The Process of Implementing a Mobility Technician in the General Medicine and Surgical Population to Increase Patient Mobility and Improve Hospital Quality Measures: A Pilot Study

Abstract

Background: Hospital-associated disability (HAD) has been linked to prolonged and inappropriate immobility. HAD and increased postacute care (PAC) rehabilitation spending are also associated. Purpose: This pilot aims to describe the implementation processes of a designated mobility technician (MT), providing daily mobility on a medical and surgical acute care unit. During the MT implementation, we explore the resulting effects on patient length of stay (LOS), PAC utilization, patient satisfaction, falls, and hospital cost. Methods: A quality improvement pilot study was created comparing the percentage of PAC discharge locations before and during the mobility pilot (MP) on 1 general medical (GM) unit (37 beds) and 1 general surgical (GS) unit (27 beds). Following the nursing assessment of medical stability and mobility with a progressive mobility algorithm, patients were assigned a Johns Hopkins Highest Level of Mobility (JH-HLM) score and placed on the MT schedule. The MT mobilized each selected patient to the next appropriate level of mobility, with a goal of at least 1 JH-HLM level of increase and recorded the score. Patient discharge location was recorded at the end of the inpatient stay. Patient satisfaction scores, LOS, and incidence of falls were also monitored throughout the pilot. Outcomes: Eighty-nine percent of GM compared with 83% of the baseline data group patients and 83% of the GS compared with 90% for the baseline data group patients discharged to home with an average increase in JH-HLM score of 1.22 per mobility session. In addition, during the MP both units decreased the LOS by 5.84% to 9.03%, the GS unit experienced increased patient satisfaction scores by 9.19%, and both units improved Press Ganey ratings of Responsiveness of Staff by 16.47% to 37.00%. No falls were associated with the MT or MP and the GM unit decreased overall falls by 53.3%. Discussion: The MP is a promising tool for increasing patient mobility in the nonintensive care GM and GS setting, while potentially decreasing the need for PAC rehabilitation for many patients with minimal mobility deficits. Although not all of the results were statistically significant, positive effects on hospital ratings show promise toward helping to improve the overall patient experience during admission, decreasing LOS, decreasing overall fall rate, and an associated decrease in GM patient PAC spending in those most likely to be affected by HAD related to immobility. These positive effects can potentially improve hospital profit margins through the Centers for Medicare & Medicaid Services' value-based purchasing reimbursement program.

Extended mobility scale (AMEXO) for assessing mobilization and setting goals after gastrointestinal and oncological surgery: a before-after study

“…In line with previous studies, the majority of patients showed a change in mobility score when healthcare professionals used the JH-HLM to assess mobilization of hospitalized patients [ 12 , 17 , 21 , 30 ]. However, our findings also show that when healthcare professionals used the AMEXO scale to assess early postoperative mobilization instead, the number of patients who show a change in mobility score during the first three postoperative days was significantly higher.…”

“…Previous studies did not report a ceiling effect when healthcare professionals use the JH-HLM scale to assess mobilization in adult patients admitted to general medicine, neuroscience or general surgical ward [ 11 – 13 , 17 , 20 , 21 , 30 ]. The ceiling effect found in this study might be explained by the fact that ceiling effects are often encountered when an existing scale is applied to a new target population [ 25 ].…”

“…Each category is numbered consecutively from 1 = lying passively in bed to 8 = walking approximately 250 ft or more [ 13 ]. Initially, the JH-HLM scale has been developed to assist healthcare professionals caring for hospitalized general medicine patients [ 12 ]; however, the JH-HLM scale has also been used more recently in hospitalized adults at acute care units[ 17 ], hospitalized geriatric patients[ 18 ], hospitalized adults at a neuroscience/brain rescue unit[ 19 , 20 ], surgical unit[ 21 ] or intensive care unit[ 22 ]. Using a convenience sample of hospitalized adults, Hoyer et al showed that the test–retest reliability values for physical therapists and nurses (Intraclass Correlation Coefficients 0.94 and 0.95, respectively) and interrater reliability values between physical therapists and nurses (Intraclass Correlation Coefficient 0.99) were excellent [ 13 ].…”

Goal-Directed Mobility of Medical Inpatients–A Mini Review of the Literature

“…However, none of these outcomes reached statistical significance. Yet, definite conclusions cannot be drawn due to small sample size, short pilot duration, and limited data on demographics of the baseline data group ( 25 ).…”

“…Economic factors were investigated in one study, concluding that a mobility technician could be cost-effective by helping reduce length of stay and discharge to post-acute rehabilitation facilities. However, these outcomes were not significantly altered ( 25 ). Two trials created new roles for implementing the intervention ( 16 , 25 ), which could increase costs, while the others used pre-existing staff ( 18 – 20 , 24 , 26 , 27 ).…”