It was July 7, , and Howard Hughes, internationally famous engineer, film director and business magnate, had just crashed an XF-11 aircraft into three California homes near the local country club. Hughes had walked away from other plane accidents, but nothing like this one. He came out with a crushed collarbone, multiple cracked ribs, a collapsed lung and third-degree burns from trying to maneuver his way up from the wreckage.

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Though Hughes didn&#;t know it, the plane crash would change his life, sending him into a spell of drug addiction and paranoia. It would also, some say, change the American hospital bed industry. 

At a nearby hospital, Hughes had a lung drained and multiple blood transfusions. But Hughes, a rich man accustomed to bending the world to his will, didn&#;t like the bed he was in. So he called in some of his own engineers from Hughes Aircraft to redesign it, reportedly equipping the bed with hot and cold running water, six moveable sections and push-button adjustments operated by electric motors. &#;I think he left in an ambulance,&#; an unnamed nurse told the Associated Press at the time, &#;but I&#;d believe it if someone told me he flew home in that bed.&#;

His kitted-out hospital bed drew widespread publicity. Some believe it kickstarted research into improved hospital bed design and spurred a swell of interest in patient comfort. Others doubt that Hughes played much of a role in the creation of the bed, or that the bed really had all the innovative features the newspapers described. After all, separating fact from fiction could be tough when it came to this playboy-turned-billionaire recluse. Even the actual date of Hughes&#; birth was disputed. 

Whether or not Hughes&#; hospital bed was as groundbreaking as reported, he wasn&#;t solely responsible for the hospital bed revolution of the mid-20th century. A confluence of factors, including newfound postwar healthcare needs, transformed the hospital bed from a place for convalescence into an FDA-approved hub for patient care, simultaneously a site for therapy, connectivity to providers and recovery-hastening comfort.

The first hospital beds

The first modified hospital bed, with adjustable rails that moved up and down, was introduced between and , according to a Journal of Physics study. Before this innovation, the hospital bed was essentially seen as a piece of furniture, looking much like a scaled-down bed for sleeping. By , the first patent for an adjustable mattress frame was registered. In , Dr. Willis D. Gatch, former chair of the surgery department at the Indiana University School of Medicine, created the gatch bed, with three separate, adjustable segments that allowed both the head and feet to be elevated. 

Over the next few decades, the medical community paid little attention to hospital beds, until the post-World War II era, when healthcare priorities shifted from preventing mass death to providing comfort to the living. With growing numbers of wounded people and veterans in chronic pain, hospitals needed better beds &#; ones that could adjust position and accommodate multiple kinds of patients, from invalids to the elderly. 

In addition to its dimensions and its focus on comfort, Howard Hughes&#; bed helped popularize using levers to position the patient, says Guillermo Fajardo-Ortiz, a surgeon at the National Autonomous University of Mexico who authored a study on the history of the hospital bed. But &#;the conventional hospital bed had already begun to be modified after two world wars, to attend to the wounded and fractured,&#; he says; at the same time, other experts in Europe and America were also playing around with the hospital bed, independently coming up with designs very similar to Hughes&#;.

One notable innovator was Dr. Marvel Beem. In , he was already selling hospitals a new kind of bed, complete with a built-in toilet and washbasin. That same year, Beem showed off his prototype push-button bed in a LIFE magazine profile. &#;Invention of Los Angeles doctor eliminates the bedpan,&#; the article trumpeted.

Hughes&#; influence

So why does Hughes get so much attention? &#;There is some conjecture that Howard Hughes saw that LIFE article and it gave him an idea,&#; says Hughes biographer Pat Broeske, who co-authored Howard Hughes: The Untold Story. &#;But I really do think he popularized the notion of the redesign of the hospital bed, and what it could do, that it can be automated.&#;

Hughes&#; notoriety made him uniquely situated to become a hospital-bed influencer; the media was transfixed with him at the time. &#;The hospital room looked like a who&#;s who of hot women in Hollywood,&#; says Broeske. &#;It was ridiculous, all the women showing up crying and wanting to see Howard.&#; 

Broeske believes that Hughes, a lifelong tinkerer, was personally involved in redesigning the bed. &#;I think Hughes worked on something that was already being invented,&#; she says. &#;There&#;s a theory sometimes that a time comes for certain inventions, which is why you see multiple inventors working on things. A need arises. Howard was a patient in pain, and he really saw the need for this hospital bed.&#;

&#;Howard Hughes&#; bed had, from the legends I&#;ve seen on the internet, lots of different motorized parts and heating and cooling and things that you&#;d see in beds today,&#; says Neal Wiggermann, research scientist at Hill-Rom, a company that&#;s been making hospital beds and other medical products for decades. &#;It&#;s a question of whether he invented those things out of thin air, or whether a lot of those ideas maybe existed but he had the means to put them together into a bed.&#;

Still, Wiggermann says he doesn&#;t think today&#;s hospital bed owes much to Hughes. &#;Maybe some of that technology had an influence somewhere, but I wouldn&#;t say there&#;s any tangible evidence of that from my perspective.&#;

After all, the user-centered design process Wiggermann uses, which involves hours of patent comfort-testing on every bed prototype, is a way to design a bed that can be functional for as many people as possible. &#;Howard Hughes could just design for one,&#; he says. &#;We have to design for all these users, with different body shapes and different patient conditions.&#;

The modern bed

Hughes may not have invented the modern hospital bed, but he did help drag the notion of patient comfort into the mainstream. But how much does today&#;s hospital owe to Hughes&#; prototype?

After the news coverage died down, Hughes left behind the world of hospital bed redesign forever. A footnote in Richard Hack&#;s biography claims that the mattress was eventually discovered in , unused, in a storage locker at Hughes Aircraft.

But while Hughes retreated from the world, the world of hospital bed redesigning had just gotten started. By , controls allowing for upward and downward movement began to appear, and by , Hill-Rom designed the first bed with an electric engine. By , the company built its first bed with full electrical functioning. By , hospital beds had side rails with built-in control pads. The s focused on hospital bed mattresses, equipping them with motion detectors and devices to summon nurses. By , an electric bed for use at home was invented, and by , industry standards for hospital beds were put in place to prevent accidents.

The latest FDA-approved hospital beds can measure a patient&#;s heart and respiratory rates without any connecting wires or leads. The bed can detect if the patient is starting to exit and alert nurses. Some beds can detect incontinence and help turn patients to prevent bed sores.

According to Wiggermann, the hospital bed will keep getting smarter, until it can predict patient behavior and outcomes, down to how long a patient might be convalescing. The bed of the future is one that prioritizes patient comfort, just like Hughes might have wanted.

&#;Other technology might come and go,&#; Wiggermann says. &#;[Other] things that you see in an ICU room right now might be obsolete in decades, but there&#;s always going to be a bed.&#;

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Bed designed for hospital patients

A modern hospital bed at public hospital at Hong Kong Hospital beds per people

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A hospital bed or hospital cot is a bed specially designed for hospitalized patients or others in need of some form of health care. These beds have special features both for the comfort and well-being of the patient and for the convenience of health care workers. Common features include adjustable height for the entire bed, the head, and the feet, adjustable side rails, and electronic buttons to operate both the bed and other nearby electronic devices.

Hospital beds and other similar types of beds such as nursing care beds are used not only in hospitals, but in other health care facilities and settings, such as nursing homes, assisted living facilities, outpatient clinics, and in home health care.

While the term hospital bed can refer to the actual bed, the term bed is also used to describe the amount of space in a health care facility, as the capacity for the number of patients at the facility is measured in available "beds".

There are various pros and cons for the different types of hospital beds, depending on the functions and features available, among other factors.[2]

History

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Beds with adjustable side rails first appeared in Britain some time between and .[3]

In the mattress company Andrew Wuest and Son, Cincinnati, Ohio, registered a patent for a type of mattress frame with a hinged head that could be elevated, a predecessor of the modern day hospital bed.[4]

The modern 3-segment adjustable hospital bed was invented by Willis Dew Gatch, chair of the Department of Surgery at the Indiana University School of Medicine, in the early 20th century. This type of bed is sometimes referred to as the Gatch Bed.[3]

The modern push-button hospital bed was invented in , and it originally included a built-in toilet in hopes of eliminating the bedpan.[5]

Modern features

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Hospital beds at the Hospital Regional de Apatzingán in Apatzingán, Michoacán, Mexico

Alternating pressure mattress

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Alternating pressure mattresses use computer-controlled pumps to inflate and deflate automatically in order to lower the risk of bed sores.[6]

Bed exit alarm

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Many modern hospital beds are able to feature a bed exit alarm whereby a pressure pad on or in the mattress arms an audible alert when a weight such as a patient is placed on it, and activating the full alarm once this weight is removed. This is helpful to hospital staff or caregivers monitoring any number of patients from a distance (such as a nurse's station) as the alarm will trigger in the event of a patient (especially the elderly or memory impaired) falling out of the bed or wandering off unsupervised. This alarm can be emitted solely from the bed itself or connected to the nurse call bell/light or hospital /paging system.[7] Also some beds can feature a multi-zone bed exit alarm which can alert the staff when the patient start moving in the bed and before the actual exit which is necessary for some cases.

CPR function

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In the event of the bed occupant suddenly requiring cardiopulmonary resuscitation, some hospital beds offer a CPR function in the form of a button or lever which when activated flattens the bed platform and put it in lowest height and deflates and flattens the bed's air mattress (if installed) creating a flat hard surface necessary for CPR administration.[8]

Elevation

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Beds can be raised and lowered at the head, feet, and their entire height. While on older beds this is done with cranks usually found at the foot of the bed, on modern beds this feature is electronic.

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Today, while a fully electric bed has many features that are electronic, a semi-electric bed has two motors, one to raise the head, and the other to raise the foot.[9]

Raising the head (known as a Fowler's position) can provide some benefits to the patient, the staff, or both. The Fowler's position is used for sitting the patient upright for feeding or certain other activities, or in some patients, can ease breathing, or may be beneficial to the patient for other reasons.[9]

Raising the feet can help ease movement of the patient toward the headboard and may also be necessary for certain conditions.

Raising and lowering the height of the bed can help bring the bed to a comfortable level for the patient to get in and out of bed, or for caregivers to work with the patient.

There are 5 function beds which comes with many functions such as head elevation, foot elevation, Trendelenburg, reverse Trendelenburg positions with height adjustment options.[10] These type of beds are typically used in ICUs and for patients who are high dependent.

Side rails

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Beds have side rails that can be raised or lowered. These rails, which serve as protection for the patient and sometimes can make the patient feel more secure, can also include the buttons used for their operation by staff and patients to move the bed, call the nurse, or even control the television.[11]

There are many types of side rails to serve different purposes. While some are simply to prevent patient falls, others have equipment that can aid the patient themself without physically confining the patient to bed.

Side rails, if not built properly, can be of risk for patient entrapment. In the United States, more than 300 deaths were reported as a result of this between and .[12] As a result, the Food and Drug Administration has set guidelines regarding the safety of side rails.[13]

In some cases, use of the rails may require a physician's order (depending on local laws and the policies of the facility where they are used) as rails may be considered a form of medical restraint.

Specialist beds

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Many specialist hospital beds are also produced to effectively treat different injuries. These include standing beds, turning beds and legacy beds. These are usually used to treat back and spinal injuries as well as severe trauma.

Tilting

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Some advanced beds are equipped with columns which help tilt the bed to 15&#;30 degrees on each side. Such tilting can help prevent pressure ulcers for the patient, and help caregivers to do their daily tasks with less of a risk of back injuries.[14]

Wheels

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Wheels enable easy movement of the bed, either within parts of the facility in which they are located, or within the room. Sometimes movement of the bed a few inches to a few feet may be necessary in patient care.

Wheels are lockable. For safety, wheels can be locked when transferring the patient in or out of the bed.[15]

Disadvantages

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Cost

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A hospital bed can cost over US$.00; on average with different costs associated with completely manual functions, 2-motor functions and fully electric 3-motor functions (whole bed going up and down). Other costs are associated with bariatric heavy duty models that also offer extra width.[16]

Effect on health of patients

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Hospital beds can make a patient's spine more rounded because a patient who sits up a lot, such as when watching television, tends to slip down.[17] Some of the category a bed manufacturers are providing their beds with a built-in function which acts as an anti-slip. LINET is providing Ergoframe while others have different names.[18]

Safety

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During the s, patient safety had been a concern with hospital beds.

In , a 3-year-old Milwaukee girl hospitalized for pneumonia was killed when crushed by a mechanical hospital bed.[19]

In , an 11-year-old Illinois boy was strangled to death by a hospital bed.[20]

See also

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References

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