Hospital-associated disability (HAD) has been linked to prolonged and inappropriate immobility. HAD and increased postacute care (PAC) rehabilitation spending are also associated.
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.
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.
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%.
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.
Emelia Exum, PT, DPT, GCS Department of Physical Medicine and Rehabilitation, Baylor University Medical Center, 3500 Gaston Ave, Dallas, TX 75246 (USA). firstname.lastname@example.org
Brian L. Hull, PT, DPT, MBA Department of Physical Medicine and Rehabilitation, Baylor University Medical Center, Dallas, Texas.
The authors have no conflicts of interest and no source of funding to declare.