How Safety Is Compromised When Hospital Equipment Is a Poor Fit for Patients Who Are Obese

Abstract

Obesity is common, serious, and costly, and according to recent data, its prevalence is on the rise in the United States. Event reports submitted to the Pennsylvania Patient Safety Reporting System (PA-PSRS) indicate that some healthcare facilities do not have the necessary equipment to monitor and care for some individuals in this patient population, leading to embarrassment for patients, delays in care, and injuries to patients. An analysis of 107 events related to monitoring and patient care for patients who are obese submitted to PA-PSRS from 2009 through 2018 showed that imaging equipment, especially MRI and CT scanners, was most often implicated in event reports (49.5%; 53 events); other equipment included stretchers (24.3%; 26 events) and wheelchairs (11.2%; 12 events). Events most often occurred in an imaging department (30.8%; 33 events) or a medical/surgical unit (21.5%; 23 events). Analysts determined that 80 events (74.8%) resulted in a delay in care and that 44 events (41.1%) resulted in temporary harm to the patient, including skin tears and abrasions. Healthcare providers may not be able to prevent delays in care resulting from the unavailability of adequate equipment for patients who are obese, but they may be able to prevent harm and embarrassment for patients through proactive assessment.

Five Ways Health Care Can Be Better for Fat People

“…Much of the existing work on better accommodating fat people's needs within North American health care settings focuses on reducing stigma 1 and addressing inadequate medical equipment. 2 In some cases, inadequate equipment and surgery-related issues can be a matter of life or death: the computed tomography or magnetic resonance imaging scanner that was not designed to accommodate the bodies of larger members of the population 3 ; the surgeon who never learned to operate on fat bodies because their medical school refused the donation of fat cadavers 4 ; or the loss of life due to impaired health and well-being from bariatric surgery. 5,6 These deaths are, collectively, uncountable; the result, however, is the loss of precious lives and irreversible trauma to families, friends, and communities.…”

Imaging individuals with obesity

“…This requires us to routinely adapt our techniques and approaches to patient care frequently. For individuals with obesity, often our imaging equipment and environment are a poor fit that can compromise their safety, dignity and equity of access to medical care [41] . The MRP is therefore often forced to navigate these system limitations whilst trying to achieve diagnostic images and maintain a high quality of patient care and dignity ( Figure 1 ).…”

Trocar-Related Safety Events in Minimally Invasive Surgical Procedures: Risks for Organ and Vascular Complications

“…• Evaluate patient's body type prior to beginning the procedure 5,7 • Prior to surgery, determine if the size of available surgical equipment (e.g., Veress needle or trocars), along with standard equipment (e.g., blood pressure cuffs or stretchers) are the right size for patients who are obese 19,21,44,45 • Consider strategies to reduce chances of injury during trocar insertion, e.g., Palmer's point for patients who are either thin or morbidly obese 5,6,8,18,20,21 and patients at risk of adhesions 2,5,6,20 • Evaluate alternative entry sites and techniques based on history, body size, and procedure 2,7 • Seek consultation from experienced colleagues regarding questions about addressing concerns when caring for high-risk patients prior to starting the procedure 12 • Investigate preoperative ultrasound, which has been shown to help identify the presence and location of adhesions in high-risk patients prior to laparoscopic surgery [46][47][48][49] • Maintain a low threshold for imaging or investigation in the postoperative period when there is a high suspicion of injury 17…”