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Increasingly obese population poses challenge to medical facilities
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Nurses Diana Arango, of Atlantic City, left, and Christeta Manahan, of Egg Harbor Township, re-position "patient" Diana Gillespie, of Hammonton, as Katherine Bagnato, director of occupational and sports athletic training, of Egg Harbor Township, and Meghan Hardiman, of Atlantic City, observe their technique.
Photo by: Danny Drake
Standing a mere 5 feet tall, Jennifer Ketchledge doesn't seem like the type of hospital staff worker who should have to handle larger patients.
But there she was, standing face to face with a patient who towered 14 inches taller than her and was nearly double her weight.
As the clinical manager for the progressive care unit at the AtlantiCare Regional Medical Center's Mainland Campus, Ketchledge sees patients who have recently left the intensive care unit. On this particular day, she was helping lift this larger patient out of bed.
Ketchledge couldn't believe she was lifting someone so much larger than her. But she followed her training. She wrapped a bed sheet around the patient's waistline, rocked back and forth, and suddenly, the patient was standing.
Even though there was a significant difference in the weight between Ketchledge and the patient, Ketchledge said she felt like she was hardly lifting anything.
As the rate of obesity in the United States increases, the health care system is making changes everywhere - from the way nurses and hospital staff lift their patients to the way ambulances are designed. Everything from the chairs in a doctor's office to hospital gowns are being designed with larger patients in mind.
A hospital safety issue
The changes are aimed not just at caring for larger patients. Hospital workers risk injuring themselves when they attempt to lift or transport patients who are bigger than they are.
According to the U.S. Bureau of Labor Statistics, hospitals nationwide had a rate of 7.7 nonfatal workplace injuries per 100 people working in a hospital in 2007. The national average for people working in the private industry was 4.2 injuries per 100 people.
Musculoskeletal injuries are also prevalent among nurses and nursing aides. These injuries happened at a rate of 252 injuries per 10,000 nurses in 2007, according to the statistics bureau. That's the highest of any occupation, with freight and stock movers having a lower incidence at 149 injuries per 10,000 workers.
A team at the Institute for Work and Health also found that nurses and hospital workers with similar duties performed an average of 38 patient lifts during an eight hour shift. In that time, the total weight they've moved is equivalent to about 1.8 tons, and as patients get larger, the estimate continues to rise.
While state hospitals aren't being mandated to make changes to accommodate larger patients, they're getting more and more feedback from different departments about the need for new equipment and new practices as a result of treating larger patients.
"It's becoming kind of routine," said Dr. Katherine Schneider, vice president of health engagement for AtlantiCare Regional Medical Center's campuses. "It's not just about extreme cases anymore."
Changing equipment
Taking care of extremely overweight patients requires some different thinking when it comes to monitoring their health, according to Dr. Karl Strom, the chief of bariatric surgery at Southern Ocean County Hospital in Stafford Township.
Strom recalled when one of his overweight patient's blood pressure reading came back very high. When he investigated, he found the problem wasn't with the patient, but with the equipment being used in the test. The results were thrown off because the medical staff was using a normal sized blood pressure cuff that simply didn't fit the large patient.
"If you try (taking your blood pressure) using the smaller cuff on it, the blood pressure is going to read high," Strom said. Larger patients need larger cuffs for their blood pressure monitors to get accurate numbers, he said.
Even larger machines used for identifying medical problems have limitations. For example, many magnetic resonance imaging scanners, or MRI scanners, are being designed as open scanners to eliminate claustrophobia in patients. These can also be used for larger patients, who sometimes can't fit into the regular MRI machines.
"When these patients can't fit in the MRIs, it limits your ability to diagnose and treat these patients," Strom said.
But Strom said that even the open MRI scanners have their limitations. Many of these scanners cannot hold patients who weigh more than 400 pounds, and in some cases, even less. Now, MRI scanners are also being redesigned to hold patients who weigh more than 500 pounds while still delivering the same diagnostic results.
There's also collateral damage associated with taking care of larger patients. At Strom's office, a patient was too large for the toilet and it broke. Strom has heard stories from other gastric doctors about large patients falling off hospital beds because the beds were too small for them.
Even surgery is complicated by a person's size. Though Strom said laproscopic banding surgery can be used for larger patients than before, some gastric surgeons require that extremely overweight patients are within a certain size before the surgery can be performed. At AtlantiCare's campuses, if the patient doesn't lose the weight, the surgery isn't performed.
"Any surgery is more difficult, the larger you get," said Schneider.
Accommodating size
According to a study recently published in the journal "Health Affairs," $147 billion is spent in the United States meeting the medical needs of overweight and obese patients.
The larger chairs in Strom's office are just one change in the hospital setting. Strom said hospitals are ordering larger emergency room beds, oversized wheelchairs and hospital gowns in different sizes.
Some of the changes are somewhat makeshift. For example, traditional scales in a doctor's office can only hold as much as 300 pounds. Because doctors need accurate weights for prescribing medications and tests, they had to resort to a scale that could support the weight. Strom's office used an automotive scale that could hold as much as 1,000 pounds.
Strom said changes to deal better with overweight patients have been sweeping through health care in the last couple of years. But there are times when there are more overweight patients than a hospital can handle, and even with these changes, resources are still somewhat limited.
"All the other floors need the same things we need for our patients," Strom said.
Transport changes
The needs of larger patients are being addressed outside of the hospital and doctor's office as well.
Emergency vehicles have gone through a number of changes aimed at taking care of larger patients.
For example, every stretcher in every ambulance in AtlantiCare Regional Medical Center's fleet can hold a patient that weighs as much as 700 pounds. In a few of their ambulances, bariatric stretchers can hold double that amount, up to 1,400 pounds.
With a normal stretcher, the patient is kept on the side of the ambulance, allowing the workers space to deliver IVs or anything else needed before they arrive at the hospital. With bariatric stretchers, emergency service workers can reposition the stretcher to the middle of the ambulance, a more comfortable position for patients whose bodies might overhang the stretcher.
"We can accommodate them without shoving them against the side of the truck," said Johnny Delgado, who works in emergency services for AtlantiCare's ambulance fleet.
Suppliers profit
For hospital equipment manufacturers, catering to larger patients means big business.
"Most of the products we sell, there's a bariatric angle to it," said Rich Derks, vice president of marketing in the durable medical equipment division for Medline, a company that sells medical equipment worldwide.
Derks said that Medline visits hospitals and nursing homes around the country to find out what they're patients need. As a result, the company now puts out a catalogue containing only supplies for larger patients.
Ten years ago, the width of a typical wheelchair might have been 18 inches and and it might have held as much as 250 or 300 pounds, Derks said. The typical width is now between 20 and 22 inches, and it's getting larger, he said.
Derks estimates that by the end of the year, Medline will have sold nearly 1,000 wheelchairs that have a 28-inch wide seat and can hold as much as 700 pounds. And the requests keep coming in for larger equipment.
"There's not a week that goes by without someone asking for a 1,000 pound (wheelchair)," Derks said.
More comfort for patients
Alice Marcella said she's noticed a lot of things have changed from when she was a nurse years prior.
The 59-year-old Mystic Island resident went to the doctors to investigate gastric surgery to slim down from 353 pounds.
"It was the first time I went to a doctor's office with seats that I could fit into," Marcella said.
The chairs weren't the only things that Marcella noticed had changed. The examination beds at the doctor's office were much wider than the old-style beds, making her more confident about lying down without falling off. Even the toilets in the bathroom were reinforced to hold patients weighing as much as 1,000 pounds.
Tricks of the trade
Hospitals are also making sure staff is trained in the ways to handle larger patients to avoid injury.
In 2008, AtlantiCare launched its WorkRite program, which is designed to reduce injury across the hospital. Instead of relying on stronger hospital staffers to be responsible for lifting larger patients, the program taught techniques to make sure that everyone in the hospital can lift these patients when required.
When Katherine Bagnato joined AtlantiCare, she realized that not everybody on staff was finding ways to reduce their injuries.
Bagnato conducts classes with everyone at the hospital - from nurses who have constant patient contact to people working in the finance offices.
One technique taught in the class is to tie a bed sheet around the waist of a patient while they're sitting on a hospital bed. As the person lifting the patient grips onto the bed sheet, the patient holds onto the nurse or other caregiver. They rock back and forth slowly twice before a final rock that enables them to come off the bed without any personal effort.
"This gives me some better leverage to help bring the patient to a steady position," Bagnato said.
It's a proven technique. AtlantiCare estimates it will have a 29 percent reduction in patient handling injuries by the end of 2009.
Jennifer Ketchledge is one of many people who have gone through the program. She notices a difference in her ability to avoid pain when lifting and helping larger patients.
"Previously, you'd feel it in your back, you'd feel it in your shoulders," Ketchledge said. "(When I used these techniques), I didn't feel any kind of pain."
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Posted in Top_three, Atlantic on Tuesday, October 20, 2009 12:35 am Updated: 5:27 am.
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