releases the locking gear when the back rest is to be made more upright. For low angles of recline up to, say, 15ø from horizontal, a section of the mattress support hinges upwards. The mattress platform can be extended to accommodate talI patients by pulling out an extension piece at the head end, carrying with it the headpiece and back rest. The resulting gap behind the head end of the mattress is filled by a hinged panel, ultimately covered by the pillows. Separate safety sides are provided, and when attached will enclose or partly enclose the sides of the bed at will. They hinge down for temporary access to the bed. Safety sides can be stowed in recesses under the mattress platform when not in use.
A bumper strip protects the perimeter. The whole is detailed so that the number of surfaces for cleaning is at a minimum, and so that crevices and places where moisture can lie are avoided.
The finish is calculated to resist attack by organic and inorganic substances or by abrasion and impact. The colour is light stone to give a neutral background for observation of the patient's colour, etc. and to assist cleaning and hygiene.
The outside of the footpiece is patterned and in another colour to provide visual relief for patients on the opposite side of the ward.
The Royal College of Art design
In many ways the new design is surprisingly like a conventional bed. This is intentional. One of the functions of the bed is to give the patient a feeling of security and familiarity. On the other hand, the mattress platform raises and lowers, or can be tilted, for the convenience of the patient or the attendant. The Redhead and footpiece can be swiftly removed, so that the bed will resemble an examination couch or an operating table. Cot sides can also be attached, to enclose in safety a restless, confused or disabled patient. There are sockets for drip-poles and other attachments. The footpiece hinges and slides out to form a shelf, level with the top of the mattress, to take the bedclothes when the bed is being remade. And the whole is mobile, electrically continuous (to prevent the accumulation of static electrical charges) and easily disinfected. Two of the notable features are the extra-thin mattress and the dual backrest.
The four principal attitudes of the bed: 1, at sitting height for the patient to get into or out of bed; 2, at normal nursing height, with the platform level and backrest in use; 3, at workbench height for examination or treatment; and 4, with tilt for resuscitation or postural drainage.