Definition of bariatric surgical equipment and principles of hospital environment configuration
**Essential Bariatric Surgery Equipment: Making Your Equipment More Suitable for Bariatric Surgery Patients**
William Gourash, Tomasz Rogula and Philip R. Schauer
Patients with morbid obesity and morbid obesity have specific ergonomic needs that traditional hospital equipment and facilities cannot meet. Hospitals offering weight loss programs have an obligation to provide a comfortable and safe environment for obese patients during their hospital stay. Anticipating the needs of obese patients requires experience and knowledge to determine which facilities can meet their specific requirements. Furthermore, resource allocation should be continuously optimized, identifying essential and non-essential aspects and evaluating these allocation options.
This chapter will address these questions: What is bariatric surgery equipment? Why does bariatric surgery require specialized equipment? How can bariatric surgery equipment meet the needs of obese patients? What are the key pieces of equipment in bariatric surgery?
**definition**
What are bariatric surgical devices? Broadly speaking, they are all technological products used to provide medical services to people with morbid obesity. Technology is the knowledge and application skills needed to produce goods and products to achieve specific goals.
This section discusses equipment specifically related to bariatric surgery, although most of the equipment discussed can also be used in other clinical departments with obese patients. Based on function, the equipment is divided into two main categories: diagnostic and therapeutic equipment. These devices may be used preoperatively, intraoperatively, or postoperatively. This chapter focuses on the equipment needed preoperatively and postoperatively; equipment and instruments needed during surgery will be discussed in other chapters.
**Basic Principles**
Florence Nightingale believed that treatment should take place in the "patient's therapeutic environment," by "allowing the patient to be in their most natural state." The prevalence of obesity and morbid obesity inherently requires healthcare institutions at all levels to establish safe and effective facilities to address the specific needs arising from the large size and comorbidities of obese patients. It is essential to accommodate the large size and limited mobility of obese patients. Safety considerations are the primary reason why healthcare institutions must meet the specific needs of morbidly obese patients. Advance planning and meeting patient needs can contribute to better diagnostic and treatment outcomes. Safely increasing physical activity can also prevent comorbidities. A major occupational hazard for healthcare workers is musculoskeletal injury, which is directly related to assisting in the movement and care of obese patients. Many of these accidents and injuries are associated with the use of conventional, inappropriate equipment, especially during patient movement and transfer.
Reducing comorbidities, especially those related to lack of physical activity, will help improve patient outcomes. Comorbidities associated with lack of activity include pulmonary insufficiency, atelectasis, pneumonia, deep vein thrombosis, pulmonary embolism, pressure sores, infectious skin diseases, and falls. Improved facilities can also help shorten hospital stays, reduce the likelihood of accidents involving obese family members, and decrease the time spent temporarily caring for obese patients due to a lack of specialized equipment or space.
Diagnostic tests may also be impossible due to insufficient equipment. Obese patients are at risk because their large size prevents them from undergoing routine examinations. Simple blood pressure or weight measurements can be problematic without suitable tools. Accurate upper gastrointestinal examinations, computed tomography (CT) scans, polysomnography (PSG), and cardiac stress tests require equipment that meets the specific requirements of the patient's size, weight, and mobility.
Having appropriate medical equipment for obese patients can also improve the efficiency of healthcare services. Insufficient staff and equipment can lead to excessively long wait times when transporting patients, wasting not only time but also effort and money. Having suitable equipment increases patient, family, and staff satisfaction. Patients who receive safe, efficient, appropriate, and timely treatment will perceive the facilities and healthcare staff as competent. Healthcare staff can then focus more on the patient's clinical and personal needs without being distracted or complaining about increased risk of injury. Rehabilitation requires specialized equipment, including walkers or parallel bars, which provide the necessary extra space and durability.
**Investigation and Planning**
Based on our experience, the best strategy for coordinating the allocation of equipment related to bariatric surgery is to establish a "Bariatric Surgery Task Force (BTF)." This task force may initially be established temporarily to address specific issues, but it can eventually become a long-term institution, continuously assessing the needs and problems of bariatric surgery patients. The arrangement of equipment and treatment facilities also requires ongoing adjustments (including evaluation, improvement, and new construction). Before establishing a BTF, specialists or a team should present and explain the situation of obese patients, equipment, surgical procedures, and surgical outcomes to relevant experts and department managers, ensuring the hospital understands and supports the BTF's work long-term. The BTF should consist of representatives from multiple departments, including administration, parking, environmental services, patient transfer, procurement, nursing (e.g., ICU, general care, wards, outpatient, inpatient, home care, patient contacts, medical record administrators, gastroenterologists, outpatient operating rooms, postoperative recovery rooms, operating rooms, and emergency rooms), nutrition, social work, physical therapy, radiology, cardiology, pulmonology, and surgeons and their assistants.
The BTF (Bodyweight Treatment Team) will first assess the placement of existing hardware facilities and their limitations. The following questions need to be considered: How can these facilities be managed to meet the needs of patients with morbid obesity? Which healthcare professionals would be most interested in treating obese patients (e.g., nurses, gastroenterologists, physical therapists, pulmonologists)? What are the weight and width parameters of the current equipment and furniture (including waiting room chairs and hospital beds)? Which companies are currently supplying the equipment? What are the current policies regarding the use of bariatric surgery equipment? How far do patients have to walk from the clinic and emergency care area to the diagnostic testing area? The committee will also systematically review every detail of the patient's hospitalization.
The second aspect of the investigation focused on which equipment was available for purchase. There are many reliable sources of information about products and distributors, one of the most commonly used being the bariatric surgery equipment catalog from the American Society of Bariatric Surgeons (ASBS). Distributors typically have websites that showcase a large amount of information on bariatric surgery-related products with links.
The third aspect of the investigation was to understand the characteristics of the obese population the hospital would be serving, based on the hospital's previous experience treating morbidly obese patients. Bariatric surgeons should have certain expectations and estimates regarding the maximum weight, average weight, and body mass index (BMI) of their patient population. Among our patients, the first 500 patients weighed between 190 and 473 pounds (86 to 215 kilograms) and had a BMI between 35 and 69. A response plan is needed for patients weighing over 500 pounds (227 kilograms) and with a BMI over 70, although such patients are relatively few.
The goal of these surveys is to prioritize the equipment and environmental improvements that need to be purchased according to their importance. The BTF also aims to establish standards for the use of new equipment. For example, our hospital does not have a dedicated bariatric surgery ward, and hospital beds come in various types and models. Standard hospital beds have different weight limits [350–500 lbs (159–227 kg)] and width limits [34–36 inches (86–91 cm)], and the lowest of these weight limits should be the maximum allowed for the use of a standard bed. Similarly, mattresses also have weight limits of 325–400 lbs (147–182 kg). This results in all patients weighing over 325 lbs (147 kg) or with a BMI greater than 55 (which determines the required mattress width) requiring special beds for obese patients. Establishing standardized protocols helps to effectively utilize hospital resources and allows for advance planning when the patient population changes.