Promoting mobility and reducing length of stay in hospitalized general medicine patients: A quality‐improvement project

Hoyer, Erik H.; Friedman, Michael; Lavezza, Annette; Wagner‐Kosmakos, Kathleen; Lewis‐Cherry, Robin; Skolnik, Judy L.; Byers, Sherrie P.; Atanelov, Levan; Colantuoni, Elizabeth; Brotman, Daniel J.; Needham, Dale M.

doi:10.1002/jhm.2546

Cited by 175 publications

(194 citation statements)

References 51 publications

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“…Several early mobility QI programmes have been successfully implemented in acute care settings (Drolet et al, 2013;Hoyer et al, 2016;Mudge, McRae, & Cruickshank, 2015;Wood et al, 2014). Successful mobility QI projects engage a combination of interprofessional staff to promote early mobility and increased levels of activity for hospitalised patients.…”

Section: Backg Rou N Dmentioning

confidence: 99%

“…These efforts could lead to a change from a culture of immobility to a culture of early mobility in hospital settings. Many of these programmes engage nursing staff with support from rehabilitation staff (Hoyer et al, 2016;Wood et al, 2014) or collaborative care models (Mudge et al, 2015) to promote higher hospital mobility levels. This research has been successful at improving mobility in patients before they leave the hospital (Drolet et al, 2013;Hoyer et al, 2016;Wood et al, 2014).…”

Section: Backg Rou N Dmentioning

confidence: 99%

“…Many of these programmes engage nursing staff with support from rehabilitation staff (Hoyer et al, 2016;Wood et al, 2014) or collaborative care models (Mudge et al, 2015) to promote higher hospital mobility levels. This research has been successful at improving mobility in patients before they leave the hospital (Drolet et al, 2013;Hoyer et al, 2016;Wood et al, 2014). Some also found reduction in length of stay (Hoyer et al, 2016;Mudge et al, 2015) or falls (Mudge et al, 2015;Wood et al, 2014).…”

Section: Backg Rou N Dmentioning

confidence: 99%

“…This research has been successful at improving mobility in patients before they leave the hospital (Drolet et al, 2013;Hoyer et al, 2016;Wood et al, 2014). Some also found reduction in length of stay (Hoyer et al, 2016;Mudge et al, 2015) or falls (Mudge et al, 2015;Wood et al, 2014).…”

Section: Backg Rou N Dmentioning

confidence: 99%

“…Fear of litigation and financial penalties related to falls in hospitals have created disincentives to promote mobility, and professional and environmental barriers serve to maintain the immobility status quo which prevents patients from feeling prepared for discharge (Doherty-King & Bowers, 2011;Growdon et al, 2017;Hoyer, Brotman, Chan, & Needham, 2015). Quality improvement (QI) projects to increase patient mobility and level of activity have shown positive results (Drolet et al, 2013;Hoyer et al, 2016;Wood et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

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Mobility bridges a gap in care: Findings from an early mobilisation quality improvement project in acute care

Johnson

Howell

2019

Journal of Clinical Nursing

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Aims and objectives To qualitatively evaluate an early mobilisation quality improvement project implemented on a general medicine unit. Background Early mobility quality improvement projects show promising quantitative results yet have failed to collect data from patient and staff experience associated with physical activity during illness and the impact of this change in clinical practice. Design A mixed methods case study was used to evaluate a mobility quality improvement project. Quantitative results will be published separately. The qualitative evaluation used a phenomenological lens to explore the patient and staff experience. Methods Semi‐structured interviews with twelve participants (four patients and eight staff) were performed during the project. Data were analysed using open coding, direct interpretation and then categorised into an overarching and four supporting themes. Findings are reported per the Standards for Reporting Qualitative Research. Results Participants reported that early mobilisation bridged a gap in care. Staff understood the benefits of early mobility. Patients expressed how mobility aligned with personal preferences and their need to prepare for hospital discharge. Greater functional independence and higher mobility levels in patients on the unit reduced staff level of care. When patients were consistently presented with opportunities to be mobile and active, they expected mobility to be a part of their daily care plan. Conclusions Findings suggest that early mobility quality improvement projects have the potential to transform clinical practice and improve the quality of care for patients in acute care. Relevance to clinical practice All members of the healthcare team, including the patient, recognise the importance of maintaining mobility and function during hospitalisation yet focus on these needs are often delayed or missed. Early mobility quality improvement projects help to set patient expectations and build a culture that promotes patient mobility and function during acute illness.

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Section: Backg Rou N Dmentioning

confidence: 99%

Section: Backg Rou N Dmentioning

confidence: 99%

Section: Backg Rou N Dmentioning

confidence: 99%

Section: Backg Rou N Dmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Mobility bridges a gap in care: Findings from an early mobilisation quality improvement project in acute care

Johnson

Howell

2019

Journal of Clinical Nursing

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Assessment of Patient Ambulation Profiles to Predict Hospital Readmission, Discharge Location, and Length of Stay in a Cardiac Surgery Progressive Care Unit

et al. 2020

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IMPORTANCE Promoting patient mobility during hospitalization is associated with improved outcomes and reduced risk of hospitalization-associated functional decline. Therefore, accurate measurement of mobility with high-information content data may be key to improved risk prediction models, identification of at-risk patients, and the development of interventions to improve outcomes. Remote monitoring enables measurement of multiple ambulation metrics incorporating both distance and speed. OBJECTIVE To evaluate novel ambulation metrics in predicting 30-day readmission rates, discharge location, and length of stay using a real-time location system to continuously monitor the voluntary ambulations of postoperative cardiac surgery patients. DESIGN, SETTING, AND PARTICIPANTS This prognostic cohort study of the mobility of 100 patients after cardiac surgery in a progressive care unit at Johns Hopkins Hospital was performed using a real-time location system. Enrollment occurred between August 29, 2016, and April 4, 2018. Data analysis was performed from June 2018 to December 2019. MAIN OUTCOMES AND MEASURES Outcome measures included 30-day readmission, discharge location, and length of stay. Digital records of all voluntary ambulations were created where each ambulation consisted of multiple segments defined by distance and speed. Ambulation profiles consisted of 19 parameters derived from the digital ambulation records. RESULTS A total of 100 patients (81 men [81%]; mean [SD] age, 63.1 [11.6] years) were evaluated. Distance and speed were recorded for more than 14 000 segments in 840 voluntary ambulations, corresponding to a total of 127.8 km (79.4 miles) using a real-time location system. Patient ambulation profiles were predictive of 30-day readmission (

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Interventions to Reduce Hospital Length of Stay in High-risk Populations

et al. 2021

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Key Points Question Which hospital-led interventions are associated with reducing length of stay (LOS) for high-risk populations? Findings In this systematic review including 19 systematic reviews, 8 strategies for reducing LOS in high-risk populations were identified: discharge planning, geriatric assessment, medication management, clinical pathways, interdisciplinary or multidisciplinary care, case management, hospitalist services, and telehealth. Interventions were most frequently designed for older patients or patients with heart failure and were often associated with inconsistent outcomes in LOS, readmissions, and mortality across populations. Meaning This systematic review found that across all high-risk populations, there are inconsistent results on the effectiveness associated with interventions to reduce LOS, such as discharge planning, which are often widely used by health systems.

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Promoting mobility and reducing length of stay in hospitalized general medicine patients: A quality‐improvement project

Cited by 175 publications

References 51 publications

Mobility bridges a gap in care: Findings from an early mobilisation quality improvement project in acute care

Mobility bridges a gap in care: Findings from an early mobilisation quality improvement project in acute care

Assessment of Patient Ambulation Profiles to Predict Hospital Readmission, Discharge Location, and Length of Stay in a Cardiac Surgery Progressive Care Unit

Interventions to Reduce Hospital Length of Stay in High-risk Populations

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