- An mHealth program that encourages and measures daily exercise after major surgery can help hospitals reduce the average length-of-stay and send those patients home sooner.
That’s the take-away from researchers at Cedars-Sinai Hospital who have been giving patients wearables and asking them to take at least 1,000 steps a day.
“Activity monitors provide an inexpensive platform for more precise assessment, ordering, and monitoring of step count toward evidence-based daily goals and may indeed become a sixth vital sign for surgical teams,” the researchers, led by Timothy J. Daskivich, MD, a urologist at the Los Angeles-based health system, reported in a study recently published in the Journal of the American Medical Association.
Daskivich is part of a team of 10 providers at Cedars-Sinai who launched the program in 2016, using Fitbits. At the time, little was known about how to measure steps with a wearable or quantify their value, so he and Brennan Spiegel, MD, Cedars-Sinai’s director of health services research, set a baseline of 1,000 steps a day and started setting parameters.
“In the context of major surgery, ambulation is one of the most critical outcomes we focus on post-operatively,” Daskivich told mHealthIntelligence in a January 2018 interview. But doctors traditionally just asked their patients how much exercise they’d had and took those answers at face value.
“Given the high stakes for poor ambulation, surgical teams have a need for better information regarding postoperative ambulation, including a simple method for quantification of an objective ambulation goal linked to a relevant clinical outcome,” Daskivich and his colleagues wrote in the study.
Through their study, which focused on 100 patients, the researchers found that patients taking 1,000 steps a day – beginning on the first day after surgery - had a lower probability of a prolonged hospital stay. They also found that the odds of a shorter hospital stay improved incrementally for every 100 steps but didn’t increase significantly after 1,000 steps.
They also noted that step counts taken from a wearable can be integrated into the electronic medical record to allow for real-time feedback to patients and providers.
“Such systems will be crucial to integrating step count into busy workflows and providing a platform for feedback to patients, nurses, and physicians about progress toward step count goals,” the study noted.
For that benchmark, Daskivich and his colleagues examined how to go about creating a post-operative exercise routine that would appeal to the patients.
“Because most patients and clinicians have no reference for translating step counts into physical distance, we also believe that the transition to integrating granular step count into practice will require benchmarking of typical postoperative ambulation routes into step count distances,” they wrote. “To this end, we have mapped out the floors of our surgical units to allow physicians and patients to plan ambulation regimens to reach daily goals. For example, a lap around the nursing unit at Cedars-Sinai Medical Center takes approximately 250 steps; hence, 4 laps around the unit throughout the day will allow the patient to reach the daily goal of 1000 steps.”
“Activity-based courses benchmarked for step counts may also further engage patients to reach daily goals,” they continued. “For example, we have leveraged the unique museum-quality art collection at Cedars-Sinai Medical Center to create step count–benchmarked art tours, providing curated narrations about art pieces around the surgical units through a downloadable smartphone application. Activity-based routes could alternatively incorporate other media, such as biographies, moments in sports, or local history. Regardless, tying step counts to physical landmarks in the hospital will help patients and physicians better conceptualize step count and apply it to achievement of daily goals.”
Daskivich and his team see this study as a guide for future programs that use mHealth wearables to improve clinical outcomes after major surgery.