BOOSTing patient mobility and function on a general medical unit by enhancing interprofessional care

Abstract

Low mobility during hospitalization remains prevalent despite associated negative consequences. The goal of this quality improvement (QI) project was to increase patient mobility and function by adding a physical therapist (PT) to an existing interprofessional care team. A mobility technician assisted treatment group patients with mobility during hospitalization based on physical therapist recommendations. Change in functional status and highest level of mobility achieved by treatment group patients was measured from admission to discharge. Observed hospital length of stay (LOS), LOS index, and 30-day all cause hospital readmission comparisons between treatment group and a comparison group on the same unit, and between cross-sectional comparison groups one year prior were used for Difference in Difference analysis. Bivariate comparisons between the treatment and a cross-sectional comparison group from one year prior showed a statistically significant change in LOS Index. No other bivariate comparisons were statistically significant. Difference in Difference methods showed no statistically significant change in observed LOS, LOS Index, or 30-day readmission. Patients in the treatment group had statistically significant improvements in functional status and highest level of mobility achieved. Physical function and mobility improved for patients who participated in mobility sessions. Mobility technicians may contribute to improved care quality and patient safety in the hospital.

Outcomes of a COVID Mobility Team

“…This is attributed to the prioritization of COVID-positive and PUI patients and seeing patients with negative COVID results, if able. Wood et al 5 reported an increased length of stay due to an increased case-mix index, and Johnson et al 1 contribute an increased length of stay to failure to control for confounding variables.…”

“…Immobility affects every body system and leads to costly hospital-acquired complications, including delirium, pneumonia, venous thromboembolism, pressure injury, and falls. [1][2][3][4][5] In addition to the hospitalacquired complications, immobility leads to functional decline, especially in the older adult. [1][2][3][4][5][6][7][8] During a single hospital admission, bed rest can lead to functional decline as quickly as 72 hours from admission because of muscle atrophy in a healthy adult.…”

“…[1][2][3][4][5] In addition to the hospitalacquired complications, immobility leads to functional decline, especially in the older adult. [1][2][3][4][5][6][7][8] During a single hospital admission, bed rest can lead to functional decline as quickly as 72 hours from admission because of muscle atrophy in a healthy adult. 9 Within 10 days, a substantial loss of muscle mass and strength occurs.…”

“…The detrimental effects of immobility are well documented in the literature, yet immobility still plagues the hospitalized adult. Immobility affects every body system and leads to costly hospital-acquired complications, including delirium, pneumonia, venous thromboembolism, pressure injury, and falls 1–5 . In addition to the hospital-acquired complications, immobility leads to functional decline, especially in the older adult 1–8 .…”

How to Improve Hospitalized Older Adults’ Activity Level: A Mixed Methods Study

“…16 A functional assessment is considered the key assignment for PTs and occupational therapists (OTs), and early involvement of the PT has been shown to facilitate an earlier delivery of walking devices. 17 Unfortunately, the functional assessment is typically followed by a recommendation of mobilization targeting the entire nursing staff 6,[18][19][20] This is, however, an inconvenient situation, as it is known that recommendations with no clear assignation of responsibility often result in poor implementation due to increasing the workloads of others. 21 While hospitals are experiencing a shortage in nursing staff, PTs and OTs are available to work with patients; thus hospitals should reconsider work assignments related to patient mobilization.…”