Could Your Hospital Save Money? The Economic Benefits of Ambulation

The medical community widely recognizes that prolonged bedrest can have harmful effects on patients while early mobility can lead to better outcomes. Yet, deep sedation of mechanically ventilated patients,  and prolonged bed rest remain frequent practices in many ICUs.

Mobilization goals can be difficult to achieve, because establishing mobility programs requires multi-disciplinary teams, education, concerted coordination, and communication. But despite these barriers, patients and hospitals alike can benefit from mobilizing  sooner and more often.

The Effects of Bedrest
As illustrated in Figure 1, bedrest leads to muscle weakening, bone loss, cardiopulmonary complications, and can ultimately result in organ and tissue deterioration.[1,2,3,4] Early ambulation interventions can have significantly beneficial clinical impact in countering and preventing these negative effects of bedrest.[1] For example, patients randomized to an early mobility intervention had better functional outcomes at discharge, fewer vent days, and a shorter duration of ICU delirium.[5]

Figure 1: The Impact of Bedrest.

The Business Case for Ambulation
These positive clinical outcomes with early mobility interventions could translate to economic benefits for the hospital.

Engel and colleagues assessed early mobility programs at three different ICUs (Wake Forest University, Johns Hopkins Hospital, and the mixed medical-surgical ICU at the University of California San Francisco Medical Center) and their results — published in 2013 — showed that all three settings experienced a decreased ICU length of stay as well as an overall hospital length of stay.[6] The Johns Hopkins ICU program also showed a decrease in rates of delirium and the need for patient sedation. Finally, the Wake Forest University Medical Center program resulted in a savings of $504,789 for the patients in the early mobility program as compared to those not enrolled in it.

In 2015 Bognar and colleagues published a financial model of early mobility programs and found similarly encouraging results.[7] By their analysis, annual cost-of-care savings for a hospital with 1000 yearly ICU admissions, with an early mobility program is approximately $927,000 due to a reduction of ICU days and length of stay. They also note that hospital readmissions rates are reduced through an early mobility program, which creates an additional $93,000 savings a year.

Each hospital is a little different and the exact numbers won’t apply to each hospital that implements an early mobility protocol. However, the overall data and studies strongly suggest that investing in an early mobility program can pay off as hospitals can experience cost savings through decreased critical care patient days, decreased overall hospital stay, and fewer complications.

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The Importance of Early Ambulation

[1] Morris, P. E., Goad, A., Thompson, C., Taylor, K., Harry, B., Passmore, L., & Penley, L. (2008). Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Critical Care Medicine, 36(8), 2238-2243.
[2] Van den Berghe, G. (2002). Nueroendocrine pathobiology of chronic critical illness. Critical Care Clinics, 18(3), 509–528.
[3] Vanhorebeek, I., & Van den Berghe, G. (2006). The neuroendocrine response to critical illness is a dynamic process. Critical Care Clinics, 22(1), 1–15.
[4] Babb, T., Levine, B., & Philley, J. (2012). ICU-acquired weakness: an extension of the effects of bed rest. American Journal of Respiratory and Critical Care Medicine, 185(2), 230-231.
[5] Schweickert, W. D., Pohlman, M. C., Pohlman, A. S., Nigos, C., Pawlik, A. J., Esbrook, C. L., … & Schmidt, G. A. (2009). Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomized controlled trial. Lancet373(9678), 1874-1882.
[6] Engel HJ, Needham DM, Morris PE, Gropper MA. ICU early mobilization: from recommendation to implementation at three medical centers. Crit Care Med. 2013 Sep;41(9 Suppl 1):S69-80. doi: 10.1097/CCM.0b013e3182a240d5.
[7] K Bognar, JW Chou, D McCoy, AL Sexton Ward, J Hester, P Guin, and AB Jena. Financial implications of a hospital early mobility program. Intensive Care Med Exp. 2015 Dec; 3(Suppl 1): A758. Published online 2015 Oct 1. doi: 10.1186/2197-425X-3-S1-A758