Providing safe care to obese patients requires obese specific infrastructure and sensitivity

Obese patients face additional safety issues

A recent study in the U.K. reviewed the types of patient safety issues faced by obese patients.  It specifically focused on patient safety incidents where obesity was deemed to be a factor, reported to that country’s National Patient Safety Agency.  The results of the study shed light into the causes of errors and safety issues related to care of obese patients.  They also provide administrators and clinicians with data that could drive the development of a safer environment of care for this specialized but growing segment of the population.

The group carrying out the study, led by Dr. J.A. Moore of Manchester University Hospitals NHS Foundation Trust, searched the National Reporting and Learning System database for all reported incidents involving obese patients over some 3 1/2 years.  It should be noted that all incidents listed in the database were voluntarily reported and may or may not be representative of the actual error rates prevalent in the health system.  Of 555 patient safety incidents identified by the group, 388 met the study’s criteria for further analysis.  148 (38%) of these were related to assessment, diagnosis or treatment of the obese patient while 213 (55%) were infrastructure related, 84 (22%) were surgery related, and 28 (7%) represented staffing implications.  While the majority of incidents – 86%, were classified as causing no or low harm, 12% represented moderate harm and three deaths, all related to anesthesia issues fell into the category of fatal errors.

Some errors centered around the inability of staff charged with conducting pre-admission assessments not accurately documenting the needs of obese patients – scheduling them for surgery without considering adjunct needs or equipment availability.  Such oversights caused delays or the need to reschedule or relocate surgery. 

The authors of the study considered the following findings to be noteworthy:
1. Significant harm directly relating to the care of obese patients occurs within the UK health service.
2. Death and severe harm can occur during anaesthesia and the provision of critical care as a direct consequence of obesity.
3. Lack of adequate obesity specific equipment provision is the leading cause of incidents reported to the National Reporting and Learning System in the UK.
4. Lack of robust operational policy for assessment and elective treatment of obese patients results in potential and real harm.
5. Safe care of the obese patient requires coordinated obesity specific infrastructure, obesity patient care pathways, and multidisciplinary training.

I thought the study did a great job of pinpointing non-human factors involved in providing safe care to obese patients.  Its methodology could not however shed any light on the impact of weight bias on the provision of care and how it affects the safety of the obese patient.  Researchers at Yale University’s Rudd Center for Food Policy and Obesity have done considerable work in this regard (see links below) and have found that weight bias by physicians, nurses and other members is prevalent.  A study of obese patients found that 69% had experienced weight bias by physicians.  Another study found that physicians spent less time with, were reluctant to perform certain critical screenings of, and discussed care less with obese patients.  One study of 498 obese women found that many delayed preventive services despite having easy and high access to healthcare because they felt they were disrespected by providers, were embarrassed of being weighed and did not appreciated repeated unsolicited advice to lose weight.  Providers can quite possibly help obese patients by assessing their own biases and determining how best to evacuate these biases from the environment of care.  Perhaps integrating sensitivity into ones practice is a good place to start. Some considerations, provided by Rebecca M. Puhl, Ph.D. and Kelly D. Brownell, Ph.D. at the Rudd Center are listed below.

Integrate sensitivity into practice:
1) Consider patients’ previous negative experiences
2) Recognize that being overweight is a product of many factors
3) Explore all causes of presenting problems, not just weight
4) Recognize that many patients have tried to lose weight repeatedly
5) Emphasize importance of behavior changes rather than weight
6) Acknowledge the difficulty of making lifestyle changes
7) Recognize that small weight losses can improve health

It is clear that in planning for the provision of health services for obese patients, administrators need to take into account environmental, equipment, therapeutic and human interaction factors.

Related Resources:

Patient safety incidents associated with obesity

Anesthetic Concerns for Performing Bariatric Surgery in a Free-standing ambulatory care center – Jay B. Brodsky, MD and Jerry Ingrande, MD.

Weight, Weight Bias, and Obesity – The challenge of obesity in the healthcare system – Keith Bachman, MD FACP

Weight Bias in Health Care Settings – Rudd Center for food policy and obesity – Rebecca M. Puhl, Ph.D, Kelly D. Brownell, Ph.D

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