Background and Issues: Patient volume increased significantly over first half of 2011 on the Neurology Service. Bed occupancy increased by 14% over previous year and bed availability became a major constraint. Data showed, patients were discharged late in the day or sometimes stayed an extra night because discharge orders were released too late to place patients in rehab or skilled nursing facilities. Only 16% of patients were discharged by 2:00 pm due to communication barriers and inadequate information exchanged between multidisciplinary teams. There was also an issue with inconsistent acceptance criteria from primary placement facilities which resulted in a longer length of stay. Purpose: Primary goal of project was to free up capacity on the Nursing Division to accommodate the increase in patient volumes without increasing staffing or the number of available beds. Methods: In September 2011, a multidisciplinary team was assembled to understand causes of the problems and develop solutions to resolve. Solutions implemented include working with partner Rehab and Skilled Nursing Facilities to define standardized Acceptance Guidelines to ensure issues could be addressed before day of discharge. Also, processes for releasing discharge orders were redesigned so orders were more frequently written and placed “on hold” the day before expected discharge. A mobile computer was issued to physician rounding teams so orders could be released during rounds instead of batch-released in the afternoon. Additionally, team communication was significantly improved by standardizing a daily multidisciplinary team huddle and implementing a visual communication board to track key information about patients to proactively plan for discharge. Results: The overall length of stay of patients on the Neurology Service decreased from 4.26 days in 2011 to 3.69 days in 2012. Conclusions: Many variables contributed to the decrease in length of stay for patients in this study. No decisive conclusions can be made about the effectiveness of any particular variable. Other variables during this timeframe likely contributed, however the authors of this study presented the most likely factors. Although the findings are exciting, further analysis is needed to isolate the main drivers.

Background: Literature review has shown that in an ICU setting, the use of a mobility team decreased both the ICU and hospital stay. Patients also experienced improved functional status, strength and an improved sense of well being. Many patients appear more empowered and more involved in their care when they are moving. There was no current literature available regarding the use of a mobility team with the acute stroke patient population in an inpatient setting. Purpose: The purpose of this pilot program was to evaluate the impact of a dedicated mobility team in an acute neuroscience setting on mobility levels, fall rates, patient satisfaction and discharge disposition. Methods: This pilot was implemented in a Primary Stroke Center within a large tertiary medical center. This facility admits 1200-1300 stroke patients annually. A RN-Patient Care Technician mobility team was available from 0830-1700, Monday-Friday, rotating on three neuroscience divisions. Patients with orders for chair and ambulation were mobilized per the team. If on bedrest, range of motion and turning was provided. The team attempted to round on all patients twice per day. All activities completed with patients were documented in the electronic medical record. Outcomes were analyzed in aggregate. Results: The mobility team was piloted for a 90 day period ending May 20, 2011. Of the eligible patients, 83% received mobility interventions. Patient testing and patient refusal were the top reasons an intervention was not provided. Mobility levels demonstrated an increase in ambulation of 22%. Falls decreased 37%. Patient satisfaction scores increased up to 19%. An increase in discharges to home with outpatient therapies and a subsequent decrease in inpatient rehabilitation were observed. Conclusions: In conclusion these results demonstrate the positive impact of the mobility team on patient mobility, falls, patient satisfaction and discharge disposition. The mobility team continues to be used with ongoing data collection to evaluate ongoing outcomes.