Evidence-based design respects the dignity of obese patients.

By Thomas Hammer

Hospitals are struggling with ways to serve the growing number of obese patients. As a result, healthcare systems
are turning to design professionals for bariatric design strategies to accommodate the additional services these patients will require. In addition, healthcare organizations are being forced to change their delivery of care model in addition to the staff-related physical issues associated with administering this care.

An evidence-based design (EBD) process for healthcare is the deliberate attempt to make building decisions on the best available evidence with the goal of achieving the best possible outcomes for patients, family and staff. Through advocating specific design solutions as a crucial tool in the care of bariatric patients, the result will significantly improve long-term outcomes.

Bariatric design should emphasize the similarities between patients rather than accentuating their differences. This keeps patients from feeling alienated and restricted as they ambulate throughout the facility. Evidence suggests a carefully choreographed EBD project can help the patient, family and staff come together to enhance the experience, increase safety and deliver a higher quality of care.

There is a very compelling case for building better and safer hospitals through the integration of evidence-based design. Understanding the balance between onetime capital costs and ongoing operational savings are critical in deciding whether an EBD approach aligns with the organization’s goals. Considering the popularity of bariatric surgical programs, hospitals should begin planning to address the special design and equipment needs of obese patients on both a short and long-range plan. What follows are a few strategies to consider on a future project:

Bariatric Patient Room
Bariatric room design modifications are typically implemented to existing private or semiprivate rooms with a head-to-foot-wall of approximately twelve feet. However, research shows that fourteen feet with a headwall of at least fifteen feet is best for obese patients. Room layouts apply accordingly, and are altered for specialized equipment, as well as maneuverability of patient lifts. Other furnishing obstacles, such as handrails to reduce falls, along with the aid of several care givers require additional supplementary space. Bathing facilities should allow staff access to all sides, and toilet fixtures should mount to the floor as opposed to the wall to withstand bodyweight. By implementing proper space requirements, EBD increases administrative efficiency and encourages patient participation while everyone’s safety is considered.

Waiting Areas
Generally there are two types of obese patients: Those whose weight is concentrated below the hips and thighs, while the second type’s weight is concentrated in the waist and chest area. Understanding  the difference between the two is imperative to maximize the design of the space. Standard and over-sized seating with arms are a significant problem in basic waiting areas’ furnishings because they often lack the proper size and weight capacity that are necessary to address the obese patient’s needs. Providing seating that accommodates both types of obese patients also serves the general public and those accompanying bariatric patients, making the decision to modify the waiting area apparent. Special consideration should be given to the percentage of bariatric seats
provided in high volume areas, such as the emergency department, cardiac rehab, and other specialty clinics.

Appropriate Accommodations
There are numerous reasons why an evidence-based design approach to address the needs of bariatric patients is necessary, but perhaps the most important reason is the need to maintain the respect and dignity of the patient.

For years, facilities have not had the infrastructure and space to care for obese patients, often giving care on an ad hoc basis, ultimately inflecting severe humiliation to the patient. Although some facilities have begun the process of responding to this need, unfortunately many have not embraced the unique need of this patient population.

Obesity will continue to rise significantly, which will have enormous implications for our healthcare system and pending reform. Increasing clinical outcomes and respecting the dignity of the obese patient can be achieved through an evidence-based design approach. Design is one of the critical tools which can be utilized to improving the long term outlook for these patients by providing appropriate facilities and spaces, proper equipment and furnishing.

Thomas Hammer, AIA, is director—healthcare at Luckett & Farley in Louisville