No patient wants the bed or wheelchair they are using to be at risk of falling apart, but that is a concern for severely obese patients at Dunedin Hospital, head of the paediatrics and child health section Prof Barry Taylor says.
A buying policy for equipment, which took into account the increasing average size of patients, was needed; along with records which clearly showed staff the capability of stock.
Information about the weight limit and recommended physical dimension capabilities of commonly used equipment, including beds, mattresses and chairs, is being checked as part of a feasibility project for an integrated chronic care management plan for morbid obesity.
The Otago District Health Board approved the $55,000 first stage of the feasibility study last year, but warned extra funding would not be available to cover the second phase, involving the establishment of a multidisciplinary care team with members from the hospital and community groups.
One of the issues being addressed by the project team is the lack of uniform recording of height and weight.
Prof Taylor said ideally the group would like to see height, weight and body mass index information (BMI) recorded electronically, in one place; so clinicians who needed this information would readily be able to find it. At the moment the information was recorded in several different places.
In the long term, it would be valuable for hospital clinicians to have access to such information on patients in the community, but that would involve community health services being able to interact with hospital information systems and could involve politically some "very difficult territory". The team's initial approach was for the hospital to get its own house in order.
By the end of the six-month project it was hoped there would be clear information about how the hospital would deal with cases as they presented themselves.
For instance, if a 120kg-plus pregnant woman came to give birth, the sort of equipment needed and a clear path for her care would be identified.
Prof Taylor also saw value in the setting up of a specialised service, similar to the hypertension clinics established through the work of Olaf Simpson, to improve treatment available.
This would involve collaboration between the board, university researchers and the community.
Clinics would not need to be a permanent structure, but could have a five to 10-year span, in which time the most effective treatments would be established, and become standard practice within community health services.
Strong health leaders who looked ahead up to 20 years were "desperately" needed.
While it was important to balance existing budgets, that could not be the only consideration; people would regret decision-making which did not "look at the big picture" and plan for the future, Prof Taylor said.
He acknowledged that obesity was not a "sexy" subject in health care, but said it was often a factor in surgery.
For example, obesity was one of the main contributors to hip damage, he said.
Obesity facts
• More than 7000 Otago adults estimated to be morbidly obese (having a body mass index greater than 35).
• Body mass index is calculated by your weight in kilograms divided by your height (in metres) squared.
• Normal weight is considered to be 18.5-24.9.
• Overweight 25- 9.9.
• Obese 30-39.9.
