Showing papers in "Journal of Hospital Medicine in 2020"
TL;DR: Whether glucocorticoid treatment is associated with changes in mortality or mechanical ventilation in patients with high or low CRP needs study in prospective, randomized clinical trials.
Abstract: The efficacy of glucocorticoids in COVID-19 is unclear. This study was designed to determine whether systemic glucocorticoid treatment in COVID-19 patients is associated with reduced mortality or mechanical ventilation. This observational study included 1,806 hospitalized COVID-19 patients; 140 were treated with glucocorticoids within 48 hours of admission. Early use of glucocorticoids was not associated with mortality or mechanical ventilation. However, glucocorticoid treatment of patients with initial C-reactive protein (CRP) ≥20 mg/dL was associated with significantly reduced risk of mortality or mechanical ventilation (odds ratio, 0.23; 95% CI, 0.08-0.70), while glucocorticoid treatment of patients with CRP <10 mg/dL was associated with significantly increased risk of mortality or mechanical ventilation (OR, 2.64; 95% CI, 1.39-5.03). Whether glucocorticoid treatment is associated with changes in mortality or mechanical ventilation in patients with high or low CRP needs study in prospective, randomized clinical trials.
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TL;DR: This research presents a novel and scalable approach called “SmartCardiovascular Intervention,” which aims to provide real-time information about the safe and effective treatment of central nervous system disorders in children.
Abstract: 1Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; 2Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio; 3Department of Pediatrics, Drexel University College of Medicine, Philadelphia, Pennsylvania; 4Section of Hospital Medicine, St. Christopher’s Hospital for Children, Philadelphia, Pennsylvania; 5Department of Pediatrics, University of Missouri School of Medicine, Columbia, Missouri; 6Department of Pediatrics, Tufts University School of Medicine, Boston, Massachusetts; 7Department of Pediatrics, The Barbara Bush Children’s Hospital, Maine Medical Center, Portland, Maine; 8Department of Pediatrics, University of Arizona College of Medicine–Phoenix, Phoenix, Arizona; 9Division of Hospital Medicine, Phoenix Children’s Hospital, Phoenix, Arizona; 10Faculty Development, Drexel University College of Medicine, Philadelphia, Pennsylvania; 11Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio; 12University of Cincinnati Medical Center, Cincinnati, Ohio.
44 citations
40 citations
TL;DR: A user-friendly nomenclature is provided while describing eight types of diagnostic errors of concern and highlighting mitigation strategies to reduce potential preventable harm caused by those errors.
Abstract: A s the death toll from the coronavirus disease 2019 (COVID-19) pandemic rapidly increases, the need to make a timely and accurate diagnosis has never been greater. Even before the pandemic, diagnostic errors (ie, missed, delayed, and incorrect diagnoses) had been one of the leading contributors to harm in health care.1 The COVID-19 pandemic is likely to increase the risk of such errors for several reasons. The disease itself is new and knowledge of its clinical manifestations is still evolving. Both physical and psychological safety of clinicians and health system capacity are compromised and can affect clinical decision-making.2 Situational factors such as staffing shortages and workarounds are more common, and clinicians in certain geographic areas are experiencing epic levels of stress, fatigue, and burnout. Finally, decisions in busy, chaotic and time-pressured healthcare systems with disrupted and/ or newly designed care processes will be error prone.1 Based on emerging literature and collaborative discussions across the globe, we propose a new typology of diagnostic errors of concern in the COVID-19 era (Table). These errors span the entire continuum of care and have both systems-based and cognitive origins. While some errors arise from previously described clinical reasoning fallacies, others are unique to the pandemic. We provide a user-friendly nomenclature while describing eight types of diagnostic errors and highlight mitigation strategies to reduce potential preventable harm caused by those errors.
39 citations
TL;DR: The COVID-19 pandemic has required medical wards to rapidly adapt with expanding use of RIUs and use of technology emerging as critical approaches and reports of unrecognized or delayed diagnoses highlight how such adaptations may produce potential adverse effects on care.
Abstract: Importance Although intensive care unit (ICU) adaptations to the coronavirus disease of 2019 (COVID-19) pandemic have received substantial attention , most patients hospitalized with COVID-19 have been in general medical units. Objective To characterize inpatient adaptations to care for non-ICU COVID-19 patients. Design Cross-sectional survey. Setting A network of 72 hospital medicine groups at US academic centers. Main outcome measures COVID-19 testing, approaches to personal protective equipment (PPE), and features of respiratory isolation units (RIUs). Results Fifty-one of 72 sites responded (71%) between April 3 and April 5, 2020. At the time of our survey, only 15 (30%) reported COVID-19 test results being available in less than 6 hours. Half of sites with PPE data available reported PPE stockpiles of 2 weeks or less. Nearly all sites (90%) reported implementation of RIUs. RIUs primarily utilized attending physicians, with few incorporating residents and none incorporating students. Isolation and room-entry policies focused on grouping care activities and utilizing technology (such as video visits) to communicate with and evaluate patients. The vast majority of sites reported decreases in frequency of in-room encounters across provider or team types. Forty-six percent of respondents reported initially unrecognized non-COVID-19 diagnoses in patients admitted for COVID-19 evaluation; a similar number reported delayed identification of COVID-19 in patients admitted for other reasons. Conclusion The COVID-19 pandemic has required medical wards to rapidly adapt with expanding use of RIUs and use of technology emerging as critical approaches. Reports of unrecognized or delayed diagnoses highlight how such adaptations may produce potential adverse effects on care.
38 citations
TL;DR: This research presents a novel and scalable approach to personalized medicine that addresses the barriers to effective and efficient treatment of addiction in patients with a history of abuse.
Abstract: 1Division of Hospital Medicine, Department of Medicine, Oregon Health & Science University, Portland, Oregon; 2Section of Addiction Medicine, Department of Medicine, Oregon Health & Science University, Portland, Oregon; 3School of Medicine, MD/PhD Program, Oregon Health & Science University, Portland, Oregon; 4School of Public Health, Oregon Health & Science University-Portland State University, Portland, Oregon; 5Department of Family Medicine, University of California, San Francisco, California; 6Division of Hospital Medicine, Zuckerberg San Francisco General Hospital and the Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California; 7University of Colorado, Department of Medicine, Division of General Internal Medicine and Division of Hospital Medicine, Denver, Colorado; 8Division of General Internal Medicine, Department of Medicine, Oregon Health & Science University, Portland, Oregon.
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33 citations
TL;DR: Early protocols for ward-based HFNC protocols were paradoxically associated with increased ICU utilization, and these effects were subtracted from effects measured among adopting hospitals.
Abstract: Background Hospitals are increasingly adopting ward-based high-flow nasal cannula (HFNC) protocols that allow HFNC treatment of bronchiolitis outside of the intensive care unit (ICU). Our objective was to determine whether adoption of a ward-based HFNC protocol reduces ICU utilization. Methods We examined a retrospective cohort of infants aged 3 to 24 months hospitalized with bronchiolitis at hospitals in the Pediatric Health Information System database. The study exposure was adoption of a ward-based HFNC protocol, measured by direct contact with pediatric hospital medicine leaders at each hospital. All analyses utilized an interrupted time series approach. The primary analysis compared outcomes three respiratory seasons before and three respiratory seasons after HFNC adoption, among adopting hospitals. Supplementary analysis 1 mirrored the primary analysis with the exception that the first season after adoption was censored. In supplementary analysis 2, effects among nonadopting hospitals were subtracted from effects measured among adopting hospitals. Results Of 44 contacted hospitals, 41 replied (93% response rate), of which 18 were categorized as non-adopting hospitals and 12 were categorized as adopting hospitals. Included ward-based HFNC protocols were adopted between the 2010-2011 and 2015-2016 respiratory seasons. The primary analysis included 26,253 bronchiolitis encounters and measured immediate increases in the proportion of patients admitted to the ICU (absolute difference, 3.1%; 95% CI, 2.8%-3.4%) and ICU length of stay (absolute difference, 9.1 days per 100 patients; 95% CI, 5.1-13.2). Both supplementary analyses yielded similar findings. Conclusion Early protocols for ward-based HFNC were paradoxically associated with increased ICU utilization.
29 citations
TL;DR: The diagnosis, treatment, and prevention of CAUTIs in adults, including catheter-associated urinary tract infections, are discussed.
Abstract: Urinary tract infections (UTIs) are among the most common healthcare-associated infections, and 70%-80% are catheter-associated urinary tract infections (CAUTIs). About 25% of hospitalized patients have an indwelling urinary catheter placed during their hospital stay, and therefore, are at risk for CAUTIs, which have been associated with worse patient outcomes. Additionally, hospitals face a significant financial impact since the Centers for Medicare & Medicaid Services incentive program penalizes hospitals with higher than expected CAUTIs. Hospitalists care for many patients with indwelling urinary catheters and should be aware of and engage in processes that reduce the rate of CAUTIs. This article will discuss the diagnosis, treatment, and prevention of CAUTIs in adults.
TL;DR: Challenges arising from communication barriers in the time of COVID-19 are discussed and opportunities to overcome them by preserving human connection to deliver high-quality care are discussed.
Abstract: The coronavirus disease of 2019 (COVID-19) pandemic is the health crisis of our generation and will inevitably leave a lasting mark on how we practice medicine.1,2 It has already rapidly changed the way we communicate with patients, families, and colleagues. From the explosion of virtual care—which has been accelerated by need and new reimbursement policies3—to the physical barriers created by personal protective equipment (PPE) and no-visitor policies, the landscape of caring for hospitalized patients has seismically shifted in a few short months. At its core, the practice of medicine is about human connection—a connection between healers and the sick—and should remain as such to provide compassionate care to patients and their loved ones.4,5 In this perspective, we discuss challenges arising from communication barriers in the time of COVID-19 and opportunities to overcome them by preserving human connection to deliver high-quality care (Table).
TL;DR: The Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease (2019 Report) is presented, which aims to provide a global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease.
Abstract: GUIDELINE TITLE Chronic obstructive pulmonary disease in over 16s: Diagnosis and management1 RELEASE DATE: December 5, 2018 with update July 2019 PRIOR VERSION(S): NICE guideline CG101 June 2010, 2004 FUNDING SOURCE: Department of Health and Social Care, United Kingdom TARGET POPULATION: Patients age 16 and older with Chronic Obstructive Pulmonary Disease (COPD) GUIDELINE TITLE: Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease (2019 Report)2 RELEASE DATE: November 14, 2018 PRIOR VERSION(S): 2017, 2016, 2015, 2014, 2013, 2008, 2001 FUNDING SOURCE: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) TARGET POPULATION: Adults with Chronic Obstructive Pulmonary Disease (COPD).
TL;DR: This article traces the growth of PHM from 1996 to the present, highlighting developments that fueled the hospital movement in general and PHM in particular (Table).
Abstract: In 1996, internists Robert Wachter, MD, and Lee Goldman, MD, MPH, coined the term “hospitalist” and predicted an “emerging role in the American health care system.”1 Pediatrics was not far behind: In 1999, Dr Wachter joined Paul Bellet, MD, in authoring an article describing the movement within pediatrics.2 An accompanying editorial, coauthored by a pediatric hospitalist and an office-based practitioner, attempted to answer which was “better” for a hospitalized child: A practitioner who knew the child and family or a hospitalist who might be more knowledgeable about the disease, its inpatient management, and how to get things done in the hospital?3 The authors could not answer which model was better for an individual child with an invested primary pediatrician, but concluded that hospitalists have the potential to improve care for all children in the hospital—the future promise of Pediatric Hospital Medicine (PHM). This article traces the growth of PHM from 1996 to the present, highlighting developments that fueled the hospital movement in general and PHM in particular (Table).
TL;DR: This research presents a poster presented at the 2016 USGS Workshop on Infectious Diseases and Hospital Medicine: Prepared for Use in the Healthcare Setting, which aims to provide real-time information about how infectious diseases and hospital medicine affect patients’ health.
Abstract: 1Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts; 2Harvard Medical School, Boston, Massachusetts; 3Division of Infectious Diseases, VA Ann Arbor Healthcare System, Ann Arbor, Michigan; 4Division of Infectious Diseases and Hospital Medicine, University of Michigan, Ann Arbor, Michigan; 5Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts; 6Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts; 7Partners In Health, Boston, Massachusetts.
TL;DR: In a single-center study of patients hospitalized with sepsis, LEP was associated with mortality across nearly all races, a novel finding that will require further exploration into the causal nature of this association.
Abstract: Background Limited English proficiency (LEP) has been implicated in poor health outcomes. Sepsis is a frequently fatal syndrome that is commonly encountered in hospital medicine. The impact of LEP on sepsis mortality is not currently known. Objective To determine the association between LEP and sepsis mortality. Design Retrospective cohort study. Setting 800-bed, tertiary care, academic medical center. Patients Electronic health record data were obtained for adults admitted to the hospital with sepsis between June 1, 2012 and December 31, 2016. Measurements The primary predictor was LEP. Patients were defined as having LEP if their self-reported primary language was anything other than English and interpreter services were required during hospitalization. The primary outcome was inpatient mortality. Mortality was compared across races stratified by LEP using chi-squared tests of significance. Bivariable and multivariable logistic regressions were performed to investigate the association between mortality, race, and LEP, adjusting for baseline characteristics, comorbidities, and illness severity. Results Among 8,974 patients with sepsis, we found that 1 in 5 had LEP, 62% of whom were Asian. LEP was highly associated with death across all races except those identifying as Black and Latino. LEP was associated with a 31% increased odds of mortality after adjusting for illness severity, comorbidities, and other baseline characteristics, including race (OR 1.31, 95% CI 1.06-1.63, P = .02). Conclusions In a single-center study of patients hospitalized with sepsis, LEP was associated with mortality across nearly all races. This is a novel finding that will require further exploration into the causal nature of this association.
TL;DR: A multimodal intervention improved hand hygiene adherence rates in physicians and nurses in Niigata, Japan; however, further improvement is necessary.
Abstract: BACKGROUND: Hand hygiene is key to preventing healthcare-associated infection and the spread of respiratory viruses like the novel coronavirus that causes COVID-19. Unfortunately, hand hygiene adherence of healthcare workers (HCWs) in Japan is suboptimal according to previous studies. OBJECTIVES: Our objectives were to evaluate hand hygiene adherence among physicians and nurses before touching hospitalized patients and to evaluate changes in hand hygiene adherence after a multimodal intervention was implemented. DESIGN, SETTING, AND PARTICIPANTS: We conducted a pre- and postintervention study with HCWs at four tertiary hospitals in Niigata, Japan. Hand hygiene observations were conducted from June to August 2018 (preintervention) and February to March 2019 (postintervention). INTERVENTION: The multimodal hand hygiene intervention recommended by the World Health Organization was tailored to each hospital and implemented from September 2018 to February 2019. MAIN OUTCOMES AND MEASURES: We observed hand hygiene adherence before touching patients in each hospital and compared rates before and after intervention. Intervention components were also evaluated. RESULTS: There were 2,018 patient observations preintervention and 1,630 postintervention. Overall, hand hygiene adherence improved from 453 of 2,018 preintervention observations (22.4%) to 548 of 1,630 postintervention observations (33.6%; P < .001). Rates improved more among nurses (13.9 percentage points) than among doctors (5.7 percentage points). Improvement varied among the hospitals: Hospital B (18.4 percentage points) was highest, followed by Hospitals D (11.4 percentage points), C (11.3 percentage points), and Hospital A (6.5 percentage points). CONCLUSIONS: A multimodal intervention improved hand hygiene adherence rates in physicians and nurses in Niigata, Japan; however, further improvement is necessary. Given the current suboptimal hand hygiene adherence rates in Japanese hospitals, the spread of COVID-19 within the hospital setting is a concern.
TL;DR: The data suggest that unless a hip fracture patient is unstable and likely to require active management by a consultant, such consults offer limited benefit when weighed against the negative impact of surgical delay.
Abstract: Background Hip fractures typically occur in frail elderly patients. Preoperative specialty consults, in addition to hospitalist comanagement, are often requested for preoperative risk assessment. Objective Determine if preoperative specialty consults meaningfully influence management and outcomes in hip fracture patients, while being comanaged by hospitalists DESIGN: Retrospective cohort study SETTING: Tertiary care hospital in Connecticut PATIENTS: 491 patients aged 50 years and older who underwent surgery for an isolated fragility hip fracture, defined as one occurring from a fall of a height of standing or less. Intervention Presence or absence of a preoperative specialty consult MEASUREMENTS: Time to surgery (TTS), length of hospital stay (LOS), and postoperative complications RESULTS: 177 patients had a preoperative specialty consult. Patients with consults were older and had more comorbidities. Most consult recommendations were minor (72.8%); there was a major recommendation only for eight patients (4.5%). Multivariate analysis demonstrates that consults are more likely to be associated with a TTS beyond 24 hours (Odds Ratio [OR] 4.28 [2.79-6.56]) and 48 hours (OR 2.59 [1.52-4.43]), an extended LOS (OR 2.67 [1.78-4.03]), and a higher 30-day readmission rate (OR 2.11 [1.09-4.08]). A similar 30-day mortality rate was noted in both consult and no-consult groups. Conclusions The majority of preoperative specialty consults did not meaningfully influence management and may have potentially increased morbidity by delaying surgery. Our data suggest that unless a hip fracture patient is unstable and likely to require active management by a consultant, such consults offer limited benefit when weighed against the negative impact of surgical delay.
TL;DR: This research presents a novel and scalable approach to caring for children with complex medical conditions that combines traditional and innovative approaches to care.
Abstract: 1Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio; 2Department of Internal Medicine, Division of General Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio; 3Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts; 4Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts; 5Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
TL;DR: There was some decrease in the utilization of "low-value" services from 2008 to 2017, and a limited impact of the CWC on clinical practice in these areas is suggested.
Abstract: Background The Choosing Wisely® Campaign (CWC) was launched in 2012. Five recommendations to reduce the use of "low-value" services in hospitalized children were published in 2013. Objectives The aim of this study was to estimate the frequency and trends of utilization of these services in tertiary children's hospitals five years before and after the publication of the recommendations. Methods We conducted a retrospective, longitudinal analysis of hospitalizations to 36 children's hospitals from 2008 to 2017. The "low-value" services included (1) chest radiograph (CXR) for asthma, (2) CXR for bronchiolitis, (3) relievers for bronchiolitis, (4) systemic steroids for lower respiratory tract infection (LRTI), and (5) acid suppressor therapy for uncomplicated gastroesophageal reflux (GER). We estimated the annual percentages of the use of these services after risk adjustment, followed by an interrupted time series (ITS) analysis to compare trends before and after the publication of the recommendations. Results The absolute decreases in utilization were 36.6% in relievers and 31.5% in CXR for bronchiolitis, 24.1% in acid suppressors for GER, 20.8% in CXR for asthma, and 2.9% in steroids for LRTI. Trend analysis showed that one "low-value" service declined significantly immediately (use of CXR for asthma), and another decreased significantly over time (relievers for bronchiolitis) after the CWC. Conclusions There was some decrease in the utilization of "low-value" services from 2008 to 2017. Limited changes in trends occurred after the publication of the recommendations. These findings suggest a limited impact of the CWC on clinical practice in these areas. Additional interventions are required for a more effective dissemination of the CWC recommendations for hospitalized children.
TL;DR: This research presents a novel and scalable approach to personalized medicine that addresses the underlying cause of relapse in patients with a history of substance abuse.
Abstract: 1Division of Hospital Medicine, Department of Medicine, Oregon Health & Science University, Portland, Oregon; 2Section of Addiction Medicine, Department of Medicine, Oregon Health & Science University, Portland, Oregon; 3Center for Addiction Research and Effective Solutions, American Institutes for Research, Chicago, Illinois; 4Department of Family Medicine and Department of Community Behavioral Health, Rush Medical College, Chicago, Illinois; 5Division of General Internal Medicine, Department of Medicine, Oregon Health & Science University, Portland, Oregon; 6Division of Hospital Medicine, Zuckerberg San Francisco General Hospital; 7Department of Medicine, University of California, San Francisco, San Francisco, California; 8Department of Family and Community Medicine, University of California, San Francisco, California; 9Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts; 10School of Medicine, MD/PhD Program, Oregon Health & Science University, Portland, Oregon.
TL;DR: Hospitalist Program, Division of General Internal Medicine, Department of medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, and section of Hospital Medicine, South Texas Veterans Health Care System, San Antonio, Texas.
Abstract: 1Department of Hospital Medicine, Regions Hospital, Health Partners, St. Paul, Minnesota; 2Divisions of Pulmonary & Critical Care Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, New York, New York; 3Division of Hospital Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York; 4Division of Hospital Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, New York, New York; 5Division of Hospital Medicine, Weill Cornell Medicine, New York, New York; 6Hospitalist Program, Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland; 7Division of General & Hospital Medicine and Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health San Antonio, San Antonio, Texas; 8Section of Hospital Medicine, South Texas Veterans Health Care System, San Antonio, Texas.
TL;DR: The impact of COVID-19 on physicians’ PIF is explored and strategies to support PIF in physicians and other healthcare professionals during times of crisis are identified.
Abstract: In 1957, Merton wrote that the primary aim of medical education should be “to provide [learners] with a professional identity so that [they] come to think, act, and feel like a physician.”1 More than a half-century later, the Carnegie Foundation for the Advancement of Teaching echoed his sentiments in its landmark examination of the United States medical education system, which produced four key recommendations for curricular reform, including explicitly addressing professional identity formation (PIF).2 PIF is a process by which a learner transforms into a physician with the values, dispositions, and aspirations of the physician community.3 It is now recognized as crucial to developing physicians who can deliver high-quality care.2 Major changes to the learning environment can impact PIF. For example, when the Accreditation Committee for Graduate Medical Education duty-hour restrictions were implemented in 2003, several educators were concerned that the changes may negatively affect resident PIF,4 whereas others saw an opportunity to refocus curricular efforts on PIF.5 Medical education is now in the midst of another radical change with the novel coronavirus disease 2019 (COVID-19) pandemic. Over the past several months, we have begun to understand the pandemic’s effects on medical education in terms of learner welfare, educational experiences/value, innovation, and assessment.6-8 However, little has been published on the pandemic’s effect on PIF.9 We explore the impact of COVID-19 on physicians’ PIF and identify strategies to support PIF in physicians and other healthcare professionals during times of crisis.
TL;DR: The value of systematically measuring mobility in the hospital is emphasized and a simple decision tree is provided to facilitate early discharge planning and accurately classified the discharge location for 73% of patients.
Abstract: Delayed hospital discharges for patients needing rehabilitation in a postacute setting can exacerbate hospital-acquired mobility loss, prolong functional recovery, and increase costs. Systematic measurement of patient mobility by nurses early during hospitalization has the potential to help identify which patients are likely to be discharged to a postacute care facility versus home. To test the predictive ability of this approach, a machine learning classification tree method was applied retrospectively to a diverse sample of hospitalized patients (N = 761) using training and validation sets. Compared with patients discharged to home, patients discharged to a postacute facility were older (median, 64 vs 56 years old) and had lower mobility scores at hospital admission (median, 32 vs 41). The final decision tree accurately classified the discharge location for 73% (95% CI, 67%-78%) of patients. This study emphasizes the value of systematically measuring mobility in the hospital and provides a simple decision tree to facilitate early discharge planning.