Jeremy Kam, BMedSci, Advanced Medical Science Student; David McD Taylor, MD, MPH, Director of Emergency and General Medicine Research.
Obesity significantly increases the difficulty of patient management in the emergency department
Article first published online: 12 AUG 2010
© 2010 The Authors. Emergency Medicine Australasia © 2010 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine
Emergency Medicine Australasia
Volume 22, Issue 4, pages 316–323, August 2010
How to Cite
Kam, J. and Taylor, D. M. (2010), Obesity significantly increases the difficulty of patient management in the emergency department. Emergency Medicine Australasia, 22: 316–323. doi: 10.1111/j.1742-6723.2010.01307.x
- Issue published online: 12 AUG 2010
- Article first published online: 12 AUG 2010
- Accepted 6 June 2010
- emergency care;
- nursing care;
- patient care management
Objective: To determine which aspects of ED management are adversely affected by patient obesity, to determine the level of obesity above which management is made more difficult and to make recommendations on how these effects might be mitigated.
Methods: This was a cross-sectional survey of patients and the staff caring for them in a single ED. Doctors, nurses and radiographers managing consecutive patients, during a range of enrolment periods, completed a self-administered questionnaire. Each was asked to record how the level of their patient's obesity increased the difficulty of specific management items, using a Likert scale. Staff also provided recommendations to mitigate the effects of obesity for each patient, if applicable. For each management item, body mass index (BMI) and management difficulty were correlated (Spearman's rank correlation).
Results: Seven hundred and fifty patients and their ED carers were enrolled. Patient BMI was positively correlated with all aspects of ED clinical management examined (correlation coefficient range 0.28–0.57, P < 0.001). BMI most strongly correlated with difficulty in finding anatomical landmarks, venous pressure measurement, physical examination, patient positioning and procedures generally, especially cannulation and venipuncture (coefficient > 0.5, P < 0.001). Doctors reported more difficulties than nurses and radiographers. Generally, management difficulty did not increase until the BMI was in the obese or morbidly obese range. Most staff recommendations related to issues of patient mobility including equipment, staffing and bariatric devices.
Conclusion: Patient obesity significantly increases the difficulty of ED patient management. Staff recommendations to mitigate these effects were few but may inform changes in ED practice.