An increase in obesity takes a toll on EDs

Trend affects staff preparation and equipment costs

The national rise in obesity is significantly affecting the nation’s EDs. In fact, a recent nationwide survey of Irving, TX-based VHA hospitals showed 90% of the respondents said they had treated obese patients who were first seen in the EDs. The increase in ED obese patients not only requires adjustments by ED managers and their staffs in terms of treatment, but it also translates into higher costs for specialized equipment such as larger beds, wheelchairs, and blood pressure cuffs.

The survey was conducted by Novation, an Irving-based firm that offers management consulting and supply chain services to hospitals and other health care facilities, including members and affiliates of VHA, a national health care alliance. It queried 584 directors of materials management and directors of surgical services across the country to determine the influence that treating severely obese patients (more than 100 pounds overweight) had on hospitals in 2004.

The numbers also reflect a broach spectrum of patients, says Sandy Wise, RN, MBA, senior director of medical and surgical services at Novation. "These are not patients coming to the hospital for bariatric surgery, but patients who are being seen for other medical conditions," she explains.

William Beaumont Hospital in Royal Oak, MI, has seen rising numbers, but they are not alone, says Val Gokenbach, DM, RN, CAN, chief nurse and executive administrative director at the hospital. "The issue, first of all, is sheer volume," she says. "This is a national crisis.

"People who do not manage their weight are going to see an increase in cancers, cardiac disease, and injury potential," Gokenbach adds. "They have fractures from falling, an increase in diabetes, and pulmonary problems," she says.

Even obese patients who present to the ED for other reasons present special problems, Wise adds. "It can be people who come to the ED for a car accident," she notes. "The reason that EDs are seeing more obese patients is mainly due to the fact that more people are obese."

It is the transport and comfort of such patients, rather than their specific care, which should be treated differently in the ED, Gokenbach notes. "From the perspective of care, the medical protocols probably would be the same, because you are treating symptoms," she explains.

However, she notes, with an increase in the percentage of obese individuals in the population has come an increase in bariatric surgery, which can lead to post-surgery visits to the ED, Gokenbach says. "As with any surgery, bariatric surgery can have complications," she adds. "And the more surgeries you do, the more complications you will have."

Post-op patients can present with adhesions or with abdominal pain that may, in fact, be related to healing, she explains. "There are also nutritional changes post-op, and some patients present with electrolyte imbalances," Gokenbach observes.

However, the number of bariatric surgery patients who return for ED treatment may not be as high as some would expect, says Patricia Flanagan, RN, emergency room clinical nurse specialist at Massachusetts General Hospital in Boston. "We do not see a lot of returning bariatric patients, because they are usually direct admits," she declares. "When we do, we make sure to have the appropriate equipment."

Some of that equipment is not actually in the ED, she notes. "We link into the inpatient side for [oversized] beds, but we do have appropriate-sized blood pressure cuffs in the department," Flanagan adds.

ED managers also must be aware of the emotional needs of these patients. Wise, for example, recommends staff sensitivity training. "Many obese patients have related how they have been humiliated by overhearing staff talk about things like big-boy beds,’" she explains. "This is a satisfaction issue, but also good, ethical nursing care."

Depending on how your ED responds to the growing number of ED patients, the costs can be considerable. "The beds can be $1,000 more," Gokenbach says. "They can be expensive, but we have purchased increased numbers, and we’re getting ready to purchase lift equipment."

Renovations are another consideration, says Wise. Normal doorways do not accommodate oversized beds or wheelchairs, she notes. "Also, if you are obese and come into an ED and you need to go to the bathroom, you can’t sit on a wall-mounted commode," Wise says. "EDs will have to make some adjustments."

In the Novation survey, the mean cost of renovations made to accommodate obese patients was $22,000, compared with $15,250 in 2003. "That can range from a whole new bariatric room to trading out a few toilets," Wise says. Mean costs for obesity-related equipment equipment were up 13%.

The bottom line is that your staff and your equipment must be up to the task, Wise says. "If you have a patient coming in for bariatric surgery, you are geared up; but with an ED, you could have a 600-pound person involved in an accident, and you do not know when they will present," she notes. "You should always be prepared with a larger wheelchair, stretcher, and lift, so you’re ready for these patients."

Flanagan agrees. "More often than not, we are notified by the fire department or EMS that they are bringing in a patient of size, so we have a heads-up and are ready with a bed in the bay for the patient," she says.

Sources/Resource

For more on handling obese patients, contact:

  • Patricia Flanagan, RN, Emergency Room Clinical Nurse Specialist, Massachusetts General Hospital, 100 Charles St., Boston, MA 02114. Phone: (617) 724-4932.
  • Val Gokenbach, DM, RN, CAN, Chief Nurse, Executive Administrative Director, William Beaumont Hospital, 3601 W. Thirteen Mile Road, Royal Oak, MI 48073. Phone: (248) 898-1995.
  • Sandy Wise, RN, MBA, Senior Director of Medical and Surgical Services, Novation, 125 E. John Carpenter Freeway, Suite 1400, Irving, TX 75602-2325. Phone: (972) 581-5000. Web: www.novationco.com.
  • For a free complete copy of the survey, go to www.novationco.com and click on the link on the right-hand side under "News" that says, Novation Surveys VHA Members Regarding Bariatric Supplies.’ When the story appears, scroll to the bottom and click the link that reads, "2004 Obese Patients Care Survey Market Research Report."