The 12-Second Free Test that Can Reduce Hospital Readmissions

VBCC - November 2014, Vol 5, No 9 - The Patient Perspective
Julie K. Silver, MD
Associate Professor and Associate Chair for Strategic Initiatives
Department of Physical Medicine and Rehabilitation
Harvard Medical School
Boston, MA

"Mary” is a 67-year-old woman who was diagnosed with cancer and underwent surgery. She was hospitalized and then readmitted to the hospital after falling at home. I see a lot of Marys (or Joes) in my practice, as do most oncologists and physiatrists. It would take 12 seconds to identify many of the Marys and Joes and help to prevent their readmissions.

I can usually spot them as I glance up from the computer I use in the hallway and watch them walking from the waiting room to an examination room with my medical assistant. These are the folks who are slow and, for lack of a better term, wobbly. Identifying these patients can take seconds, with the help of a free, evidence-based test.

Why is this so important? Wobbly patients have a lot of falls that lead to laceration and bone fractures, head injuries, and other problems that require medical treatment, including hospital readmissions. The significant healthcare costs associated with their wobbliness is well-documented. To zero in on the patients at highest risk, as well as the least-expensive solutions that will provide the best possible outcomes (think Triple Aim), let us focus on the elephants in operating rooms.

This was the topic of a 2014 review article titled “Patient Frailty: The Elephant in the Operating Room” and published in the journal Anaesthesia. In this article, Hubbard and Story highlight­ed what every rehabilitation clinician knows: research has shown that slow gait speed is an excellent way to identify patients who are at risk for falls or other postoperative complications. Wobbly patients slow down to compensate for a lack of strength and balance.

The 12-Second Solution
The Timed Up and Go (TUG) test is a validated tool that can be used in the office setting during preoperative evaluations to quickly identify patients who may benefit from a rehabilitation referral before surgery (ie, prehabilitation). Because this is such a fast, easy, and good predictor of which patients would likely benefit from a physiatry or physical therapy referral, when I am giving lectures to oncology healthcare professionals, I often do a demonstration so that they can see just how easy this test is to perform.

This has become an “aha” moment in my lectures, where the attendees instantly realize that they can significantly affect outcomes by performing the TUG test. In fact, the average fifth grader could likely learn to perform this test in less than 5 minutes (although the test should be done by trained healthcare professionals). If there is time, the TUG test can be performed with other validated measures that assess things such as patient frailty.

How to Perform the TUG Test

  1. The patient should sit in a standard armchair wearing regular footwear and using a walking aid if needed.
  2. Ask the patient to stand up from the chair and walk to a line on the floor that is 10 feet away, turn, and come back to the chair and sit down.
  3. If this takes the patient 12 seconds or more to complete, the patient is at high risk for falling and should be referred before surgery for a physiatry or physical therapy consultation.
  4. A copy of the form used for the TUG test can be found at the Centers for Disease Control and Prevention initiative titled “Stopping Elderly Accidents, Deaths & Injuries (STEADI): think steady, not wobbly.” You can find the single-page form and instructions at www.cdc.gov/injury/STEADI.
Help Reduce Hospital Readmissions
In my practice, when I see patients walking slowly down the long corridors, I can instantly tell if they are wobbly, and if they have tried to solve their own problems. These patients usually have a cane that they picked up at the local drugstore. It is not the right height, and frequently they are using it on the wrong side.

A single visit to a physical therapist is sometimes all that is needed to make the patient much steadier, by adjusting the height of the cane, and teaching the patient how to use it properly, including stepping off curbs and going up and down stairs.

If you want to decrease the incidence of hospital readmissions and reduce the length of stays, consider adding the TUG test to the preoperative screening protocol at your practice or institution. Combine the screening with a rehabilitation referral process before surgery if the patient cannot complete the TUG test in less than 12 seconds.

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Last modified: November 24, 2014
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