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Hospitalists should promote mobility among inpatients

Promoting mobility among hospitalized patients may help to reduce the negative consequences associated with bedrest, according to a paper published in Annals of Internal Medicine.

“A robust literature has found that bedrest leads to functional decline in hospitalized patients,” S. Ryan Greysen, MD, MHS, and Mitesh S. Patel, MD, MBA, MS, both from the Perelman School of Medicine at the University of Pennsylvania, wrote. “In particular, persons aged 65 years or older are at substantial risk: approximately one in three have functional decline after hospitalization.”

In the paper, Greysen and Patel offered several recommendations for hospitalists to encourage health mobility during acute care.

Hospitalists should establish a baseline and set goals by evaluating patients’ mobility level at the time of hospitalization, they wrote. Discussing the patient’s current level of mobility with family members and reviewing the patient’s chart and results on the nursing assessment of activities of daily living and mobility can be helpful, they noted.

Mobility and function issues should be addressed at the beginning of hospitalization, according to Greysen and Patel.

For each patient admitted to the hospital, clinicians should develop an individualized mobility plan outlining an appropriate schedule for time out of bed and walking, Greysen and Patel recommended.

Hospitalists should conduct discussions with the bedside nurse and patient about the mobility plan to ensure that the plan is followed, they wrote. They noted that coordinating with patient care assistants or hospital volunteers who can help patients with walking may be useful.

“Although robust evidence is lacking, our clinical experience leads us to believe that the existence of a thoughtful plan to address functional status and mobility during and after hospitalization could help reduce the number of discharges to skilled nursing facilities, enhance patient engagement and experience, and perhaps even influence postdischarge outcomes of care,” Greysen and Patel concluded.

“Conversely, the lack of a thoughtful mobility plan contributes to functional decline during hospital stays, particularly for older adults,” they added. “Assessment of functional status and mobility on admission and throughout the hospitalization must become our new norm. It’s time for hospitalists to take a leading role in promoting patient mobility in the hospital to neutralize the toxicity of bedrest.” – by Alaina Tedesco

Disclosure: Greysen reports no relevant financial disclosures. Patel reports receiving support from Catalyst Health, HealthMine Services INce, Life.io and from Holistic Industries.