CHF Inpatient Ambulation Trial

By implementing an ambulatory study, the goal is to decrease the hospital length of stay by half of a day, decrease the percentage of patients being discharged to an extended nursing care facility, and improve quality of life for the patient. Fiscal year 2014 the average length of stay for a CHF patient at Lancaster General Health was 6.0, and as of fiscal year 2015 this was decreased to 5.8. According to Harlan M Krumbholz's theory of post hospital syndrome, patients are subjected to a time of increased risk of impaired stamina, coordination, strength and readmission for about thirty days after discharge due to deconditioning during their hospitalization. By implementing the ambulatory study, the hope is to prevent such extensive deconditioning to help improve the patient's quality of life after discharge; thereby reducing length of stay, discharges to skilled nursing facilities, 30 day readmissions and costs.

The advent of wearable activity and/or health monitors in the health and fitness industry segment has the potential to revolutionize the industry. More importantly, these devices allow new variables to be collected to provide an impact on patients' care and outcome such as steps taken per day.

The intention of the ambulation study is to prevent hospital acquired deconditioning; which in turn would not only decrease the length of stay, but also improve the discharge disposition and place them at home rather than hospice, an extended care facility or rehab. Not only is the intent of the study to decrease the length of stay and also improve the patient's disposition, but also improve their quality of life. In addition, the study will test the effectiveness of the addition of a mobility aide to assist with patients walking on the nursing units.

Inclusion criteria

• Diagnosis of heart failure
• The heart group as attending or consultant
• Patient on 5 West at the time of admission
• Admission diagnosis of heart failure
• Age ≥ 18
• Initial assessment completed within 10 hours of admission by a registered nurse

Exclusion criteria

• Patient admitted from acute rehabilitation or skilled nursing facility
• Altered weight bearing or unable to complete initial 2 minute walk test
• Unwilling or unable to participate or consent
• Acute delirium or dementia by history
• Hospice or actively dying
• Ventricular assist device or listed for heart transplantation
• Inotrope dependence
• Active ischemia
• Heart rate (HR) <50 or >130 at rest
• Blood pressure (BP) <80 or >180 at rest
• Pulse oximetry <88% at rest
• Patient is in isolation for multi-drug resistant organism such as MRSA or C-diff