By Jodie Tillman
c.2014 Tampa Bay Times@
TAMPA When St. Joseph's Hospital unveiled its new emergency room in July, officials touted its modern additions, from bedside ultrasound machines to cellphone charging stations.
But the new feature that says even more about American health care? A treatment room for obese patients, complete with a larger bed, floor-mounted commodes and scales and a lift that can hoist a person weighing up to 1,000 pounds.
It's the latest example of how hospitals here and elsewhere are investing in design and equipment that can better serve the increasing number of severely obese patients while also protecting health care workers from injury caused by lifting these patients. That also means buying items such as bigger operating tables, recliners and CT scanners and longer needles for drawing blood.
The trend began more than a decade ago when bariatric surgeries to help people lose weight took off and hospitals needed to accommodate those larger patients. In 2010, an industry group published its first set of architectural guidelines that included bariatric design principles from the width of doorways to the weight capacity of furniture.
Florida requires new hospital projects since March 2012 to incorporate many of these features, including at least one special "bariatric" room in ER projects. A survey of hospitals nationwide, released in February by Texas health care supplier Novation LLC, found a quarter of respondents had invested in physical renovations to accommodate severely obese patients in the past year.
Nearly every hospital has adapted in some way, such as keeping larger blood pressure cuffs on hand or renting heavy-capacity beds if they have time to plan, said Cathy Denning, senior vice president for Novation's sourcing operations. However, it's not unusual for hospitals to still be playing catch up. "Every year we see facilities that recognize their elevators aren't big enough," she said.
For several years, area hospitals, including St. Joseph's and Tampa General, have had beds that support patients up to 1,000 pounds. In its critical care unit, for instance, St. Joseph's has a room that include ceiling lifts capable of moving the heaviest patients from their wheelchairs to the bed. And nurses needing to insert an IV have a special sonogram device that locates veins in patients with excessive body fat.
But finding equipment and beds for severely obese emergency patients can be a scramble, something that should be remedied by the ER's special bariatric room, said Patricia Donnelly, vice president of patient care services for St. Joseph's. The room is being temporarily used for trauma patients until October.
"You make do," she said. "But to be prepared and treat the patient with dignity is the right thing."
More than a third of American adults are considered obese, meaning they have a body mass index of at least 30, according to the federal Centers for Disease Control and Prevention. For a 5-foot-8 person, that would be about 200 pounds.
Close to 15 percent of Americans are classified as morbidly or severely obese, which means their BMI exceeds 40. That would be about 260 pounds for a 5-foot-8 person.
Hospitals routinely see patients that large. St. Joseph's Hospital, for instance, typically sees patients weighing more than 400 pounds once a week, said Donnelly. Patients weighing more than 600 pounds are rare.
Every hospital will get these larger patients, either due to an emergency such as a heart attack, or a scheduled admission for surgery, said Dr. Raul Rosenthal, an officer of the American Society for Metabolic and Bariatric Surgery. He is chairman of the department of general surgery at Cleveland Clinic Florida.
"You need to make sure you have the proper equipment and tools to take care of these people," Rosenthal said
The special equipment comes, of course, with higher price tags. St. Joseph's, for instance, estimates that equipping a standard patient room costs about $24,000. By contrast, a bariatric room costs around $55,000 to equip. That difference is due to the beds ($12,000 for a standard versus $32,000 for a bariatric) as well as the cost of a ceiling lift.
But early investment will pay off, said Doug Erickson, a Little Rock, Ark., engineer who chairs a committee that drafts recommendations for the nonprofit Facilities Guidelines Institute. Hospitals are having a harder time when they find they need to retrofit their facilities.
"We know that sooner or later you will have someone who will require the larger accommodations," he said.
Access to health care is one of the most pressing problems facing people with obesity, said Joe Nadglowski, chief executive of Obesity Action Coalition, a national advocacy group based in Tampa.
Obese patients may delay seeing a health care provider for routine medical care and so may be much sicker when they finally do seek care. They may also be less likely to receive certain health tests, such as Pap tests, breast exams and pelvic exams.
They face challenges in hospitals that range from inconvenient to humiliating. Hospitals must weigh patients because many medications are dosed according to weight. But sometimes that has meant taking patients who exceed the capacity of standard medical scales out to the freight docks for weighing, a psychologically demeaning experience, he said.
"You want them to go to the doctors but if you turn them off they're not going to go," he said.
Industry guidelines also were developed as a response to other issues, such as back problems among nurses and orderlies who must move heavy patients, said Erickson. The guidelines are flexible, depending on community demographics. For instance, he noted, a hospital in Mississippi, which has the highest obesity rates in the United States, may need more bariatric accommodations than a facility in Colorado, which has lower rates.
Fire rescue units, too, have had to adapt to serve larger patients, especially the home-bound. Hernando County and the city of Tampa, for instance, have stretchers that carry people up to 700 pounds. And Tampa has a bariatric rescue truck for the largest patients.
Hernando Assistant Fire Chief Kevin Carroll noted that the power stretchers lift automatically so that rescue workers don't have to try to lift patients.
"Our guys were hurting their backs and so we had to look at a way to make it safer for them and these patients," he said.
Nadglowski said obese people's struggles for medical care don't draw much sympathy from those who blame them for their size. That mentality, he said, ignores scientific research showing the strong role of genetics as well as emerging research suggesting other factors, including gut bacteria, may be at play, particularly when a person is carrying hundreds of extra pounds.
"I think the general perception is that we can insult or stigmatize people into losing weight," he said.
Contact Jodie Tillman at firstname.lastname@example.org or (813) 226-3374. Follow @JTillmanTimes.
Obesity-related conditions include heart disease, stroke, Type 2 diabetes and certain types of cancer, some of the leading causes of preventable death.
The estimated annual medical cost of obesity in the United States in 2008 U.S. dollars
Additional medical costs for people who are obese compared with those of normal weight
Portion of health care spending that obesity-related expenses will account for by 2018
Sources: The Centers for Disease Control and Prevention and the National Collaborative on Childhood Obesity Research