Patient Transfers & Transport

Mechanical (Hoyer) Lifts

A mechanical or hydraulic lift, commonly called a Hoyer lift, is used to transfer patients who cannot bear weight, cannot physically assist, are very heavy, or are at high fall risk. Safety points the PCT must follow every time:

• Select a sling of the correct size and type, full-body or limb-support, for the specific patient.
• Position the sling smoothly under the patient with seams facing away from the skin, spread evenly from shoulders to knees.
• Attach all straps and hooks securely to the lift bar, with hook openings facing away from the patient to prevent snagging skin or clothing.
• Lock the wheels of the lift base before raising the patient, and unlock the wheels only once the patient is safely raised and the lift needs to move.
• Raise the patient slowly, only high enough to clear surrounding surfaces, and never leave a patient suspended in the sling unattended.
• Use at least two caregivers whenever possible: one operates the lift while the other guides and supports the patient.
• Lower the patient slowly and evenly onto the destination surface, and check the patient's positioning before releasing or unhooking the sling straps.

Understanding Weight-Bearing Status

Before any transfer, the PCT must know the patient's weight-bearing order, because using the wrong technique risks a fall or can reinjure a healing fracture or surgical site.

Weight-bearing status directly determines whether a patient can perform a standing pivot transfer or requires a mechanical lift or slide board instead.

Pivot and Slide-Board Transfers

A standing pivot transfer is used for a patient who can bear at least partial weight on one or both legs and has some trunk control. The PCT applies a gait belt, blocks the patient's knees and feet with their own, helps the patient stand, and pivots the patient about 90 degrees to the new surface, whether bed, chair, or commode, before lowering the patient slowly into place.

A slide (transfer) board bridges the gap between two surfaces of similar height, such as bed to wheelchair, for a patient who cannot stand or bear weight but has adequate upper-body strength. The board is positioned under the patient's hip, and the patient, or the caregiver using a scooting motion, moves across the board in small increments; the board is removed once the transfer is complete. For both pivot and slide-board transfers, locking the wheels on both surfaces and removing wheelchair armrests or footrests beforehand is essential to prevent the surfaces from shifting mid-transfer.

Stretcher and Wheelchair Transport

When transporting a patient by stretcher, always raise and secure both side rails, fasten the safety straps across the patient, and push the stretcher from the head end so the caregiver can continuously watch the patient's face for any change in condition; move at a controlled walking pace and travel feet-first except when facility protocol specifies otherwise for a particular destination. For wheelchair transport, lock the wheels before the patient transfers in or out, attach the footrests only after the patient is fully seated, and back the wheelchair into and out of elevators so the patient does not roll forward off an unlevel threshold gap.

Side Rails and Fall Prevention

Bed side rails serve two purposes: assisting a patient to reposition or turn in bed, and acting as a visual and physical safety reminder near the edge of the bed. However, side rails become a restraint issue when they are used specifically to prevent a patient from getting out of bed against their wishes; depending on facility policy, raising all rails on a bed can be considered a restraint that requires a physician's order, an individualized care plan, and ongoing documentation. Confused, agitated, or physically frail patients are at the highest risk of entrapment if the rails and mattress do not fit together properly, so the PCT should always check the care plan for that specific patient's rail order rather than raising rails by default. After completing any transfer, the PCT should leave the bed in its lowest position with the wheels locked and the call light within the patient's reach.

General Transfer Safety Checklist

• Confirm the patient's weight-bearing status and any transfer restrictions before starting.
• Apply a gait belt for any transfer that requires the patient to stand or pivot.
• Lock all wheels, including the bed, wheelchair, stretcher, and lift base, before every transfer.
• Explain the process to the patient in simple terms and get help for any patient unable to assist.
• Move at the patient's own pace, watching continuously for dizziness, pallor, or shortness of breath.
• Never operate a mechanical lift without first checking that every sling attachment point is secure.