Seeking Hospitalists: Preventing Pressure Injuries and Mobility Challenges For an upcoming Medscape article, I’m seeking US-based hospitalists to discuss how pressure injuries and mobility challenges are prevented during inpatient care for patients with obesity. The piece will explore real-world strategies hospitalists use to reduce risk, how staffing, equipment, and workflows influence prevention efforts, and where gaps in routine care can lead to avoidable complications during hospitalization. Questions: In hospitalized patients with obesity, where do you most often see the highest risk for pressure injuries or mobility complications develop — and which patients are hardest to protect, even when resources are available? What preventive strategies do you find most effective, and which are most likely to fail in real-world conditions such as staffing shortages or limited equipment? How do equipment availability, staffing levels, or unit workflows influence your ability to prevent skin breakdown and mobility complications in real time? Can you give an example when this helped—or hindered—prevention? Can you describe a situation where a patient nearly developed a pressure injury or mobility complication — and what ultimately prevented it or led to intervention? How do you approach conversations with patients and care teams about mobility and repositioning when physical limitations, discomfort, or safety concerns are present? What is one practical change — at the unit, hospital, or system level — that could meaningfully reduce pressure injuries and mobility-related complications for hospitalized patients with obesity? Requirements for participation: Must be US-based Must be a practicing hospitalist (MD or DO) Experience managing inpatient care for patients with obesity required Conflict of interest disclosure required, if applicable Responses are considered permission to quote with attribution in Medscape and may be lightly edited for clarity, accuracy, and flow

Risk Areas & Hard-to-Protect Patients: The area of highest risk for pressure injuries for patients with obesity is in skin folds or under medical devices. The panniculus (lower abdominal fold) is especially vulnerable to skin damage caused by moisture. Edema patients are the most difficult to protect due to their extremely fragile skin. Effective vs. Failing Strategies: Micro-positioning patients and the "Rule of 30" (tilting the patient 30 degrees) are excellent for reducing pressure on an area. Unfortunately, manually turning schedules often fail during extreme staffing shortages. For patients with class III obesity, we need at least three to four staff members to safely turn the patient. Without enough staff, these turns happen less frequently than the standard two-hour protocol calls for. Impact of Equipment and Staffing: Bariatric low-air-loss beds are critical for maintaining skin microclimates and skin moisture. I can recall a situation when the lack of a ceiling lift limited the ability to mobilize a patient early. On the other hand, having a designated "Turn Team" when our census is high has been key in improving our prevention rates. Intervention Example: I recently had a patient whose sacral redness was identified early through our multidisciplinary "skin rounds." This allowed us to immediately apply the prophylactic silicone foam dressing and an air-redistribution mattress. This quick intervention prevented a Stage 1 injury from becoming an open wound. Communication Approach: I communicate the need for mobility as a "prescription for recovery" rather than a task. I acknowledge the discomfort of the patient while explaining that movement aids in the prevention of pneumonia and blood clot formation. I remind my staff that "safe patient handling" is a non-negotiable part of the medical plan. Practical System Change: Every hospital should mandate the installation of ceiling-mounted lifts in all designated bariatric rooms to help reduce physical burden on staff and ensure that patients are moved safely and frequently. COI Disclosure: None.