Author Identifier

Kim McClean

Date of Award


Document Type



Edith Cowan University

Degree Name

Doctor of Philosophy


School of Medical and Health Sciences

First Supervisor

Martyn Cross

Second Supervisor

Sue Reed


Healthcare staff who manage obese patients are at increased risk of sustaining patient handling injuries, and this risk is anticipated to intensify as projected Australian obesity rates increase to 42% by the year 2035 and obese patients admitted to hospitals also increase. High cost burdens to healthcare organisations will result due to increased funding requirements for bariatric risk management solutions and growing costs of workers’ compensation claims of injured staff. Five (5) studies explored if identification of obese patients impacts the safety of nurses and other healthcare staff who manage obese patients and investigated the accuracy of obesity data recorded in hospital data systems. Additionally, financial impacts to hospitals relating to obesity data accuracy was also examined. Very little research currently exists on these risks.

A literature review was conducted which investigated risks to healthcare staff and organisations that manage obese patients. Availability of obesity data to mitigate risks was also explored. Thirty (30) studies were included in the review, which identified high risks of injury to healthcare staff and high liability and financial risks to healthcare organisations. Availability of obesity data within clinically captured information was also verified.

A pilot study successfully investigated accuracy of obesity data in the Western Australian Country Health Service (WACHS), and factors potentially impacting completeness of obesity data recording and accuracy of obesity coding. The methodology and data used in the pilot study was expanded to examine 590 patient records, and poor completeness of obesity data recording and coding accuracy was determined.

Financial implications to hospitals due to inaccurate obesity data were also examined. Eighty five (85) records of inaccurate obesity data were identified and corrected, and adjusted Diagnosis Related Groups, National Weighted Activity Units and Activity Based Funding were examined. Estimated annual lost funding opportunities of A$2.23 million due to obesity coding inaccuracy was calculated.

Finally, an intervention to improve completeness of obesity recording and data accuracy was conducted at a WACHS hospital site over a 1 year timeframe. The intervention outcomes demonstrated improved obesity recording and coding, including increases in weight and height recording, BMI recording, obesity coding, and sensitivity.

The 5 completed studies illustrate the risks to healthcare staff and organisations that manage obese patients, and the ability to use accurate obesity data to mitigate risks and improve hospital finances. Obesity data recording and coding has been demonstrated to be inaccurate, however improvement programs will enhance obesity data recording and accuracy which will positively impact safety of hospital workers and hospital finances.


Paper Location