Time-motion observations to characterize the developmental environment in a paediatric post-acute care hospital.

Abstract

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. 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 7am to 7pm 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. Patients were median 1year and 8months of age (range 2months to 3years 9months) 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 1h and 34 min (range 41 min to 4h:30 min). Patients spent 4h:6min (2h:57 min to 6h:30 min) interacting with someone and 3h:51 min (57 min to 6h:36 min) out of bed each day. Patients were simultaneously out of their beds, interacting with someone and awake for 2h:21 min (51 min to 4h:19 min) each day. 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.