TY - JOUR
T1 - Time-motion observations to characterize the developmental environment in a paediatric post-acute care hospital
AU - Hogan, Patrick G.
AU - Wallace, Claire E.
AU - Schaffer-Nay, Nanette R.
AU - Al-Zubeidi, Duha
AU - Holekamp, Nicholas A.
N1 - Publisher Copyright:
© 2023 The Authors. Child: Care, Health and Development published by John Wiley & Sons Ltd.
PY - 2024/1
Y1 - 2024/1
N2 - Background: Chronically hospitalized children are at risk for neurodevelopmental delay, compounded by restricted social interactions, movement and environmental stimulation. We measured patients' movements and interactions to characterize developmentally relevant aspects of our inpatient environment and identify opportunities for developmental enrichment. Methods: As part of a quality improvement initiative to inform neurodevelopmental programming for children with medical complexity at our paediatric post-acute care specialty hospital, we conducted >232 hours of time-motion observations. Trained observers followed 0- to 5-year-old inpatients from 7 am to 7 pm on weekdays, categorizing observations within five domains: Where, With, Position, State and Environment. Observations were collected continuously utilizing REDCap on iPads. A change in any domain initiated a new observation. Results: Patients were median 1 year and 8 months of age (range 2 months to 3 years 9 months) with a median length of hospitalization of 514 days (range 66–1298). In total, 2636 unique observations (or median 134 observations per patient-day [range 95–210]) were collected. Patients left their rooms up to 4 times per day for median 1 h and 34 min (range 41 min to 4 h:30 min). Patients spent 4 h:6 min (2 h:57 min to 6 h:30 min) interacting with someone and 3 h:51 min (57 min to 6 h:36 min) out of bed each day. Patients were simultaneously out of their beds, interacting with someone and awake for 2 h:21 min (51 min to 4 h:19 min) each day. Conclusions: Despite a care model prioritizing time out of bed and social interaction, time-motion observations indicate patients spent many of their waking hours in bed and alone. Quantifying our inpatients developmental opportunities will inform neurodevelopmental programming initiatives.
AB - Background: Chronically hospitalized children are at risk for neurodevelopmental delay, compounded by restricted social interactions, movement and environmental stimulation. We measured patients' movements and interactions to characterize developmentally relevant aspects of our inpatient environment and identify opportunities for developmental enrichment. Methods: As part of a quality improvement initiative to inform neurodevelopmental programming for children with medical complexity at our paediatric post-acute care specialty hospital, we conducted >232 hours of time-motion observations. Trained observers followed 0- to 5-year-old inpatients from 7 am to 7 pm on weekdays, categorizing observations within five domains: Where, With, Position, State and Environment. Observations were collected continuously utilizing REDCap on iPads. A change in any domain initiated a new observation. Results: Patients were median 1 year and 8 months of age (range 2 months to 3 years 9 months) with a median length of hospitalization of 514 days (range 66–1298). In total, 2636 unique observations (or median 134 observations per patient-day [range 95–210]) were collected. Patients left their rooms up to 4 times per day for median 1 h and 34 min (range 41 min to 4 h:30 min). Patients spent 4 h:6 min (2 h:57 min to 6 h:30 min) interacting with someone and 3 h:51 min (57 min to 6 h:36 min) out of bed each day. Patients were simultaneously out of their beds, interacting with someone and awake for 2 h:21 min (51 min to 4 h:19 min) each day. Conclusions: Despite a care model prioritizing time out of bed and social interaction, time-motion observations indicate patients spent many of their waking hours in bed and alone. Quantifying our inpatients developmental opportunities will inform neurodevelopmental programming initiatives.
KW - children with medical complexity (CMC)
KW - neurodevelopment
KW - paediatric post-acute care
KW - quality improvement
KW - time-motion
UR - http://www.scopus.com/inward/record.url?scp=85172912722&partnerID=8YFLogxK
U2 - 10.1111/cch.13179
DO - 10.1111/cch.13179
M3 - Article
C2 - 37747458
AN - SCOPUS:85172912722
SN - 0305-1862
VL - 50
JO - Child: Care, Health and Development
JF - Child: Care, Health and Development
IS - 1
M1 - e13179
ER -