Epidemiology of Inpatient Ambulation to Assess Potential Improvement Strategies for Deep Vein Thrombosis (Dvt) Prevention

1Rush University Medical Center, Chicago, IL
2John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
3Metro Infectious Disease Consultants, LLC, Chicago, IL
4Northwestern Memorial Hospital, Chicago, IL

Meeting: Hospital Medicine 2012, April 1-4, San Diego, Calif.

Abstract number: 97615

Background:

Pharmacologic prophylaxis is recommended for general medical inpatients (GMI) at risk of DVT; this includes GMI who are not fully ambulating. However, full ambulation is not well defined in the current literature. In addition, it is unknown whether encouraging patients to ambulate while in the hospital has any effect. We provide a description of the epidemiology of ambulation of GMI at two teaching institutions in Chicago: Rush University Medical Center (RUMC) and Cook County Hospital (CCH). We also explore whether encouragement affects their ambulatory habits during the admission.

Methods:

From 10/2008 to 9/2010, we surveyed GMI at RUMC and CCH during weekday afternoons and evenings about their preadmission walking status and inpatient walking, including frequency of walking (FOW) and approximate distances walked over the 6 h prior to the survey. The encouraged group (EG) was defined as those GMI who recalled talking about ambulation as a strategy to prevent DVT with a member of the healthcare team during the admission; the others were included in the usual care group. Only the GMI with no limited walking prior to admission were included for the final analysis.

Results:

Out of 294 patients surveyed, 281 met the inclusion criteria (52% from RUMC, 48% from CCH) and 80 (28% of 281 patients) were in the EG. Most patients were on prophylactic heparin (61%) despite high proportions of frequent ambulation. Among the 281 enrolled patients, 23% walked every hour and 25% walked every 2 h. These proportions did not differ statistically by group. Patients walked to the bathroom most often (mean three times every 6 h) and least often in the hallway (mean 0.7 times every 6 h). There was no statistically significant association between encouragement and reported FOW (P = 0.7). Nor was there an association between reported FOW and prophylactic heparin (P = 0.1).

Conclusions:

This study describes the epidemiology of ambulation of GMI at two separate hospitals. Our data suggest a surprisingly high FOW, but the actual distance walked is limited. We found no association between heparin prophylaxis and ambulatory status. Whether the patient was encouraged to walk had no significant association with either FOW or the method of DVT prophylaxis. This may suggest that baseline ambulatory status, although important, is not being considered by providers prior to making the decision for inpatient DVT prophylaxis.

Table 1Demographics

  Encouraged Usual Care
CCH (%) 46 48
RUMC (%) 54 52
Men (%) 50 53
Mean age 54 56

Table 2Method of Prophylaxis (% Patients)

  Encouraged Usual Care
Ambulation 41 41
Compression stockings 0 0.5
Coumadin 8 8
Heparin prophylaxis 65 60
Heparin treatment 4 4
Sequential compression device 11 19
None 6 2
Unable to determine 6 7

To cite this abstract:

Harting B, Lucas B, Lowrey G, Kim J, Skarupski K, Odwazny R, McNutt R, Tchernodrinski S. Epidemiology of Inpatient Ambulation to Assess Potential Improvement Strategies for Deep Vein Thrombosis (Dvt) Prevention. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97615. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/epidemiology-of-inpatient-ambulation-to-assess-potential-improvement-strategies-for-deep-vein-thrombosis-dvt-prevention/. Accessed May 26, 2019.

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