In her job as a nurse for Gundersen Lutheran Hospital, one of the things Patti Anderson does most is move patients. Sometimes she moves them on stretchers. Other times she uses beds or wheelchairs.
In theory, it's a simple task. But with the number of obese patients on the rise, that's not always so easy to do.
"If you have a patient that's 500 pounds -- even if you have two nurses trying to push that up and down -- that really puts everyone at risk," Anderson said. "We wouldn't want to be halfway up a ramp and not be able to push a patient the rest of the way up the ramp."
About one-fourth of all residents in Minnesota and Wisconsin are considered obese. Although the obesity rate in both states is several points lower than the national average of 33.8 percent, it has forced hospitals like Gundersen Lutheran to remodel their facilities to accommodate larger patients.
Hospitals are spending millions of dollars on new equipment for larger people. Such changes are not always obvious to patients, but those who notice often agree that they're needed.
In one of the rooms, 44-year-old Jason Blackcoon of Sparta, Wis., rested after being treated for a pancreatic attack. At 220 pounds, he's overweight but not obese. Still, nurses used a ceiling lift in the room to move him from the bed to a chair. The hospital invested $1.5 million to add lifts to 220 patient rooms.
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"I thought it was a pretty handy device as far as them saving their back and any extra painstaking work that would go with them, because I'm not that light," Blackcoon said.
Gundersen Lutheran Health System is one of the largest hospital networks in the Upper Midwest, serving western Wisconsin, southeastern Minnesota and northeastern Iowa.
With obesity rates on the rise, system administrators started five years ago spending extra money to accommodate heavier patients like Blackcoon -- and to keep employees like Anderson safe.
After the lifts were installed, worker injury costs due to patient handling dropped from $6.5 million to $2.5 million between 2004 and 2006, hospital officials estimate. Anderson, program manager for bariatric surgical services at the hospital, said spending money on equipment is less expensive than caring for injured employees.
"I unfortunately was one of those nurses who had had a back injury," she said. "I can't do the hands-on care that I used to, and if I can help prevent other nurses from having the same thing occur to them, I'm all for it."
Other changes to care for obese patients have been more subtle.
In the bathrooms, floor-mounted toilets replaced the ones that hang on the wall. Sinks were reinforced to support a heavier patient leaning on them.
Stronger stretchers can accommodate up to 750-pound patients, instead of the standard ones that hold patients who weigh from 250 to 300 pounds. Doorways were widened. Nurses now push heavy wheelchairs with motorized power drivers, similar to the ones supermarket employees use to push long rows of shopping carts back to the store.
Nationwide, the U.S. market for bariatric equipment was estimated to reach $1.6 billion in 2010.
One in three hospitals nationwide has been renovated or plans to renovate facilities to accommodate obese patients, according to a 2010 Bariatric Report by Novation, a health care supply contractor.
"Even though it's a growing percentage of the population, it's still a very minor percentage of the population," said Kari Houser, director of construction and facility planning at Gundersen.
While just about 2 percent of Gundersen's patients are obese, the hospital is making changes whenever it renovates, she said.
One of the first things Houser learned was that bariatric patients aren't just those in the bariatric wing. Some of the highest number of bariatric patients were visiting the hospital's orthopedic, psychiatry and cardiovascular departments. That made training doctors across the hospital how to handle obese patients a priority.
Houser said the upgrades are a challenge. Unlike the Americans with Disabilities Act that provides specific design standards for hospitals, there are no federal or state standards that address bariatric patient needs.
The closest thing to a standard is a small appendix in the American Institute of Architects guidelines for planning, construction and design of health care facilities.
"That leaves organizations like us going, 'Well, do you provide for a 450-, a 750- or 1,250-pound patient?' At some point, this will get codified, standardized, and then the rest of the system can build beyond that," Houser said. "Because there's nothing defined, you're sort of left to create what you think is the best solution."
Another unexpected challenge is the conflicting nature of ADA requirements and the needs of bariatric patients. The kind of hospital equipment that works for a patient with disabilities might not work for a patient in the bariatric unit, where more space and larger equipment is needed.
Until there are better standards, Houser said, the hospital will continue to make these upgrades. In a new hospital wing currently under construction, 15 percent of the rooms are being built to accommodate bariatric patients.