Ward Sanders, manager, Clinical Services, Surgical and Critical Care Technologies Group, STERIS Corp., Mentor, OH
It’s no secret that the bariatric patient population poses considerable challenges to the healthcare provider, particularly in the outpatient segment, and to the healthcare product manufacturer. One has to prepare its facilities to accommodate the patients; the other has to make products that facilitate such preparation.
For some providers, the bariatric patient represents a revenue opportunity tempered by budgetary and reimbursement headaches. For example, the costs to retrofit a facility’s footprint or invest in bariatric-specific equipment must be offset by additional patient volume. For product manufacturers, the bariatric patient represents a potentially lucrative – and until a few years ago – virtually untapped market segment.
As technological development outpaces provider budgets and overtakes reimbursement from payers, it’s important that vendors from the imaging, oncology and surgery sectors recognize the limits and roadblocks outpatient care centers face to attract bariatric patients.
Outpatient Care Technology wanted to explore how manufacturers of bariatric equipment are looking ahead, including product improvements in the pipeline now and how those developments will enhance performance, so it asked a group of representatives at some of the leading players for their insights.
If bariatric patients represent such a large and growing segment of the patient population, why does it make more sense to carve out a product niche for them than to merely change your overall manufacturing strategies, processes and product line to accommodate patients of all sizes up to, say, 800 pounds? In essence, eliminate the “bariatric” label because your existing product line would cover anyone?
Fred Cox, vice president, sales and marketing, Cardinal/Detecto Scale Manufacturing Co., Webb City, MO
In fact, Detecto continues to launch new products that are specifically marketed for bariatrics yet are universal to all patients. For instance, we have heard so many times from nurses that patients are very embarrassed to be wheeled out to a loading dock scale to check their weight. Their physical condition deserves the same quality care as any other patient. Detecto recently introduced a low-profile, extra-wide wheelchair scale that accepts the largest of wheelchairs and can weigh up to 1,000 pounds. However, to compensate for the size of the scale, Detecto constructed it of lightweight aluminum that any one nurse can move to another location of the facility.
Ward Sanders, manager, clinical services, surgical and critical care technologies group, STERIS Corp., Mentor, OH
You’re right. It is an emerging clinical trend. Your question makes perfect sense. Let me answer this way. STERIS provides surgical patient positioning systems to fit everyone – including very big people. The term we use is ‘human factored.’ It’s what industrial designers do. The product is right-sized for the people who use the product and for the patients who are placed on it. We ‘human factor’ our products to meet all the needs of the operating room. People come in all sizes. We design products that can be used for all sized patients. For example, our Cmax Surgical Table is capable of supporting the smallest to the largest of surgical patients, up to 1,100 pounds. These weight capabilities stand as fully tested and qualified, even if they’re never used.
Our one-size-fits-all approach makes purchase decisions easy. That’s what we strive to do. We consider the investment that customers already have made into their general surgical tables and develop accessories to extend the versatility of those tables. We’re trying to protect their investment and don’t want them to have to buy a dedicated bariatric table. For a reasonable price, we can turn their existing surgical table into a bariatric table by simply adding width adjusters and extenders. However, some accessories and equipment are designed to meet specific patient and staff requirements. For example, the bariatric power-lift stirrups are different from the standard ones we sell because they are sized for bigger, wider and heavier feet and legs. Using anthropomorphic studies, human scale drives the metrics of our products. The products have to be right-sized for patient and staff safety.
Dave Rector, director, marketing communications, TRUMPF Medical Systems Inc., Charleston, SC
That is what TRUMPF is doing with its surgical tables. The TRUMPF TITAN and new TRUMPF MARS surgical tables have patient weight capacities of 1,000 pounds and 800 pounds, respectively. Both tables, however, are not limited to bariatric procedures. Both the TITAN and the MARS are true universal surgical tables, offering patient positioning options and modular accessories that meet the need of virtually every surgical discipline. For the healthcare facility, this means a single surgical table that meets all their needs: Reducing costs, reducing storage space requirements of multiple tables and eliminating the need to change tables based on the type of procedure scheduled.
Kevin Gilroy, national sales director, surgical tables; Brian Campe, product manager, surgical tables; Getinge USA Inc., Rochester, NY
MAQUET has always been the gold standard in surgical tables, setting the standard in weight capacity and low-height capability. In terms of surgical tables, what was once considered a ‘bariatric table’ has in many cases become the standard operating platform for all surgical procedures. These tables offer benefits to both patient and staff by allowing for lower height adjustment, increased patient weight capacity and better patient access for the surgical staff. Many hospitals/bariatric centers also have internal guidelines related to patient acceptance and risk tolerance. For example, bariatric center XYZ may only accept patients up to 500 pounds based on anesthesia concerns while another center may accept a larger person. For this reason MAQUET offer tables for 600-pound or 1,000-pound patient weight capacity to meet the varying needs and budget constraints of our customers.
What are the marketing and/or pricing advantages to promote products under the “bariatric” label? Why could you not retain those advantages if “bariatric” patients were part of the mainstream patient population your products typically helped?
COX: Detecto is gearing up our product line with low-cost, high-capacity scales that even the home patient can afford. For instance, Detecto just launched a new low-cost digital scale with a weight capacity of 550 pounds that many can afford either with insurance support or outright purchase. With the mainstream population’s average mean weight growing each year, we must be prepared to weigh all of our citizens.
SANDERS: STERIS as a company works to meet the needs of all patients. We don’t apply a marketing or pricing premium for ‘bariatric’ products. When we sell a table or accessories we offer to meet the weight of patients and provide [buyers] an advantage. Anthropomorphic studies show that bariatric products generally can hold up to 600 pounds. In general, surgeons don’t do surgery on patients bigger than that unless it involves life-or-death and they’re willing to take the risk of operating on that patient.
I’m trained as a product designer. Given the opportunity I would first design a product to fit all sizes. I would only provide customized sizing when human factors contradict what we know about patients. Bariatric is just a different sized product – not something that needs a premium price.
RECTOR: For facilities that specialize in bariatric procedures I think there is a comfort level in having that bariatric label and getting the sense that the manufacture or the product shares their specialization. On the other hand, general facilities might be dissuaded by that label, feeling the product isn’t designed to meet general applications. So from a marketing perspective, if you do offer a true universal product the bariatric label can be a positive and a negative. As the industry moves toward products that meet the needs of the entire population terms like ‘universal’ need to be recognized and better understood. As I said, the economic, space and efficiency benefits of TRUMPF’s universal products are significant for the healthcare facility.
GILROY/CAMPE: As society continues to recognize the growing obesity trend and the government increases funding for this specialty, hospitals will compete for this funding. MAQUET continues to stay on the front lines in developing products that meet and exceed the demands of the market. MAQUET tables and accessories are built with flexibility in mind and will never be defined by one specialty, bariatric or otherwise.
What are some of the more recent noteworthy improvements in the bariatric equipment models you manufacture and why do they matter clinically and operationally?
COX: As scales are required to weigh heavier patients, the scale must be designed with lighter and stronger materials so they can still be mobile and easy to move.
SANDERS: This is an emerging clinical opportunity for everyone in the industry. We’re learning more about bariatric technique and surgical conditions from obese patients. We started by providing accessories that increase the width of our surgical tables and then developed wider arm and leg supports and stirrups. Then we went to a series of restraints to keep patients safe in various surgical positions. Some of the procedures they do, such as lap banding and stapling, require reverse Trendelenburg tilt, so they need reverse Trendenlenburg restraint straps, for example. We also created a butt plate to hold the patient in place and foot plates at the end of the table to restrict slide. Knee restraints keep knees from buckling. Products of that kind are evolving on a regular basis as industry devises more effective techniques to operate on bariatric patients and we create technology to service them.
RECTOR: With both the TITAN and the new MARS, TRUMPF is offering surgical tables that remain stable at their full advertised patient weight capacity in all configurations and even at extreme positioning angles. Clinically and operationally that means surgical staff can proceed confidently knowing the table will more than handle the weight regardless of the positions required by a given procedure.
With a low height adjustment of just 24 inches off the ground in the case of the TITAN and less than 24 inches with the MARS, both tables provide medical team access and comfort in general cases, and bariatric cases where the patient’s stomach will be higher. TRUMPF offers the lowest-height positioned mobile tables on the market that has a built-in X-ray channel that goes over the column.
During bariatric procedures, the table’s positioning capabilities, including Trendelenburg and reverse Trendelenburg, can be used to sink excess body tissue away from the surgical site and improve access. The TRUMPF’s lateral tilt also provides precise access to the surgical site and with larger patients can be used to counterbalance girth.
The TITAN and MARS also come standard with a TRUMPF dual articulating headrest which can be positioned up or down for neck and throat access in various procedures. This headrest position compensates for the large back and the neck of the obese patient.
The TRUMPF 2-part Abducting, Split Leg Plates move up and down independently or simultaneously. They also abduct and transverse. This increases surgical team access and comfort in reaching the surgical site. The 2-Part Split Leg Plates also have continuous rails. This will allow you to adjust the footboard, moving it closer to meet the foot of the obese patient who will tend to have shorter legs.
GILROY/CAMPE: Any products that can increase safety for both the patient and staff are worth talking about. MAQUET set the standard for low-height tables with split-leg capabilities to allow for greater surgical access as well as more comfortable working conditions for the staff. The MAQUET ALPHAMAQUET pioneered the concept of removable table tops as a solution for reducing patient transfers in the OR, both increasing productivity as well as increasing safety for patient and staff. MAQUET tables also have an optional motor drive system built into our tables to allow for easier movement of the table while the patient is on the table.
How do you make the bariatric equipment you manufacture today even more user-friendly without compromising effectiveness?
COX: Simple electronics and easy to use weight displays are important. For example, when patience are wheelchair bound, Detecto’s weight indicator provides an easy way to zero off the weight of the empty wheelchair so the patient can simply be moved on to the scale for accurate weight.
SANDERS: We start with paying a lot of deliberate attention to instructions for use. We provide safety information and often label products accordingly so that users have the information when and where they need it. That’s not unique to bariatric products. We do that for all our products. We stay within comfortable ergonomic expectations and utilize methods to reduce the handling weight and increase strength. We want to make the products easy to handle and apply. We realize that professional organizations like AORN are taking a stand on optimizing the work environments for their members. We want to preserve the health and safety of the patients and workers as much as they do. That’s the thought behind our power-lift stirrups, for example, which reduce the effort required of staff to position the bariatric patient’s legs and provide comfortable cradling for the patient. We also offer ergonomic back supports for shoulder procedures that use the energy of the table itself and reduce effort for the operator. We turn to any means we have available to reduce staff effort. We make sure we can accommodate the heaviest weight possible and document that capacity number on the product label and in the operator manual. This way, the hospital staff doesn’t have to assume anything.
We have a comprehensive surgical table accessory catalog. It includes specific weight references for each accessory in addition to descriptions and photography. We want people to use products effectively and safely. They need to regard tables and accessories as part of a complete patient positioning system.
RECTOR: Stability and modularity are two concepts that significantly assist the user. In the case of surgical table stability, the fact that the TITAN and MARS remain stable regardless of patient angle or configuration even at full weight capacity means the surgical team can proceed confidently and focus on the procedure. Modularity is another aspect of all TRUMPF surgical tables. TRUMPF Modularity allows components and accessories – specifically those that will assist in bariatric procedures - to be easily added to the table.
GILROY/CAMPE: Development work in dialogue with physicians and surgeons this is one of the principles which has made MAQUET the world’s market leader in operating tables. Close cooperation and decades of know-how make for products optimized to meet the needs of practice. They facilitate work in the operating room and help to enhance patient safety and comfort.
What do you foresee as the next big development in bariatric equipment applications to expand functionality or improve performance? Why? What additional capabilities and features will be available to improve patient care in the outpatient setting?
COX: The lower profile weight platforms are the most popular. As new weighing technologies become available, the bariatric patient will benefit.
SANDERS: Bariatrics is a vast subject. From our perspective, we’re going to meet clinical demand on an ongoing basis. New surgical tables will include capabilities not seen before. One industry focus is patient transfer and transport. Manufacturers are seeking to reduce the number of times patients need to be moved from one surface to another. This would reduce staff and patient safety risks and would improve productivity.
In terms of demands, there’s one opportunity that needs to be met by the industry. One of the most difficult moves in the OR involves anesthetizing and intubating the patient on a surface and rolling and positioning them in a prone posture. That’s a formidable task under the best of circumstances. It’s hard to imagine how people are doing it.
We are constantly engaging our OR customers to identify their most pressing problems in surgical settings. We’re doing everything we possibly can to extend clinical capabilities and make products easier to use, reliable, durable and safer. We also want to offer a great return-on-investment. That’s what we’re after. Bariatrics is a big part of our focus because it’s a growing area of need.
RECTOR: Patient transport is a significant issue with safety ramifications for both patients and staff. The TITAN and MARS both offer the advantage of being mobile surgical tables that move easily at full capacity so they can serve as components of a facilities patient transport system. In addition, TRUMPF’s dedicated patient transport solutions, including the ORBIT PT, are evolving to manage larger patients.
GILROY/CAMPE: MAQUET is the world leader in research and development for surgical tables. In the future tables such as the MAQUET MAGNUS will redefine the requirements of the surgical staff with extreme positioning capabilities such as 80 degrees trendelenburg and 45 degrees tilt, both increasing the effect of gravity as a method to expose the surgical site as well as allowing for better surgeon access, all of which lead to better patient outcomes.
