Facilities must change to accommodate obese patients

December 1, 2008

Because of their physical size, obese patients often cannot use standard wheelchairs, waiting-room armchairs, blood pressure cuffs, hospital beds and gowns, or M.R.I. and CAT scan machines.

According to research compiled by America Sports Data Inc. in the United States, 3.8 million people weigh in at more than 300 pounds, over 400,000 people (mostly males) carry over 400 pounds, and the average adult female weighs 163 pounds.

Also, according to the National Institute of Health, approximately one-third of all hospital patients weigh 350 pounds or more. In fact, bariatric surgery volume skyrocketed from 16,000 cases in 1992 to 103,000 cases in 2004.

Because of their physical size, these patients often cannot use standard wheelchairs, waiting-room armchairs, blood pressure cuffs, hospital beds and gowns, or M.R.I. and CAT scan machines. Likewise, X-rays might not penetrate far enough into their bodies to produce useful images, causing possible care delays.

Safety incidents, such as toilets collapsing, chairs breaking, patient beds malfunctioning and wheelchairs that cannot roll under the weight of severely obese patients, are inspiring hospitals to respond. Healthcare equipment and furnishing manufacturers have also had to respond to the situation by creating a whole new line of equipment that caters to severely obese patients.

New equipment is likely to impact a project's overall cost and potentially its timeline. Determining the additional costs for certain elements, such as furniture and medical equipment can be done easily based on the numbers needed for each project. However, calculating costs becomes more challenging when you consider the overall project. For example, accommodating obese patients will usually mean designing larger patient rooms, which increases the overall square footage of a project and therefore impacts the cost.

Project completion dates can also be impacted when including design for obese patients, especially with remodels. In existing facilities, designers have to consider many different elements and how much the current building layout needs to be altered to make the proper accommodations.

During the design of Jackson South Community Hospital in Miami, Fla.'s new 160,000-square-foot expansion and renovation project, the design team identified a series of rooms within the hospital dedicated for obese patients. The design team had to make sure that the doorways were wide enough and that both the floor-mounted toilets and showers could handle patients that weighed up to 500 pounds. They also developed a reinforced over-bed gurney system to assist medical personnel in lifting immobilized patients out of bed and into wheelchairs or stretchers. Bathroom stalls and showers were designed with larger footprints to accommodate the patient and staff.

When planning a healthcare facility, it is necessary to keep the patients' dignity in mind.

Since neither the American Institute of Architects/Academy of Architecture for Health or the American Disabilities Act provide specific guidance on physical design associated with care of extremely obese patients, they are challenged with educating the staff and making sure that they stay updated with all of the latest product lines available for specification in the design of new or renovated hospitals.

Rolando Conesa, AIA, is a principal with Coral Gables-based MGE Architects, headquartered in Coral Gables, Fla.