The potential consequences of inadequate patient mobility during hospital stays, particularly those involving prolonged bed rest, have rightfully become a significant concern within the healthcare industry. Some patients experience a functional decline and deconditioning from baseline mobility as early as the second day of hospitalization. This can lead to hospital-acquired immobility.
Clinically, the consequences of hospital-acquired immobility include higher rates of complications such as Deep Vein Thrombosis (DVT), pulmonary embolism, muscle atrophy, pressure injuries, and more. The economic implications are equally concerning. Reduced patient satisfaction, longer recovery times, prolonged hospital stays, costly medical interventions, and potential hospital readmissions contribute to increased healthcare expenditures that further strain resources.
Hospital-acquired immobility can lead to:
Reduced Hospital Capacity and Access: One of the most pressing concerns for hospital administrators is access to care, often hindered by capacity constraints. Hospital-acquired immobility can contribute to prolonged length 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. This can have downstream effects that decrease capacity and the ability to admit new patients.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.
Chronic Conditions: Patients may develop long-term complications from hospital-acquired immobility, which require ongoing treatment and can decrease quality of life. These complications lead 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 some healthcare payment models. One study found that mobility level during and after acute illness may be linked to the risk of early hospital readmission. On average, patients who were admitted within 30 days walked significantly less (about 1/3 less) than patients who were not readmitted.
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. Beyond financial costs, hospitals may suffer reputational damage, which can erode patient trust and future revenue.
Systemic Costs: Preventable conditions such as hospital-acquired immobility contribute to higher healthcare costs, reduced workforce productivity, and increased insurance premiums.
Illustrative Example: The Link Between Hospital-Acquired Immobility and Deep Vein Thrombosis
The increased risk of Deep Vein Thrombosis illustrates the clinical and financial impacts 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 or become blocked. A DVT is a blood clot that forms in the leg. If the clot breaks loose and travels to the lungs, it results in Pulmonary Embolism (PE). Together, they are known as Venous Thromboembolism (VTE). VTE is the leading cause of preventable hospital death in the United States, with as many as 70% of HA-VTEs being preventable.
Mechanical prophylaxis, such as intermittent pneumatic compression (IPC) devices, is a widely accepted method 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. The cords and tubes connected to these devices are equally problematic, 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 an average cost of $17,367.
Prioritizing Early Mobilization to Prevent Hospital-Acquired Immobility
It is crucial to prioritize patient mobilization early and often to mitigate the effects of hospital-acquired immobility and reduce the risk of complications such as DVT. Early mobilization encompasses more than just ambulating; patients can also benefit from periodic changes in position, such as turning or sitting up in bed, dangling their legs at the side of the bed, and/or moving to the chair. Research has shown that early mobilization efforts are associated with improved functional outcomes, reduced hospital costs and risk of readmissions, and decreased length of stay.
A straightforward approach to enhancing early mobilization efforts is to focus on practical ways to remove some barriers in the healthcare setting. For example, the Association of Perioperative Registered Nurses (AORN) Guideline for the Prevention of Venous Thromboembolism recommends that IPC devices be portable and battery-operated. This recommendation not only can increase compliance with prophylaxis but also allows the patient to mobilize without needing assistance to unplug the lines, tubes, and cords associated with common IPC devices found in the hospital.
To better understand the financial benefits of early mobilization, examining the return on investment (ROI) of implementing devices that benefit patient mobilization is essential. The following analysis illustrates the potential cost savings associated with reducing a patient’s length of stay (LOS) by using a cordless and tubeless wearable therapeutic compression device:
- 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)
Incorporating Data-Driven Insights to Reduce Hospital-Acquired Immobility
AORN guidelines further recommend using IPC devices that record wear time compliance. Accessibility to meaningful, actionable insights empowers bedside caregivers with the critical metrics needed to support the execution of in-hospital mobility and adherence to these guidelines that recommend IPC devices remain on and functioning for a minimum of 18 hours of a day to obtain the optimal benefit for VTE prevention.
Clinical Validation of the Data-Driven Approach
A study published in an international, peer-reviewed trauma nursing journal aimed to determine whether using a commercially available cordless and tubeless wearable mechanical prophylaxis device compared with an IPC device impacts compliance with mechanical VTE prophylaxis in trauma patients. The results obtained from the study concluded thatthe absence of cords and tubes with the wearable mechanical prophylaxis device promotes safe mobility. This significantly influenced compliance and enabled patients to be mobilized safely without the need to unplug/re-plug the device.
Patients who used the cordless and tubeless mechanical prophylaxis device exhibited considerably more time upright than patients using the current standard of care IPC. The difference was attributed to its ability to provide real-time mobility data on the patient’s upright time, walking time, and the number of steps taken.
Another comparative study published in the American Journal of Nursing highlighted the potential of the same wearable mechanical prophylaxis device. Key findings include:
- Tripping hazards created by tubes and cords on current IPC devices and the negative impact on mobility were substantially improved with the use of the novel mechanical compression device
- Significantly longer wear time, with more patients wearing the novel mechanical compression device for at least 18 hours per day
- Improved patient comfort
- Significantly greater patient satisfaction with achieving mobility goals
Among the key findings, the system’s data-driven approach enhanced clinical usability for nurses, with accurate documentation of patient mobility levels. The study stated that “patients were more satisfied with the mobility assistance provided by the [wearable mechanical prophylaxis system] than with the standard IPC device. Given the strong data supporting the importance of mobility in hospitalized patients, this is a clinically relevant finding.”
Conclusion
Prioritizing early and progressive mobilization is crucial to preventing hospital-acquired immobility and reducing the risk of complications. A data-driven approach, leveraging wearable therapeutic compression devices with access to patient mobility and wear time compliance data, can enhance clinical decision-making and improve patient outcomes. Studies have shown that cordless and tubeless wearable mechanical prophylaxis devices can improve wear time compliance, patient comfort, and mobility while reducing tripping hazards and enhancing clinical usability.
As healthcare challenges continue to evolve, it is essential to prioritize patient mobilization alongside data-driven decision-making to address the complex challenges of hospital-acquired immobility.
Jason Bobay
Jason Bobay, president and CEO of RF Health, has over 15 years of experience in the med-device industry. He was a pivotal member of the small team that invented the Movement And Compressions (MAC) System, the world's first tubeless, cordless mechanical compression device that also measures and displays patient mobility data.
