Hospital-acquired immobility, a condition resulting from a lack of mobility and physical function due to prolonged bed rest during a hospital stay, is an increasingly serious issue in healthcare that can have far-reaching consequences for patients, healthcare providers, and the broader healthcare system.
Patients can experience a functional decline and deconditioning from baseline mobility as early as the second day of hospitalization. The resulting conditions of hospital-acquired immobility can lead to costly medical interventions, extended length of stay, longer recovery times, and hospital readmissions, ultimately increasing healthcare costs.
Hospital Capacity and Access
One of the most pressing concerns for hospital administrators is access to care, hindered by capacity constraints. Inefficient processes often lead to prolonged lengths of stay, resulting in significant costs—averaging $3,167 per day for nonprofit hospitals in the US, with higher costs incurred for more intensive care. Hospital-acquired immobility can be a key contributor to prolonged length of stay as it can lead to complications for patients such as deep vein thrombosis, muscle atrophy, pressure ulcers, and more—all of which can lengthen the time patients need to recover fully and, in turn, extend their stay in the hospital. This can have downstream effects that lower capacity and the inability to admit new patients in a timely manner.
While building new hospitals is one solution, optimizing efficiency at existing facilities and mobilizing patients to reduce the length of stay can also significantly expand capacity and access.
Even a modest reduction in the average length of stay—by just a fraction of a day—can free up capacity for thousands of additional patients annually.
The Broader Economic Impact
Hospital-acquired immobility can also lead to:
Legal and Liability Costs: Hospitals and healthcare providers may face medical malpractice and legal claims if patients develop preventable conditions due to hospital-acquired immobility. The costs of medical malpractice claims and potential settlements or judgments can be substantial. Beyond financial costs, hospitals may suffer reputational damage, which can erode patient trust and future revenue.
Chronic Conditions: Patients may develop long-term complications which require ongoing treatment and increase overall healthcare costs. Furthermore, the complications can result in a decreased quality of life for patients, leading to additional healthcare needs and expenses related to managing long-term health issues.
Hospital Readmissions: Low mobility is closely linked to hospital readmissions, which are costly and can result in financial penalties under certain healthcare payment models.
Systemic Costs: On a larger scale, hospital-acquired immobility can lead to significant financial burdens on healthcare systems, as preventable conditions contribute to higher healthcare costs, reduced workforce productivity, and increased insurance premiums.
Exploratory Scenario: Deep Vein Thrombosis (DVT) as a Result of Hospital-Acquired Immobility
The increased risk of deep vein thrombosis (DVT) serves as a strong example to illustrate the significant economic impact of hospital-acquired immobility. When a patient is immobile for an extended time, such as after surgery or while on bed rest in the hospital, blood flow in the veins can slow down or become blocked. A DVT is a blood clot that forms in the leg. If the blood clot breaks loose and travels to the lungs, it results in a pulmonary embolism (PE). Together, they are known as venous thromboembolism. In the hospital setting, roughly 1 out of 10 deaths are related to blood clots, making them the leading cause of preventable hospital death.
Mechanical prophylaxis, such as intermittent pneumatic compression (IPC) devices, are a widely accepted method and prescription for preventing DVT. However, compliance with mechanical prophylaxis devices is a significant issue, particularly with IPCs, where adherence as low as 40% has been reported. Non-compliance with mechanical prophylaxis leads to a higher incidence of DVT and costly medical interventions.
Multiple studies have identified reasons for non-compliance, including discomfort associated with wrapping a non-breathable air bladder around the leg. Another part of the problem is the multiple cords and tubes connected to mechanical prophylaxis devices, which hinder patient mobility by tethering them to the bed. This creates a reluctance to mobilize for both the healthcare worker and the patient. Furthermore, if the IPC Sleeves are removed for patient mobilization, they are not always reapplied in a timely manner.
The cost of patients’ non-compliance with mechanical prophylaxis devices can be significant; preventable DVT alone costs an estimated $2.5B annually, with each case resulting in a direct hospital cost of $17,367.
Reducing Costs by Prioritizing Early Mobilization to Prevent Hospital-Acquired Immobility
Early and progressive mobilization is crucial for preventing hospital-acquired immobility. By initiating an early mobilization protocol, healthcare workers can take proactive steps to prevent the onset of hospital-acquired immobility and other related complications.
Early mobilization encompasses more than just ambulating; in addition to walking, patients benefit from periodic changes in position, such as turning or 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 readmission risk, and decreased length of stay.
A straightforward approach to enhancing early mobilization efforts is to focus on practical ways to remove some of the barriers in the healthcare setting. This includes minimizing lines, tubes, and cords from IPC devices used to prevent DVT and replacing them with a wearable therapeutic compression device, such as the MAC System, that is cordless and tubeless and delivers 3x over baseline femoral vein response to avoid venous stasis during recovery. The cordless and tubeless design increases patient comfort and allows for greater mobility.
The ROI of Early Mobilization
A sample ROI analysis for a hospital illustrates the potential cost savings early mobilization has on a patient’s length of stay (LOS) with wearable therapeutic compression devices in terms of reduced hospital stays:
- Average length of stay: 4.16 days
- Number of patients: 569
- Average cost per day: $11,700
- 2.5% Reduction: 0.104 days or 2.5 hours (potential cost savings: $692,359)
- 5% Reduction: 0.208 days or 4.99 hours (potential cost savings: $1,384,718)
- 10% Reduction: 0.416 days or 9.98 hours (potential cost savings: $2,769,437)
Conclusion
Hospital-acquired immobility is a growing concern for healthcare systems, with significant economic implications for the broader healthcare system. Prioritizing patient mobilization early and often can help mitigate the economic impact of hospital-acquired immobility on healthcare systems while improving patient outcomes and reducing the risk of complications.