A randomized trial of a behavioral intervention to decrease hospital length of stay by decreasing bedrest

English version

Autoři: Juliana Tolles ^aff001; Gabriel Waterman ^aff003; Charles E. Coffey, Jr. ^aff004; Rebecca Sandoval ^aff005; Ross J. Fleischman ^aff001; Mailee Hess ^aff002; Laura Sarff ^aff004; Roger J. Lewis ^aff001; Brad Spellberg ^aff004;
Působiště autorů: Department of Emergency Medicine, Harbor-University of California Los Angeles (UCLA) Medical Center, Torrance, California, United States of America ^aff001; David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America ^aff002; CareMore Health, Pico Rivera, California, United States of America ^aff003; Los Angeles County + University of Southern California (USC) Medical Center, Los Angeles, California, United States of America ^aff004; Department of Medicine, Keck School of Medicine at USC Los Angeles, Los Angeles, California, United States of America ^aff005; Department of Medicine, Harbor-UCLA Medical Center, Torrance, California, United States of America ^aff006
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0226332

Souhrn

Background

Approximately half of hospitalized patients suffer functional decline due to spending the vast majority of their time in bed. Previous studies of early mobilization have demonstrated improvement in outcomes, but the interventions studied have been resource-intensive. We aimed to decrease the time hospital inpatients spend in bed through a pragmatic mobilization protocol.

Methods

This prospective, non-blinded, controlled clinical trial assigned inpatients to the study wards per routine clinical care in an urban teaching hospital. All subjects on intervention wards were provided with a behavioral intervention, consisting of educational handouts, by the nursing staff. Half of the intervention wards were supplied with recliner chairs in which subjects could sit. The primary outcome was hospital length of stay. The secondary outcome was the ‘6-Clicks’ functional score.

Results

During a 6-month study period, 6082 patient encounters were included. The median length of stay was 84 hours (IQR 44–175 hours) in the control group, 80 hours (IQR 44–155 hours) in the group who received the behavioral intervention alone, and 88 hours (IQR 44–185 hours) in the group that received both the behavioral intervention and the recliner chair. In the multivariate analysis, neither the behavioral intervention nor the provision of a recliner chair was associated with a significant decrease in length of stay or increase in functional status as measured by the ‘6-Clicks’ functional score.

Conclusion

The program of educational handouts and provision of recliner chairs to discourage bed rest did not increase functional status or decrease length of stay for inpatients in a major urban academic center. Education and physical resources must be supplemented by other active interventions to reduce time spent in bed, functional decline, and length of stay.

Trial registration

ClinicalTrials.gov, HS-16-00804.

Klíčová slova:

Hospitals – Nurses – Patients – Research assessment – Inpatients – Hospitalizations – Electronic medical records – Multivariate analysis

Zdroje

1. Graf C. Functional decline in hospitalized older adults. The American journal of nursing. 2006;106(1):58–67, quiz -8. doi: 10.1097/00000446-200601000-00032 16481783

2. King BD. Functional decline in hospitalized elders. Medsurg nursing: official journal of the Academy of Medical-Surgical Nurses. 2006;15(5):265–71; quiz 72.

3. Brown CJ, Friedkin RJ, Inouye SK. Prevalence and outcomes of low mobility in hospitalized older patients. Journal of the American Geriatrics Society. 2004;52(8):1263–70. doi: 10.1111/j.1532-5415.2004.52354.x 15271112

4. Suesada MM, Martins MA, Carvalho CR. Effect of short-term hospitalization on functional capacity in patients not restricted to bed. American journal of physical medicine & rehabilitation / Association of Academic Physiatrists. 2007;86(6):455–62.

5. Brown CJ, Redden DT, Flood KL, Allman RM. The underrecognized epidemic of low mobility during hospitalization of older adults. Journal of the American Geriatrics Society. 2009;57(9):1660–5. doi: 10.1111/j.1532-5415.2009.02393.x 19682121

6. Pashikanti L, Von Ah D. Impact of early mobilization protocol on the medical-surgical inpatient population: an integrated review of literature. Clinical nurse specialist CNS. 2012;26(2):87–94. doi: 10.1097/NUR.0b013e31824590e6 22336934

7. Hirsch CH, Sommers L, Olsen A, Mullen L, Winograd CH. The natural history of functional morbidity in hospitalized older patients. Journal of the American Geriatrics Society. 1990;38(12):1296–303. doi: 10.1111/j.1532-5415.1990.tb03451.x 2123911

8. Sands LP, Yaffe K, Covinsky K, Chren MM, Counsell S, Palmer R, et al. Cognitive screening predicts magnitude of functional recovery from admission to 3 months after discharge in hospitalized elders. The journals of gerontology Series A, Biological sciences and medical sciences. 2003;58(1):37–45. doi: 10.1093/gerona/58.1.m37 12560409

9. Padula CA, Hughes C, Baumhover L. Impact of a nurse-driven mobility protocol on functional decline in hospitalized older adults. Journal of nursing care quality. 2009;24(4):325–31. doi: 10.1097/NCQ.0b013e3181a4f79b 19395979

10. Jette DU, Stilphen M, Ranganathan VK, Passek SD, Frost FS, Jette AM. Validity of the AM-PAC "6-Clicks" inpatient daily activity and basic mobility short forms. Physical therapy. 2014;94(3):379–91. doi: 10.2522/ptj.20130199 24231229

11. Jette DU, Stilphen M, Ranganathan VK, Passek SD, Frost FS, Jette AM. AM-PAC "6-Clicks" functional assessment scores predict acute care hospital discharge destination. Physical therapy. 2014;94(9):1252–61. doi: 10.2522/ptj.20130359 24764073

12. Jette DU, Stilphen M, Ranganathan VK, Passek S, Frost FS, Jette AM. Interrater Reliability of AM-PAC "6-Clicks" Basic Mobility and Daily Activity Short Forms. Physical therapy. 2014.

13. Convertino VA. Cardiovascular consequences of bed rest: effect on maximal oxygen uptake. Medicine and science in sports and exercise. 1997;29(2):191–6. doi: 10.1097/00005768-199702000-00005 9044222

14. Creditor MC. Hazards of hospitalization of the elderly. Annals of internal medicine. 1993;118(3):219–23. doi: 10.7326/0003-4819-118-3-199302010-00011 8417639

15. Chuang KH, Covinsky KE, Sands LP, Fortinsky RH, Palmer RM, Landefeld CS. Diagnosis-related group-adjusted hospital costs are higher in older medical patients with lower functional status. Journal of the American Geriatrics Society. 2003;51(12):1729–34. doi: 10.1046/j.1532-5415.2003.51556.x 14687350

16. Mundy LM, Leet TL, Darst K, Schnitzler MA, Dunagan WC. Early mobilization of patients hospitalized with community-acquired pneumonia. Chest. 2003;124(3):883–9. doi: 10.1378/chest.124.3.883 12970012

17. Hoyer EH, Brotman DJ, Chan K, Needham DM. Barriers to Early Mobility of Hospitalized General Medicine Patients: Survey Development and Results. American journal of physical medicine & rehabilitation / Association of Academic Physiatrists. 2015;94(4):304–12.