May 21, 2018
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Hospitals adapting to larger patients

By Mary Jo Layton, The Record

HACKENSACK, N.J. — More hospitals are buying larger beds and operating tables, and wider wheelchairs with reinforced steel frames, and building specialized rooms to treat the growing ranks of obese patients.

Englewood Hospital and Medical Center debuted a new stretcher and loading ramp this month for ambulances to transport patients weighing up to 1,100 pounds. Hackensack University Medical Center is spending $200,000 on two new operating tables to hold extra-large patients.

And St. Joseph’s Regional Medical Center has four new bariatric rooms with wider doors, special beds and ceiling lifts that can hold patients in excess of 1,000 pounds, accommodations that cost about $400,000. Renovation plans for the pediatric unit at the Paterson, N.J., hospital include a room for obese teens.

“Not only here, but across the country, you’re always looking to accommodate larger, bigger and heavier because it’s what we’re seeing,” said Madelyn Pearson, senior vice president for patient-care services at Englewood. “With every new bit of construction and new purchase, we are looking at how we can best accommodate larger patients.”

America’s growing girth is causing a dramatic increase in diabetes, hypertension and other chronic diseases. It’s also forcing hospitals and ambulance crews to make systemic changes in the treatment and transport of patients and to invest in expensive equipment and special training for the staff.

Obesity has risen rapidly nationwide — 13 percent of adults were obese in 1987, compared with 35.7 percent today. Some 10 million Americans are more than 100 pounds overweight and considered morbidly obese. In New Jersey, one in four adults is obese. Those startling statistics come in the face of stepped-up efforts by insurance companies, health officials and even politicians, to prod Americans to live healthier lives. They are the reason why first lady Michelle Obama and New York City Mayor Michael Bloomberg are sounding the alarm for Americans to trade in the soda and junk food for healthy cooking.

To accommodate larger patients, hospitals are being forced to rethink every aspect of care: It starts in waiting rooms with chairs three times the size of traditional furniture, discreetly designed as a three-seater without arms. Treatment rooms must be stocked with extra-large blood pressure cuffs as well as gowns and robes for the obese.

Even surgical equipment is specialized in the treatment of morbidly obese patients — instruments are longer, retractors are designed to maneuver excess tissue, said Katherine Holloway, surgical services administrator at Englewood.

“We had a patient who crushed the bedpan. It was humiliating for her, and the staff felt horrible,” Holloway said. “We ordered new ones that can hold up to 1,200 pounds so it never happens again.”

These changes are expensive — and drive up health care costs. In a national survey, hospitals reported spending up to $1.5 million last year on equipment and other needs of obese patients, according to Novation, a national health care supply company. HHC, the New York City Health and Hospitals Corp., has spent more than $17 million to accommodate these patients at its 11 hospitals.

“In one hospital in the Bronx, we bought 40 new toilets that can support people in excess of 500 pounds,” said Antonio Martin, HHC’s chief operating officer.

Yet in one area — radiology — technology has not caught up with the rapid expansion of waistlines, leaving the heaviest patients unable to undergo CT scans or MRIs because they’re simply too large to fit in the equipment, experts say.

Even the new magnetic resonance system that Englewood purchased this year partly with larger patients in mind — the opening is wider — has a weight limit of 440 pounds.

It’s a problem faced in hospitals nationwide.

“This is a tragedy of sorts. … It takes us back decades in the way we do medicine,” said Dr. James Thrall, former president of the American College of Radiology and chairman of radiology at Massachusetts General Hospital.
“If you have a tiny tumor in your pancreas, we’re not going to see it.”

And even when a technician can take an X-ray on large patients, there are still frustrating limitations, said Dr. Hans Schmidt, division chief for bariatric surgery at Hackensack. “That’s actually a real problem if you’re morbidly obese. Even an X-ray on a patient who is morbidly obese can result in an inferior image.”

The rising incidence of obesity leads directly to more hospital stays and higher health care costs because it increases demand for treatment of heart disease, diabetes, stroke and many other illnesses. The medical costs of obesity are staggering — $147 billion in 2008, according to the federal Centers for Disease Control and Prevention. On average, annual health care costs for the obese patient is $1,429 more — 42 percent higher — than the annual costs for patients of normal weight.

Hospitalizations among obese children increased 75 percent nationally from 2001 to 2005, and the costs of caring for them doubled to $267.6 million, the American Hospital Association reported last year.

“We’ve definitely been seeing an increase in the size of our patients,” said Judy Padula, systems director for surgical services at St. Joseph’s. “We want to make it as safe and comfortable as possible for them.”

“Every hospital should have this equipment in place because we’re seeing so many obese patients,” Schmidt said.

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