title: Obesity significantly increases the difficulty of patient management in the emergency department.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Advanced Medical Science, University of Melbourne, Parkville, Victoria, Australia.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Kam
authors.forename: David McD
authors.initials: DM
authors.lastname: Taylor
mesh_terms: D015992:Body Mass Index; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D019468:Disease Management; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D009765:Obesity; D017064:Process Assessment, Health Care; D011795:Surveys and Questionnaires