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N. Koenders1, S. Potkamp-Kloppers2, Y. Geurts1, S. Bloemen1, M.W. Nijhuis – van der Sanden3, T.J. Hoogeboom3
1Radboudumc, Department of Rehabilitation, Nijmegen, Netherlands, 2Residential Care Center IJsselheem, Zwolle, Netherlands, 3Radboudumc, IQ Healthcare, Nijmegen, Netherlands
Background: Sedentary behaviour of patients during the hospital stay, especially lying in bed during daytime, is very common in patients of all ages. Well-known adverse outcomes of sedentary behaviour are discharge to an institution and a prolonged hospital stay as a consequence of functional decline. Adverse outcomes can be prevented or cured by reducing sedentary behaviour. To achieve this, we have developed and implemented our multifaceted innovation called Ban Bedcentricity.
Purpose: To explore differences in sedentary behaviour, discharge to an institution, and length of hospital stay of patients before and after Ban Bedcentricity implementation.
Methods: The Ban Bedcentricity innovation aims to
1) improve the mindset of patients, close-relatives, and healthcare professionals regarding the benefits of physical activity and risks of sedentary behaviour for patients by cultural change,
2) provide adequate materials to support inpatient physical activity, and
3) optimize the hospital cultural environment to elicit physical activity of patients.
We have developed the innovation using the Medical Research Council framework for complex interventions. Ban Bedcentricity was implemented at the Cardiothoracic surgery, Cardiology and Orthopaedics-Traumatology wards of a Dutch university medical center. Sedentary behaviour data was prospectively collected using behavioral mapping between 8 a.m. and 4 p.m. Data on discharge to an institution and length of hospital stay were routinely collected from electronic patient records. Logistic and multiple linear regression analysis were used to analyze differences in discharge to an institution and length of hospital stay.
1) improve the mindset of patients, close-relatives, and healthcare professionals regarding the benefits of physical activity and risks of sedentary behaviour for patients by cultural change,
2) provide adequate materials to support inpatient physical activity, and
3) optimize the hospital cultural environment to elicit physical activity of patients.
We have developed the innovation using the Medical Research Council framework for complex interventions. Ban Bedcentricity was implemented at the Cardiothoracic surgery, Cardiology and Orthopaedics-Traumatology wards of a Dutch university medical center. Sedentary behaviour data was prospectively collected using behavioral mapping between 8 a.m. and 4 p.m. Data on discharge to an institution and length of hospital stay were routinely collected from electronic patient records. Logistic and multiple linear regression analysis were used to analyze differences in discharge to an institution and length of hospital stay.
Results: Behavioral mapping data was collected during 30 hours of observations in 1,212 patients. Time lying in bed was 52% before and 40% after implementation at the Cardiothoracic surgery, 64% before and 46% after implementation at the Cardiology, and 53% before and 57% after implementation at the Orthopaedics-Traumatology wards. Data on the length of hospital stay and discharge to an institution were collected in 18,163 patients. The odds ratios (OR) favored discharge home after implementation at the Cardiothoracic surgery (OR: 1.23, 95% confidence interval (CI): 1.07-1.37), Cardiology (OR: 1.37, 95%CI: 1.22-1.49), and Orthopaedics-Traumatology wards (OR: 1.09%, 95%CI: 0.88-1.27). At the Cardiothoracic surgery ward, we found no statistically significant difference in length of hospital stay after implementation (+1.7%, 95%CI: -4.3% - +8.1%). At the Cardiology ward, we found a statistically significant lower length of hospital stay after implementation (-11.5%, 95%CI: -15.4% - -7.5%). At the Orthopaedics-Traumatology ward, we found a higher length of hospital stay after implementation (+7.1%, 95%CI: +1.5% - +12.9%).
Conclusion(s): The results indicate beneficial outcomes after the implementation of Ban Bedcentricity at the Cardiothoracic surgery and Cardiology wards. We found less sedentary behaviour and more discharges home, indicating less functional decline in patients during the hospital stay. The development, implementation, and evaluation of our multifaceted innovation might contribute to further reproduction and use of interventions that reduce sedentary behaviour in other hospitals and countries.
Implications: The implementation of a multifaceted innovation to reduce sedentary behaviour of patients during the hospital stay by cultural change seems might result in less sedentary behaviour of patients and more discharges to home by preventing functional decline.
Funding, acknowledgements: The study did not receive any additional funding from agencies in the public, commercial, or not-for-profit sector.
Keywords: Quality improvement, Sedentary behaviour, Physical activity
Topic: Disability & rehabilitation
Did this work require ethics approval? Yes
Institution: Radboudumc, the Netherlands
Committee: CMO Region Arnhem-Nijmegen
Ethics number: 2018-4172
All authors, affiliations and abstracts have been published as submitted.
