Hospital-acquired immobility, which refers to a lack of mobility and physical function due to prolonged bed rest and inactivity during a hospital stay, is a growing concern in healthcare. When admitted to the hospital, patients can spend up to 95% of their hospital stay in bed. The resulting condition of hospital-acquired immobility can lead to severe complications, including falls, muscle atrophy, joint stiffness, deep vein thrombosis (DVT), pressure ulcers, and longer recovery times, as well as an increased risk of readmissions.
These potential complications ultimately raise healthcare costs; for example, the estimated costs of some of the resulting health issues that can arise from immobility include falls- $6,694; pressure ulcers- $14,506; venous thromboembolism – $17,367; and an overall increase in length of stay at the hospital that could cost an estimated $11,000 per day or more in some cases.
Furthermore, hospital-acquired immobility can significantly impact a patient’s overall health and complicate the transition to home by reducing the ability to perform daily activities. Hospital-acquired immobility is often the reason why patients are not capable of walking out of the hospital at discharge and are delegated to skilled rehab facilities for weeks of costly rehabilitation.
The Impact on Patients of Size
The dangers of hospital-acquired immobility are more significant in bariatric patient populations. For example, the risk of complications such as DVT increases with body mass index (BMI). People with a BMI over 30 have a two- to threefold increase in risk, and the number is even higher for those with a BMI over 40.
One of the most significant barriers to mobilizing bariatric patients is the fear of falling. This can be exacerbated by clinicians’ concerns over being able to successfully retrieve the patient after a fall occurs.
Uneven weight distribution can further affect balance and the center of gravity, making it more challenging to mobilize safely after illness or surgery. Many hospitals also lack specialized equipment designed to accommodate patients of size, as well as the required training and experience for the hospital care team, which can intensify the fear of falling and the inability to get back up for both patients and their clinicians.
As a result, healthcare workers are often hesitant to mobilize bariatric patients due to safety concerns and the risk of injury. However, this can lead to more serious problems as hospital-acquired immobility results in patients becoming deconditioned and more susceptible to falls. On the other hand, more mobilization correlates to fewer falls and a decrease in hospital-acquired conditions.
“In the hospital setting, there’s not much encouragement to get up and mobilize as a larger patient,” said Tracey Carr, bariatric consultant and patient advocate for people of size. “Part of the reason is that the staff are worried about falls, so many healthcare workers would prefer the bariatric patient to stay in bed. But there’s also a significant risk attached to that.”
Prioritizing Mobility: A Crucial Step in Preventing Hospital-Acquired Immobility
Early and progressive mobilization is crucial for preventing hospital-acquired immobility. This is especially true for bariatric patients who can decondition faster than individuals with an average BMI. By initiating an early mobilization protocol, healthcare workers can take proactive steps to prevent the onset of hospital-acquired immobility and, subsequently, other related complications.
Encouraging patients to move as soon as possible can help maintain muscle strength, joint flexibility, and overall physical function. Early mobilization encompasses more than just ambulating; in addition to walking, patients benefit from periodic changes in position, such as turning in bed, sitting up in bed, dangling at the side of the bed, and moving to the chair. Research has shown that this early mobilization effort is associated with improved functional outcomes, reduced hospital costs, and decreased length of stay—in addition to lessening the risk of readmissions and the potential financial penalties from reduced reimbursement accompanying it.
Breaking Down Barriers: A Simple Approach to Combating Hospital-Acquired Immobility
One approach to addressing hospital-acquired immobility is to focus on practical ways to remove some of the barriers in the healthcare setting. This includes minimizing lines, tubes, and cords from equipment such as the intermittent pneumatic compression (IPC) devices used to prevent DVT. The problem with the presence of multiple cords and tubes connected to these devices is that they often hinder patient mobility by tethering them to the bed—leading to an increased risk of falls. At the same time, they can be time-consuming to disconnect and reconnect, creating a reluctance to mobilize for both the healthcare worker and the patient.
Conversations and education about the benefits of mobility can help patients lessen their fears and motivate them to adhere to mobility protocols. These conversations can unearth truths about a patient’s needs and expectations around mobility, helping them achieve their goals during and after their hospital stay. Clinicians will also be less afraid of the risks when they understand how their patients feel about moving, their concerns, and their preferences.
Conclusion
Hospital-acquired immobility is a serious concern affecting all types of patients, particularly those of size. The fear of falling is a significant barrier to mobility but not impossible to overcome. By prioritizing and teaching the importance of mobilizing patients early and often, leveraging innovative technologies such as wearable therapeutic compression devices like the Movement And Compressions (MAC) System, and breaking down barriers, healthcare workers can improve patient outcomes and reduce the risk of complications due to hospital-acquired immobility.