By Eileen Casey, PT

We don’t want to sound inhospitable, but here at Brattleboro Memorial Hospital, we get our patients up, moving, and out the door as quickly as they’re ready and able. It’s not that we don’t enjoy their company, it’s that we now know so much more than we used to about the importance of regular ambulation in the healing process.

Whereas it used to be a common belief that extended bed rest and limiting activity were the keys to recovering from an illness or surgery, recent research suggest that prolonged periods of immobility in hospitalized patients can have a serious and long-lasting negative effects. When extended periods of immobility result in a decline in functional abilities, patients are more likely to have their hospital stay extended or be discharged to long-term care. Functional decline can happen in as little as two days, and a 2008 study indicates that for every day an older adult spends in bed it takes an average of 3.8 days to return to their pre-hospitalization level of functioning.

Prolonged immobility can have negative impacts not only on our cardiac, circulatory, nervous, and musculoskeletal systems, but also on our psychological and emotional wellbeing. Patients confined to bed for extended periods often experience a higher rate of depression, anxiety, forgetfulness, and confusion, which can raise concerns about their ability to function safely and independently at home.

Rehab Services at BMH has instituted a robust new initiative that promotes getting all our patients up and moving as quickly as possible, unless otherwise ordered by their physician. The Ambulation Pride Program (APP) counteracts the negative impact of immobility and helps patients get back to optimum functioning as quickly and safely as possible. Regaining independence and returning home are top priorities for many of our patients, so by getting them up and moving, we can reduce the incidence of blood clots, muscle atrophy, infections, pneumonia, dehydration, and many other complications that can keep patients in the hospital longer or cause them to be discharged to a nursing home.

Under the new APP initiative, all patients admitted to BMH, with the exception of the Birthing Center, now have a default order for ambulation, unless otherwise ordered by a physician. Patients excluded from the protocol include those who are dependent on ventilators, those admitted with blood clots, acute stroke, acute fractures or spine fracture and other conditions in which ambulation might pose a health or safety risk. Patients’ resting heart rates, blood pressure, blood sugar and other factors are assessed before ambulation begins, and their readiness for ambulation is re-assessed by a nurse each morning of their hospital stay. We’ve designed a series of magnets to affix to each patient’s door so it is immediately visible to all staff when a patient has been cleared to ambulate, how many times that day they’ve ambulated, and how many more ambulating sessions they have left in their day. With these visual cues in place, nursing staff no longer have to refer to a patient’s chart to see their ambulation activity – their daily goals and activity are immediately visible.

Our expectation is that all of our patients will be supported to ambulate at the highest degree of their functioning possible. That means getting up and walking in the hallways at least three times a day, getting up and out of bed for meals, as well as sitting up for rounds and other visits. We’ve learned a lot of valuable lessons from the field of cardiac rehabilitation over the years. We used to think that the best way to recover from a heart attack was to rest and reduce your activity level, but now we know that heart patients do better, as do most of our patients, when we get them up and moving as soon as possible.

Instituting such a pro-active protocol requires more than declaring ambulation a priority, though. Upon admission to the hospital, every patient is now assessed for mobility and an individualized plan for ambulation entered in their record. BMH nursing and physical therapy staffs are working in partnership to ensure that patients and their families are educated about the importance of ambulation, and physical therapy staff are present regularly on the inpatient units to provide “curbside consults” to nursing staff about how to effectively and safely get their patients up and moving. Patients’ ambulation distances are measured and entered into their record so that nursing staff can evaluate their progress and ensure that their daily ambulation goals are met.

Ambulation benefits patients of every age, but is particularly important for our older patients who value their independence and wish to maintain as active a life as they can. Being able to return home to mow your lawn might not be everyone’s cup of tea, but regaining independence is a key motivator for many of our patients and helps get them up and moving. So if you should find yourself an inpatient at BMH, you can now expect that we will be planning your personalized ambulation program from the minute you are admitted, and that your entire nursing and rehab team will be supporting you in achieving your ambulation goals. Yes, we want you to rest and recover, but we also want you to get up and move so you can return home to your regular activities as soon as possible.

Eileen Casey, PT is Director of Rehab Services at Brattleboro Memorial Hospital. She can be reached by calling 802-257-8255.