"When we first started this program in 2004, we were hoping to have at least 100 hospitals participate and 300 surgeons participate," says Gary Pratt, CEO of SRC. "We were also told that there were probably only 300 to 400 hospitals total in the country doing bariatric surgery at that time. We estimate now that there are over 800 hospitals performing 10 or more bariatric surgery cases per year," he says.

Pratt explains that facilities that want to acquire the BSCOE designation must demonstrate the dedication to the appropriate care for the patient.


"If your facility is treating patients in the 500-pound range but your equipment is rated at 350 pounds, you're going to have an issue," says Pratt.

The SRC also places a significant value on compassion for the patient population and appropriate staff training. The organization's team makes sure to ask the staff questions about sensitivity and equipment use training.

"We're seeing a lot of technological advances in the areas of equipment, people getting smarter and recognizing that there's more of a direction toward the obese and morbidly obese," says Pratt.

Pratt says there are some quick ways to determine if a facility isn't fully dedicated to the bariatric surgery program. He says in the earlier years of the designation process, many institutions didn't have floor-mounted toilets or adequate waiting room furniture. Crash carts are also often an overlooked detail.

"These patients are very difficult to intubate," says Pratt. "If they're running a code, the patient starts to crash, then we start looking at whether or not the crash cart has a kit that is specifically designated for compromised or difficult airways, since you find that common with the morbidly obese."

In the early stages of the program, Pratt remembers a CEO of a hospital complaining about the amount of money he'd have to spend to get designated.

"I said, 'well, let's just say if you don't replace your toilet and you have a post-surgery patient that just broke a toilet off the wall laying prostrated on the floor with water gushing all over their body, forget the BSCOE designation, you need to think about your liability,'" says Pratt.

Designated facilities are required to undergo a renewal inspection a minimum of every three years.

"Our requirement number one is institutional commitment to bariatric surgery," says Pratt. "In the old days, it wasn't seen as a credible specialty, so they didn't get the equipment they needed; they didn't get the support they needed. Now, they've seen how this program can help them improve," he says.

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