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


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: 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:

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


Zdroje

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