Abstract
When patients are admitted to the hospital, they are generally expected to remain in or within close proximity to their assigned rooms in order to promote their safety and appropriate medical care. Although there are circumstances when patients may safely leave their hospital room or floor, guidance within the medical literature for the management of patient movement within the hospital are lacking. Excessive restrictions on patient movement may be seen as overly paternalistic, while lax requirements may interfere with high quality care, patient safety and efficient hospital practice. As a result, guidance in the form of institutional policy is warranted. Such policy development should take into consideration the potential clinical, legal, and ethical concerns in balancing the competing values of patients’ preferences and respect for autonomy, while ensuring high quality, safe, and efficacious medical care. This paper will provide a framework for hospitals to create institution-specific patient movement policies that are fair, systematic, and transparent.
Similar content being viewed by others
References
38 CFR § 17.33—Patients’ Rights. (n.d).
Alfandre, D., & Geppert, C. (2019). Ethical considerations in the care of hospitalized patients with opioid use and injection drug use disorders. Journal of Hospital Medicine, 14(2), 123–125. https://doi.org/10.12788/jhm.3100.
Baker, A. (2001). Crossing the quality chasm: A new health system for the 21st century. BMJ, 323, 1192. https://doi.org/10.1136/bmj.323.7322.1192.
Barry, M. J., & Edgman-Levitan, S. (2012). Shared decision making: The pinnacle of patient-centered care. New England Journal of Medicine, 366(9), 780–781. https://doi.org/10.1056/NEJMp1109283.
Berwick, D. M. (2009). What ‘patient-centered’ should mean: Confessions of an extremist. Health Affairs, 28(4), w555–565. https://doi.org/10.1377/hlthaff.28.4.w555
Covinsky, K., Pierluissi, E., & Johnston, C. (2011). Hospitalization-associated disability: ‘She was probably able to ambulate, but I’m not sure’. JAMA Journal of the American Medical Association, 306(16), 1782–1793.
Detsky, A. S., & Krumholz, H. M. (2014). Reducing the trauma of hospitalization. JAMA: Journal of the American Medical Association, 311(21), 2169–2170. https://doi.org/10.1001/jama.2014.3695.
Donn, S. M. (2005). Medical liability, risk management, and the quality of health care. Seminars in Fetal and Neonatal Medicine, 10(1), 3-9. https://doi.org/10.1016/j.siny.2004.09.004.
Douglas, C. H., & Douglas, M. R. (2004). Patient-friendly hospital environments: Exploring the patients’ perspective. Health Expectations, 7(1): 61–73. https://doi.org/10.1046/j.1369-6513.2003.00251.x.
Dressler, R., Dryer, M. M., Coletti, C., Mahoney, D., & Doorey, A. J. (2014). Altering overuse of cardiac telemetry in non-intensive care unit settings by hardwiring the use of American Heart Association Guidelines. JAMA Internal Medicine, 174(11), 1852–1854. https://doi.org/10.1001/jamainternmed.2014.4491.
Fätkenheuer, G., Hirschel, B., & Harbarth, S. (2014). Screening and isolation to control meticillin-resistant Staphylococcus aureus: Sense, nonsense, and evidence. The Lancet, 385(9973), 1146-1149. https://doi.org/10.1016/s0140-6736(14)60660-7.
Gourlay, D. L., Heit, H. A., & Almahrezi, A. (2005). Universal precautions in pain medicine: A rational approach to the treatment of chronic pain. Pain Medicine, 6(2), 107–112. https://doi.org/10.1111/j.1526-4637.2005.05031.x.
Halfon, P., Eggli, Y., Van Melle, G., & Vagnair, A. (2001). Risk of falls for hospitalized patients: A predictive model based on routinely available data. Journal of Clinical Epidemiology, 54(12), 1258–1266.
Handel, D. A., Fu, R., Daya, M., York, J., Larson, E., & John, M. K. (2010). The use of scripting at triage and its impact on elopements. Academic Emergency Medicine, 17(5), 495–500. https://doi.org/10.1111/j.1553-2712.2010.00721.x.
Ito, Y., Nagao, M., Iinuma, Y., Matsumura, Y., Yamamoto, M., Takakura, S., et al. (2015). Risk factors for nosocomial tuberculosis transmission among health care workers. American Journal of Infection Control, 44(5), 596-598. https://doi.org/10.1016/j.ajic.2015.11.022.
Martin, D. P., Diehr, P., Conrad, D. A., Davis, J. H., Leickly, R., & Perrin, E. B. (1998). Randomized trial of a patient-centered hospital unit. Patient Education and Counseling, 34(2), 125–133. https://doi.org/10.1016/S0738-3991(97)00089-X.
Martin, E. M., Russell, D., Rubin, Z., Humphries, R., Grogan, T. R., Elashoff, D., et al. (2016). Elimination of routine contact precautions for endemic methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococcus: A retrospective quasi-experimental study. Infection Control and Hospital Epidemiology, 37(11), 1323-1330. https://doi.org/10.1017/ice.2016.156.
Morgan, D. J., Murthy, R., Munoz-Price, L. S., Barnden, M., Camins, B. C., Johnston, B. L., et al. (2015). Reconsidering contact precautions for endemic methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococcus. Infection Control and Hospital Epidemiology, 36(10), 1163–1172.
Moyle, W., Olorenshaw, R., Wallis, M., & Borbasi, S. (2008). Best practice for the management of older people with dementia in the acute care setting: A review of the literature. International Journal of Older People Nursing, 3(2), 121-130. https://doi.org/10.1111/j.1748-3743.2008.00114.x.
New York Codes, Rules, and Regulations, Title 10. Section 405.7—Patient’s Rights. (n.d).
Oliver, D., Killick, S., Even, T., & Willmott, M. (2008). Do falls and falls-injuries in hospital indicate negligent care-and how big is the risk? A retrospective analysis of the NHS litigation authority database of clinical negligence claims, resulting from falls in hospitals in England 1995 to 2006. Quality and Safety in Health Care, 17(6), 431-436. https://doi.org/10.1136/qshc.2007.024703.
Parmet, W. E. (2007). Legal power and legal rights: Isolation and quarantine in the case of drug-resistant tuberculosis. New England Journal of Medicine, 357, 433–435. https://doi.org/10.1056/nejmp078133.
Patient Rights. (n.d). California Hospital Association. Retrieved June 16, 2019, from https://www.calhospital.org/sites/main/files/file-attachments/patientrights_english_3.pdf.
Rathert, C., Wyrwich, M. D., & Boren, S. A. (2013). Patient-centered care and outcomes: A systematic review of the literature. Medical Care Research and Review, 70(4), 351-379. https://doi.org/10.1177/1077558712465774.
Sidani, S. (2008). Effects of patient-centered care on patient outcomes: An evaluation. Research and Theory for Nursing Practice, 22(1), 24-37. https://doi.org/10.1891/1541-6577.22.1.24.
Siegel, J. D., Rhinehart, E., Jackson, M., & Chiarello, L. (2007). 2007 guideline for isolation precautions: Preventing transmission of infectious agents in health care settings. American Journal of Infection Control, 35(10 Suppl 2), S65–164. https://doi.org/10.1016/j.ajic.2007.10.007.
Smith, T. (2014). Wandering off the Floors: Safety and security risks of patient wandering. PSNet Patient Safety Network. Retrieved from https://psnet.ahrq.gov/webmm/case/326/wandering-off-the-floors-safety-and-security-risks-of-patient-wandering.
Texas Administrative Code—Patients Rights. (n.d). Title 25, Part 1, Chapter 133, Subchapter C. Rule §133.42. Retrieved June 16, 2019, from https://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=25&pt=1&ch=133&rl=42.
Volk, M. L., Lieber, S. R., Kim, S. Y., Ubel, P. A., & Schneider, C. E. (2012). Contracts with patients in clinical practice. The Lancet, 379(9810), 7–9. https://doi.org/10.1016/S0140-6736(11)60170-0.
Winkler, E. C. (2005). The ethics of policy writing: How should hospitals deal with moral disagreement about controversial medical practices? Journal of Medical Ethics, 31(10), 559–566. https://doi.org/10.1136/jme.2004.011023.
Yerevanian, A. (2016). Can I eat yet? JAMA: Journal of the American Medical Association, 315(6), 557. https://doi.org/10.1001/jama.2015.18605.
Young, K. (2019). Things we do for no reason: Contact precautions for MRSA and VRE. Journal of Hospital Medicine, 14(3), 178–180. https://doi.org/10.12788/jhm.3126
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Disclosure
The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the U.S. Department of Veterans Affairs, the US Government, or the VA National Center for Ethics in Health Care.
Rights and permissions
About this article
Cite this article
Alfandre, D., Stream, S. & Geppert, C. “Doc, I’m Going for a Walk”: Liberalizing or Restricting the Movement of Hospitalized Patients—Ethical, Legal, and Clinical Considerations. HEC Forum 32, 253–267 (2020). https://doi.org/10.1007/s10730-020-09398-5
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10730-020-09398-5