This Week in Research: You’re Not Exercising Enough; Hospitals Send Patients Home Too Early

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In this series, we look at the newest findings coming out of our area’s top research universities. We’ve got some great minds in Baltimore — let’s learn what they’re learning!

How much have you exercised this week? If you’re an average American, you can claim about two hours — which isn’t bad! After all, it’s almost three times as much physical activity than was typical forty years ago. That’s the good news. The bad news is that we need to be getting physical more than we typically do — at least 2.5 hours a week of “moderate” exercise (walking, golf, fishing, bowling) plus an hour and fifteen minutes of “vigorous” training (running, muscle strengthening) every week. And, lest you’ve forgotten, the U.S. is still “the fattest country in the world,” according to Penn State professor Geoffrey Godbey.

Godbey teamed up with University of Maryland professor John Robinson to see just how much exercise we’re getting as a nation by looking at data from the American Time Use Survey. They not only looked at how much Americans are moving, but also what our preferred activities are. The answer?  Television. “We are almost addicted to television and computers. Americans ages 18 to 64 average more than 35 hours of free time each week, but they spend half of it watching television,” Godbey says. When we do move our bodies, the most common activity is walking. On an average day, about 5 percent of Americans will go for a walk, for an average time of 53 minutes. The nation’s most popular team sport is basketball, followed by football, soccer, baseball, volleyball, and hockey.

But while teenagers are spending a respectable amount of time on fitness (41 minutes a day), their older counterparts are sadly lacking. The average time spent on fitness activities per day for those 18-64 is a paltry 17 minutes; for those over 65, it’s only 13 minutes. Part of this may be because teens are much more likely to participate in team sports — and team sports take up more time than solo activities, such as walking or running. “Among older adults, team sports are almost invisible in terms of daily time use, with only one in 500 people playing baseball or football, and one in 60 people playing basketball on a given day,” Godbey says. The one exception:  seniors go bowling just as often as their younger counterparts. So there’s room for hope after all.

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As anyone who’s waited around in an over-full emergency room knows, hospitals can have traffic jams, too. When faced with a hospital that’s bursting at the seams, doctors are often faced with the tough decision whether to send someone home and open up a bed, or to keep them a little longer. And, according to recent research out of the University of Maryland, they don’t always make the best choices.

Bruce Golden, a professor of management science at UM, looked at the ebb and flow of patients in a large medical center (he’s not saying which one). Golden and his colleagues found that patients who were discharged when the hospital was busy were much more likely (50 percent) to come back for follow-up treatment in the ensuing days. In other words, patients may have been discharged before their recovery was entirely complete.

According to Golden, this happens because physicians have to juggle a complex set of responsibilities. Not only are they responsible to their patients, but they’re also listening to the needs of the staff and administration:  “The hospital has to maintain revenue levels to meet its financial obligations. Surgeons are working to save lives and earn a livelihood. It’s what they do,” Golden says. “If the hospital says ‘sorry there are no beds available,’ there’s a lot of tension and pressure from both sides to keep things moving.”

Nonetheless, Golden says that there are ways to keep from sending a patient home too soon. Some hospitals have used checklists with “questions that would force the surgeon to think about whether they were discharging the patient for the right reason”; others approach post-operative care more flexibly, placing patients in whatever unit has empty beds.  Ultimately, according to Golden, it’s to everyone’s benefit to find a way to not release patients before their time. Even if early discharges save money in the short run, it also decreases the quality of care which, in the long run, hurts everyone.



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