Hospitalized patients are at risk for preventable harms, such as falls and loss of function from immobility. These threats to patient safety and recovery must be properly managed but have historically been seen as competing interests. Since evidence suggests that encouraging mobility can be an intervention to reduce fall risk and injury in hospitalized patients, the role of hospital space design and integrated features, furniture, fixtures, and equipment can help facility safe patient mobility, further mitigating the potential for immobility and falls.
According to Michael Friedman, Director of Strategic Program Development and faculty member of the Johns Hopkins School of Medicine, Department of Physical Medicine and Rehabilitation, “the goal is to eradicate the immobility harm.” In his role as the Co-Director of the Johns Hopkins Medicine Activity and Mobility Promotion (AMP) program, Mr. Friedman focuses on improving patient mobility from the first point of contact versus focusing just on fall prevention during an inpatient stay. Patients spend more than 85% of their time lying in bed or sitting, irrespective of the reason for admission. Low levels of mobility are associated with negative health outcomes, such as functional decline, increased length of stay, and mortality. Research shows that these negative outcomes can be counteracted by increasing mobility levels. Therefore, it is critical for the design of hospital space to support both interventions and daily activities that increase the mobility and physical activity levels of patients.
Patients categorized into higher fall risk groups are permitted less mobility throughout their entire hospitalization, despite often having the functional capacity to ambulate. This is completely counter to the CDC STEADI guidelines, which encourage strength and coordination exercise, not bedrest, to prevent falls.
Recognizing the detrimental consequences of immobility during hospital stays, healthcare providers have increasingly emphasized the significance of promoting patient movement. Engaging in early mobility interventions can enhance muscle strength, prevent functional decline, and positively impact overall patient well-being. Adding to this list reducing fall risk, falls, and associated injuries, healthcare institutions must look for ways to improve patient safety while simultaneously promoting mobility.
The design of hospital spaces plays a pivotal role in facilitating patient mobility. Legacy acute care patient units and rooms are not currently designed in a way that supports safe patient mobility because of entrenched practice patterns that resulted in flawed design solutions. For instance, patients categorized as high fall risk mobilize less during hospitalization and receive more interventions that limit mobility, for exam, in room total lifts. While this may be appropriate at times, clinicians should continuously reevaluate a patient’s status during his/her stay to ensure the maximum level of mobility is achieved regularly.
Key considerations when designing acute care units to promote safe and effective patient movement should focus on built-in features, furniture, fixtures, and equipment. Strategically incorporating elements that encourage and enhance mobility can significantly contribute to fall prevention and improved patient outcomes.
Examples of design features include the integration of benches and areas of respite in unit corridors to promote movement outside of the patient room. Other features, such as dedicating physical and occupational therapy program space close to the ends of daylit corridors allow for meaningful engagement. Strategic handrail placement between these activities is key to connecting landmarks and increasing confidence in becoming more active outside of the patient room. Adjustable-height beds and chairs further ease the patient’s transition between sitting, standing, and lying positions, promoting mobility, and reducing the potential for falls.
Moreover, the integration of assistive technologies and equipment further enhances mobility to patients. Bed alarms and fall prevention mats alert healthcare staff to potential risks, enabling prompt intervention. Walking aids, such as walkers or canes, need to be easily accessible in patient rooms to encourage patients to engage in walking exercise and regain mobility. In-room exercise equipment, such as resistance bands or pedal exercisers, provide additional opportunities for physical therapy and rehabilitation within the patient’s own space.
By incorporating design features to promote physical activity, hospitals can create environments that actively promote patient mobility and reduce fall risks. The seamless integration of these elements not only enhances patient safety but also empowers patients to actively participate in their own recovery process.
In conclusion, promoting mobility among hospitalized patients serves as a crucial intervention to reduce the risk of falls and injury. The design of hospital spaces, along with integrated features, furniture, fixtures, and equipment, plays an integral role in creating an environment that facilitates patient mobility, safety, and improved outcomes. By incorporating these elements, healthcare institutions can positively impact patient well-being, promote mobility, and enhance the overall quality of care.
Meet The Experts
Rhonda Malone Wyskiel, RN, MSN, joins HCM from the Greater Baltimore Medical Center (GBMC) where she served as the Senior Director, Performance Improvement & Innovation. Additionally, she previously served as the Patient Safety and Healthcare Innovation Lead at the Johns Hopkins Armstrong Institute for Patient Safety & Quality.
Brian Blazejak is a project manager and thought leader focusing on the design and delivery of complex acute care health environments. He has a deep passion for working with stakeholders to define a clear project vision that is organized by open team collaboration, informed by research and rooted in long-term planning. This approach seeks to drive solutions that are straightforward in execution but have inherent broad and enduring impact.