Survey Tool Reveals Strengths, Weaknesses of Bariatric Surgery Programs

As research supporting the benefits of bariatric surgery mounts—and as the number of individuals considered obese or extremely obese continues to increase—the conclusion that bariatric surgery is here to stay seems apparent. But accompanying the growing body of evidence that bariatric surgery can be a safe and effective procedure are reports of adverse outcomes and of healthcare facilities that are unprepared to handle the needs of bariatric surgery patients. Bariatric surgery is a "hot issue" in the medical malpractice world, says a San Diego-based defense lawyer, adding that hospitals must make the capital and human resources investments necessary to protect patients and staff.1

Extremely obese patients tend to have underlying health conditions, making them clinically fragile, and they require specialized equipment to be safely accommodated. Staff must also be educated to meet the unique clinical needs of extremely obese patients and must be trained in safe patient handling techniques to avoid injury. Improper patient selection, inadequate facility structures and staffing, and lack of training and proper credentialing procedures have all been identified as factors that contribute to adverse patient outcomes, staff injury, and resulting liability. Facilities need to have processes in place to mitigate these exposures.

The complexity and high-risk nature of bariatric surgery demand that healthcare facilities strive to adhere to existing standards and best-practice guidelines across all areas of the organization involved in delivery of this service. Some health systems have chosen to address this need by using the bariatric surgery module of ECRI's INsight™ risk assessment tool, an online survey that offers healthcare facilities a mechanism for examining strengths and weaknesses in high-risk areas. (See How Can INsight™ Help Advance Safety at Your Facility? for further details. )

"Even today, with all the progress in terms of bariatric surgical methods, it remains a high-risk procedure for patients," says Ian Leverton, M.D., vice president of clinical integration for Sutter Health, Sacramento, California. Leverton played a leading role in implementing the INsight bariatric surgery module in eight Sutter facilities that offer bariatric surgery. "INsight is one way to identify that the facility has the best, most up-to-date equipment, procedures, and standards in place," he adds.

This article provides a brief summary of the current state of bariatric surgery and describes how INsight works. It also provides targeted recommendations based on aggregate results from facilities that have completed the survey. (ECRI does not disclose or disseminate any identifying data from the aggregate results to third parties.)

Bariatric surgery is winning support from medical professionals and organizations as a procedure that can save lives. In a 2004 report, the Agency for Healthcare Research and Quality (AHRQ) concluded that bariatric surgery is a more effective approach to weight loss than nonsurgical interventions for individuals with a body mass index (BMI) >40 who have tried and failed to lose weight through diet and exercise. Also in 2004, ECRI's Health Technology Assessment Information Service published a report on the effectiveness of bariatric surgery. Based on an assessment of outcomes of adults who were extremely obese, ECRI concluded...