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Obesity Challenges Hospitals
Hospitals have always treated obese patients, but the number of overweight patients has steadily increased since the 1990s. That creates problems for doctors and nurses, and it has prompted the medical industry to adapt. WOSU reports what some Central Ohio hospitals are doing to accommodate bigger patients.
It’s relatively quiet on a recent Tuesday morning in an intensive care unit at the Wexner Medical Center at Ohio State University. Other than muffled conversations from a team of specialists, the only sound comes from beeping monitors or carts that roll by.
Brenda Vermillion is a clinical nurse specialist. She thinks back to 1990 and the first time she was challenged with caring for an obese patient.
“Our maintenance department had to help facilitate our ability to get a bed large enough,” Vermillion said. “At the time it really was not a common thing at all. So we actually had to put two smaller beds together to make a bed big enough for an obese patient.”
Today, 35 percent of Americans are obese. And since obesity is associated with serious health conditions such as heart disease and Type 2 diabetes, obese people often spend more time in the hospital. As a result, studies show their medical bills are about $1,500 more a year than someone of an average weight.
But it’s not just the patient who incurs extra costs. Hospitals are spending thousands of dollars each year for new instruments and equipment to care for heavier patients.
Ohio State Medical Center took into account the larger patient when it designed its billion dollar expansion. A number of rooms on each floor will be equipped with ceiling lifts and other tools to accommodate obese patients.
“One of the challenges we have in old buildings is even if you want to put ceiling lifts in every room, structurally there’s lot of infrastructure that’s not there that won’t allow us to currently do that without huge modifications to the rooms,” Vermillion said.
While Vermillion said it’s getting easier to move and turn patients with lifts and special sliding mats, transporting obese patients to surgery or just to different rooms is a challenge, and it can take numerous staff members. But she said manufacturers have caught on to the conundrum.
“Bed companies are now building beds that have an assist device in them,” she said. “Beds that help us with some basic self-propelled motion that help us transport patients easier.”
In addition to self-propelled beds, wheelchairs have to be bigger. And the modifications are not cheap.
Mount Carmel spent $500,000 to install ceiling lifts. Self-propelled, re-enforced beds can cost as much as $12,000 compared to $1,300 for a standard hospital bed. Larger wheelchairs are two-and-a-half times more expensive than standard models.
But adjusting equipment and making structural changes are just part of the equation medical personnel must solve to effectively care for an obese patient.
Assessing and diagnosing patients present certain challenges.
Mount Carmel’s Vice President of Medical Affairs, Larry Swanner, said sometimes needles and catheters have to be longer or larger to draw blood or to reach a patient’s organ.
Medical staff must be mindful, Swanner added, when assessing a patient’s vital signs.
“Certainly you have to pay attention and make sure you’re using the right instrument for the right patient,” he said. “For example, if you’re taking the blood pressure of a patient who is overweight you have to make sure the cuff of the blood pressure machine is the right size for the patient. If you don’t use the right size cuff you’re going to get an inaccurate blood pressure reading.”
And OSU’s Vermillion added listening to a larger patient’s lungs can be more difficult if they are not positioned just right.
And sometimes, she noted, radiological equipment, like an MRI, is not large enough for some patients, which can make diagnosis tougher.
Some health care industry articles report diagnosing challenges lead some doctors to choose a wait-and-see approach or turn to invasive procedures. But Dr. Swanner said neither of those methods is used consistently.
“The more appropriate response is: let’s find a different way to make the diagnosis. Now sometimes that may involve a more invasive testing than you would typically want. But that doesn’t mean you’re going to a full scale surgery just because you couldn’t get the scan you wanted,” he said.
And both Dr. Swanner and Vermillion said adjusting medications can be challenging.
“Research on medications often times the obese patient population has not been included in the trials. We’re not always sure what weight we should be using,” Vermillion said.
“Medications don’t always behave the same as every other medication in terms of distribution throughout the body,” Swanner said. “There are some medications that really don’t penetrate fat tissue very much. Just because they’re obese and have a higher percentage of body fat doesn’t necessarily mean they need more of a particular drug. So you have to be aware of what you’re prescribing.”
In Vermillion’s words, nurses are “very adaptable.” And they’ll need to be, as more Americans put on more weight.
“I think there’s always going to be challenges that we’re going to have to overcome. And it’s a challenge between getting the proper equipment to the proper person at the proper time. I think we’re doing a pretty good job.”
For Dr. Vermillion, he’s like to see the trend reverse.
“It’s not just what the medical community can do; it’s also how the patient can help themselves,” he said.