ST. LOUIS—Could staying in bed be bad for the health of patients with community-acquired pneumonia (CAP)?

Approximately 15% of such patients require hospitalization, and in 1996, the total cost for hospital care of CAP patients was $4 billion. Yet until recently, most strategies to streamline treatment for CAP have focused on risk stratification, earlier use of antibiotics, and more rapid switching from intravenous to oral drugs.

Taking a different approach, a team of researchers at Washington University in St. Louis studied the effect of early mobilization—getting patients out of bed and into an upright position within 24 hours of admission to the hospital for CAP. They found that this simple intervention shortened hospital stays by one day and reduced associated costs.[1]

“This is the first study to test for and demonstrate evidence in favor of early mobilization for CAP,” said Linda Mundy, MD, Associate Professor of Medicine in the University’s Division of Infectious Diseases.

Four hundred fifty-eight patients with CAP took part in a trial that was conducted in three St. Louis hospitals. Patients were randomized according to hospital unit. Thus, patients in one unit were given the intervention while those in another received usual care. The intervention consisted only of having patients leave their beds and remain upright for a minimum of 20 minutes daily, with progressive mobilization on each subsequent day.

SHORTER STAY, COST SAVINGS

Two hundred twenty-seven patients were in the intervention group, and 231 were assigned to usual care. Patient characteristics did not differ between groups. The mean length of hospital stay was 5.9 days for the intervention group versus 6.9 days for the usual care group. Moreover, using the Patient Outcomes Research Trial pneumonia prediction rule, the researchers found that low-risk category III patients (the most severely ill low-risk patients) who were assigned to early mobilization were discharged 2.6 days earlier than their counterparts in the usual care group.

Mortality rates did not differ between groups—overall, 14 of the 458 patients died. The researchers remarked that this mortality rate, which is low for patients hospitalized with CAP, was probably due to the exclusion of patients who were admitted or transferred to the ICU.

The adjusted mean hospital charges were $10,159 in the intervention group, compared with $12,868 in the usual care group. Early mobilization provided an estimated cost savings of $1,000 per patient.

Although it has been recommended for myocardial infarction and total knee replacement patients, early mobilization is not considered part of standard care for patients with CAP, nor is it included in current guideline recommendations.

“If early mobilization contributes to improved health outcomes for patients hospitalized with CAP, I think most clinicians will incorporate [it] into patient care when appropriate,” Dr. Mundy concluded. Further studies to improve health outcomes for patients with CAP are in development.

—Gale Jurasek

Reference
1. Mundy LM, Leet TL, Darst K, et al. Early mobilization of patients hospitalized with community-acquired pneumonia. Chest. 2003;124:883-889.

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