There are many reasons why design guidelines and considerations for the obese and bariatric patients are needed, but perhaps one of the most important reasons is patient dignity. In the past, many have been transported in freight elevators and weighed on loading docks.
"Obese patients are often fearful that new environments will not have the appropriate equipment to meet their needs or assist in their healing," says Amanda Budak, RN, MSN, CBN, a program manager of the digestive disease service line at the Medical University of South Carolina. "Many times they will delay or avoid medical treatment based on access and sensitivity to their healthcare environment."
Architects and designers need specific guidelines
Unfortunately, many hospitals are under-equipped to accommodate the growing number of bariatric patients. One reason is the lack of weight-specific design guidelines. Currently, neither the American Institute of Architects (AIA) nor the Americans with Disabilities Act (ADA) provides specific guidance on physical design associated with the care of obese patients.
"Architects and planners may think they can cover these issues by simply following the ADA guidelines," says Andy Collignon, AIA, a healthcare facility planner with Hammes Company. "But obesity is not considered a legal disability. The AIA is proposing new bariatric guidelines completely separate from the ADA rules, but these will not be incorporated into the AIA Guidelines until 2010. Meanwhile it is important to recognize and respond to these issues and address the needs of these patients in an appropriate manner."
Space planning solutions for obese patients
When planning and building a hospital, it is critical for architects and designers to consider steps that should be taken to properly admit and treat obese patients. Here are seven areas of a hospital that require particular attention when considering this patient population’s needs.
1. Building entries/Waiting areas
Building entry points should be designed with comfortable ramps, hand rails and a 3-foot-2-inch door width minimum, with ample-sized wheelchairs available upon entry. Public toilets and waiting rooms should be planned to meet the needs of obese patients.
Glen Barras, president of the healthcare seating company Sitris in Toronto, Ontario, recommends having 10-20 percent of all general seating in bariatric sizes, with a higher percentage in ED waiting areas, and up to 50 percent in cardiac units.
Care should be taken to avoid creating "obese-only" sections in general waiting areas. Loveseats can be a discreet way to mix this furniture with the standard waiting room furniture.
2. Treatment and procedure rooms
In all hospital treatment and procedure areas, doors need to be adequately sized. Door width for exam rooms should be 3 feet 6 inches, and the recommended opening size for patient rooms and procedure areas is 4 feet. Alternatively, paired doors or sliding doors on overhead tracks are other options. A 72-inch turning radius is recommended by experts in the field in lieu of the 60-inch ADA required radius.
3. Patient rooms/Toilet rooms
"We are finding that many bariatric patients also have obese family members," says Douglas Reddington, AIA, ACHA, vice president of BSA LifeStructures. "So we need a patient zone that is larger than standard, but we also need a family zone equipped with larger furniture."
Equipment manufacturer Hill-Rom recommends the bariatric room be at least 272 square feet, compared with the average private room size of 176 square feet. This allows for 5 feet of clearance around three sides of the patient’s bed to accommodate bariatric wheelchairs, walkers and portable lifts.
Toilet rooms should have a door width of 3 feet 6 inches and adequate space for two caregivers to assist patients. Toilets should be centered 24 inches from a wall as compared to the 18-inch ADA requirement. Walls should have extra strength-blocking so grab bars can support up to 800 pounds. Sinks should also be capable of supporting additional weight.
4. Elevators
The elevator doors must have a minimum width of 54 inches, although 60 inches is preferable. There is a significant up-charge for this elevator vs. a pre-engineered, 5,000-pound transport elevator. The 5,000 pound elevator is a “standard” elevator which makes it mass-produced and cheaper, while the larger elevators take up more space in a hospital and are more expensive, but they can hold larger loads and their doors open wider.
5. Toilets and sinks
Vitreous china toilets have a maximum capacity of about 300 pounds. Toilets stressed with additional weight can fail both by falling off the wall and by developing cracks in the material. The most common solution on the market today is floor-mounted stainless steel toilets with a capacity of 5,000 pounds.
6. Wheelchairs and beds
Bariatric wheelchairs are sized by weight-limit categories. The largest models have seat widths up to 48 inches and require a minimum 6-foot turning radius, as compared to the ADA-required 5-foot turning radius.
The composite bariatric bed is 98 inches long and 61 inches wide, with weight capacity ranging from 600-1,000 pounds. Other features include in-bed scales and a mechanism to raise the head of the bed while lowering the foot of the bed to bring the patient to a sitting position.
7. Furniture
Designers and medical equipment planners need to consider the weight-bearing capacity of bariatric furniture. Many pieces are designed for a 600- to 700-pound load. However, bariatric unit patients can weigh up to 1,000 pounds. Extra space is needed to accommodate this larger furniture.
Mr. Crook is a senior planner with Brookfield, Wis.-based Hammes Co., a leading full-service consulting firm providing strategic planning, facility development, project management, implementation, and real estate acquisition and advisory services to their clients. Learn more about Hammes Co .
