Quality Care
| QUICK TAKE>>> |
| The growing obesity epidemic is pervasive throughout the United States and has in turn placed a financial strain on hospitals. In this article, Kathy Pelczarski, associate director of the Applied Solutions Group, ECRI, provides insight as to how hospitals can predict more accurately the number and types of bariatric products they will need. There are many different factors to consider including assessing a hospital’s local population and determining whether it is more advantageous to rent or purchase products. |
Every health care facility is faced with the challenge of meeting the special equipment needs of extremely obese or bariatric patients. Materials management departments play a critical role in addressing this challenge. They are charged with ensuring that the appropriate equipment is acquired and is readily available, that the amount of equipment matches demand and that equipment needs are met cost effectively. Meeting bariatric equipment needs are not limited to hospitals with bariatric surgical programs. In reality, no health care facility is exempt. To further complicate equipment readiness, hospitals are unable to predict when an extremely obese patient may require care at their emergency department.
Bariatrics is the science of providing health care for extremely obese patients. Bariatric patients often require more health care.
This may be attributed, in part, to the fact that obesity is associated with numerous comorbidities, including asthma, diabetes, hypertension, sleep apnea, atherosclerotic vascular disease, heart disease, joint and back disease, gout, hyperlipidemia, depression and stress incontinence. The number of obese Americans continues to rise.
Therefore, hospitals need to make sure they have appropriate equipment on-hand to meet the needs of this patient population. Consider the following:
- Twenty-five percent of the world’s population (1.7 billion) is overweight (BMI=25–29.9) and 312 million are obese (BMI over 30kg), according to the International Obesity Task Force, May 2004.
- According to the 2004 Institute of Medicine report on preventing childhood obesity, approximately 9 million children older than 6 years are obese.
- Bariatric surgery as a weight-loss technique soared from 16,000 cases in 1992 to 103,000 in 2004; correspondingly, bariatric surgery centers continue to multiply.
- According to the CDC’s Behavioral Risk Factor Surveillance System, in 2005, 17 states had obesity prevalence rates equal to or greater than 25 percent, with three of those having prevalence equal to or greater than 30 percent. Only four states had obesity prevalence rates less than 20 percent.
Having a 400-pound individual in the emergency room has become a routine occurrence for many hospitals, yet hospitals continue to be caught unprepared. It’s not uncommon for an extremely obese patient to be weighed on a freight elevator because a hospital doesn’t have a patient scale with sufficient weight capacity. Basic care, such as taking a patient’s blood pressure may be impossible if the only available blood pressure cuff is too small to fit around a patient’s arm.
At many hospitals, staff still struggle to transfer a patient from a bed to a chair because no patient transfer aids or lifts are available. This practice constitutes a significant risk of serious injury to both patients and staff.
Know the population
Evaluate your patient population to determine the anticipated volume of extremely obese patients and corresponding equipment that will be in demand. This can be accomplished through careful consideration of patient demographics, baseline versus peak census demands, services offered and by gathering clinician input on equipment specifications.
Next, assess the existing inventory of equipment to determine if it is adequate to meet the needs of extremely obese patients. It’s essential to assess the existing inventory through the continuum of hospital care, including any department that is likely to care for extremely obese patients (e.g., emergency department, diagnostic imaging rooms, patient rooms, ORs, recovery areas).
Specifically, it is essential to identify the weight loading capacity and size specifications of all relevant equipment to determine its adequacy for use with bariatric patients. This assessment should be compared with the anticipated volume of extremely obese patients and projected demand to determine the estimated quantities of additional and/or specialized equipment that may be needed.
In assessing existing equipment or acquiring additional equipment, it’s important to keep in mind that one size does not fit all. Many vendors characterize their product offerings as bariatric, even though weight limits may vary significantly among models. For example, several wheelchair models that are categorized by vendors as “bariatric” have varying weight capacities of 400 pounds, 450 pounds, 600 pounds and 850 pounds.
Only the 600-pound or 850-pound capacity bariatric wheelchairs are suitable for a patient that weights 525 pounds. Depending on a hospital’s patient population, the model that would meet the needs of most bariatric patients should be selected. For example, if throughout a year, a hospital is likely to care for many patients in the 400- to 500-pound range, but the hospital has not had patients that weigh more than 550 pounds, it may be prudent to select the 600-pound capacity wheelchair. If a larger wheelchair is needed only on rare occasions, it may make the most sense to have a prearranged rental agreement in place.
Considering obesity statistics, it is prudent for all hospitals to have the following basic bariatric medical equipment readily available:
- Patient lifts are available as either portable lifts or fixed lifts. Portable lifts provide greater flexibility because they can be moved from room to room. Portable lifts should be strategically placed for easy access. Fixed lifts usually have an overhead track system and may be best suited for for dedicated bariatric units.
- Lateral transfer aids can be used to move a patient from a bed to operating room table or stretcher or to reposition a patient in a bed. Size and weight capacity must be sufficient to accommodate individual patients. Standard slide boards are not safe for use with bariatric patients.
- Bariatric wheelchairs are essential. In addition to ensuring sufficient size and weight capacity, it is important to check the ergonomics for easy movement with a full weight load.
- Stretchers’ size and weight capacity must be sufficient to accommodate the individual patient. Some models offer a powered high/low feature to facilitate patient transfer and positioning, and some provide a self-propelled feature to ensure easy movement.
- Scales that are wheelchair-accessible and standing scales are available with weight limits of more than 800 pounds. Wheelchair-accessible scales allow a patient to sit on a chair during weighing and have ramps to aid in the positioning of the wheelchair. If standing platform scales are used, facilities should consider selecting models with built-in hand rails to stabilize patients during weighing. As an alternative, a weighing system can be incorporated in a bariatric bed.
- Tracheal tubes that are extra long and small diameter tubes may be required for airway management of bariatric patients; difficult intubation also may require a laryngoscope and flexible bronchoscope.
- Bariatric operating room tables with extenders and foot boards are important inventory and there should be at least one. Bariatric OR tables are available with weight capacities of up to 1,000 pounds. It’s important to verify that the table will still maintain full articulation capabilities when at its weight load capacity.
- Portable bariatric commodes that will accommodate the weight and size capacity of bariatric patients should be readily available.
- Bariatric beds should have the dimensions and weight capacity to sufficiently accommodate a patient. Features and accessories that help a patient get in and out of bed, position a patient and assist with transporting a patient are important selection considerations.
In addition, integral weighing systems are a plus. Before selecting a bariatric bed, check doorway widths to patient rooms and other areas where patients may be transported to ensure the bed will fit. Some hospitals use bariatric beds in lieu of stretchers in areas such as the emergency room or post anesthesia care unit. They also use bariatric beds for transport. This reduces or eliminates the need to transfer bariatric patients from bed to stretcher or stretcher to bed.
Hospitals also should stock some level of basic supplies for extremely obese patients such as extra large blood pressure cuffs, gowns, identification bracelets and compression stockings.
Oversized chairs should be placed in public areas such as lobbies and waiting rooms to accommodate overweight patients and their family members. In addition, oversized patient chairs are essential in patient rooms and exam rooms where bariatric patients may be cared for.
Once the hospital has determined bariatric equipment needs and corresponding quantities required, it can determine whether it makes sense to rent, lease or purchase. During the past several years, ECRI has seen the market shift for bariatric equipment to outright purchases, rather than the once-popular rental options.
Many vendors now offer bariatric accessory packages for existing models that were not originally designed for bariatric patients. New models specifically designed for bariatric patients continue to emerge. Some vendors offer mixed acquisition plans that allow a hospital to rent, own or do both. Other vendors offer on-demand rental options in which the equipment is rented on demand based on fluctuations in patient census, or on-hand rental options in which the equipment can be kept at the facility for use when needed. Multiyear lease options also are available. When determining whether to rent, lease, or purchase bariatric equipment, ECRI recommends comparing all the available acquisition options (lease versus rent versus purchase versus mixed option), and performing a side-by-side life-cycle cost analysis.
When considering life-cycle costs, the hospital should include capital costs and operating costs over an extended period of time (e.g., seven years) for each alternative.
This analysis should include equipment and accessory costs, associated disposables based on projected volumes, warranty and service costs, and staff training costs. Other considerations include storage availability, average versus peak census requirements, quantity and length of rental plans, delivery time for rental equipment, etc.
Newly acquired equipment should be added to the hospital’s materials management inventory and equipment tracking system. In addition, identify which suppliers can provide rental bariatric equipment promptly and reliably when needed. It’s helpful to have prearrangements with suppliers so that specialized equipment and supplies not already in inventory can be obtained quickly to meet the needs of a newly admitted bariatric patient.
Develop a system for identifying patients that will need bariatric equipment prior to hospitalization or as soon as possible (in preadmission testing, in-patient admission or ED registration) and mechanisms for relaying this information promptly to the materials management department.
This is essential so that a patient’s equipment needs can be met promptly, either through the hospital’s existing inventory or through its rental agreements.
Maintain tracking log for all bariatric equipment inventory either at a specific location in the hospital or preferably online in the hospital information system to track the equipment throughout the hospital.
A log should include the weight and size capacity of each piece of equipment (if applicable) and its current location. This will reduce or eliminate time delays in care that may occur when a staff member has to search for the required equipment and ensure that the size and weight capacity matches the needs of the patient.
In addition, a tracking system provides valuable information on equipment use, which may aid in determining the need for additional equipment. MMHC
Kathryn Pelczarski is the associate director of the Applied Solutions Group, ECRI Institute, Plymouth Meeting, PA.
This article first appeared in the June 2007 issue of Materials Management in Health Care.
To respond to this article, please click here.
Related Articles
Assessing obesity patient needs at your organization
Calculating a patient’s body mass index
