The first step in initiating a bariatric clinic should be the creation of a multidisciplinary committee in which all the appropriate areas and stakeholders are represented. The committee should be in charge of evaluating the characteristics of the expected population and adapt the design of the facilities and the equipment to its specific needs. The approach that has worked the best in our experience to coordinate the implementation in bariatric equipment was the development of a bariatric task force (BTF). This can be a temporary problem-oriented group but most likely should function as a permanent committee that reviews the concerns relating to bariatric patients. Equipment and physical plant issues, in particular, will require ongoing attention (evaluation, updating, new construction, etc.). Prior to establishing the BTF, a fundamental presentation by a knowledgeable individual or group may provide an introduction to bariatric patients, equipment, surgical procedures, and surgical results for the hospital. Inclusion of department administrators goes a long way toward engendering some empathy and helps them to see why a BTF is needed. The task force should have a broad representation from all aspects of the facility—administration, parking, environmental services, transport, purchasing, nursing (intensive care units, intermediate care units, medical-surgical floors, clinics, administration, home care, bariatric coordinators, case managers, enterostomal therapy, outpatient surgery units, postanesthesia care units, operating room, and emergency room), nutrition, social work, physical therapy, radiology, cardiology, pulmonology, surgeons, and midlevel practitioners.

The first commission of the task force is to investigate the facility’s assets and limitations with respect to the physical structural layout and available conventional and bariatric patient care equipment [8, 10]. Questions to ask are: How have you managed with morbidly obese patients up to this point? Which practitioners have had an interest in these patients (e.g., nurses, enterostomal therapist, physical therapist, pulmonologist)? What are the weight and width limitations of the currently available equipment starting with chairs in waiting rooms and hospital beds? Who are the vendors of bariatric equipment items already in use? What are the present policies for the utilization of bariatric equipment? What distances must the patients travel from the clinic and the acute care areas and to the diagnostic testing areas? The committee should systematically review each step of the patient’s hospital experience from “home to home.”

A second area of investigation should focus on what bariatric equipment is available for purchase. There are a number of reputable sources of information on products and companies. Vendors typically have websites with listings of a wide range of bariatric products with links.

A third area of investigation should focus on the characteristics of the patients expected to make up the service population in view of the hospital’s prior experience with morbidly obese patients. The bariatric surgeons should be questioned with respect to their expectations for maximum and median weight and BMI. In our practice, the first 500 patients had a weight range from 190 to 473 lb (86–215 kg) with BMIs from 35 to 69. Thus contingency plans for patients greater than 500 lb (227 kg) and BMIs greater than 70 were needed, recognizing that these would represent a relatively small number.

One of the goals of these investigations will be to prioritize purchases and other adaptations in the environment. The task force should develop criteria for their utilization. For example, in our institution, we did not have a dedicated bariatric surgical floor, and there were hospital beds in the facility of a variety of vintages and models. The standard hospital beds had a variety of weight limits, 350–500 lb (159–227 kg) and widths of 34–36 in. (86–91 cm). The lowest of these weight limits had to become the maximum permitted for the use of a standard hospital bed. Similarly, the mattresses on the beds also had weight ratings, 325–400 lb (147–182 kg). This led to the protocol that all patients with a weight over 325 lb (147 kg) and/or a BMI greater than 55 (to capture the width parameter) would require a bariatric bed [19]. Criteria-based protocols help to utilize the hospital’s resources most effectively and allow for preplanning as the patient population changes [12, 13].

Utilization of bariatric equipment does not ensure proper health care but can greatly improve the quality and safety of care [13]. Both caregivers and patients should receive specific instructions for using specialized bariatric equipment properly in order to fully benefit from the advantages, which this equipment offers.

This review of bariatric furniture and equipment which should be considered is based on available literature and the authors’ experience in caring for over 4,000 bariatric surgical patients [8, 11, 12, 14, 19–24]. The following discussion will follow the surgical patient through the entire hospital course, from “home to home” which is divided clinically into the preoperative, operative, and postoperative periods. Since the operative period is discussed in detail elsewhere (see Chap. 10), this chapter reviews the equipment needs of the preoperative and postoperative morbidly obese patient.

Table 2 lists the bariatric equipment items discussed along with contact information for some of the vendors.