Effects of an Ambulation Orderly Program Among Cardiac Surgery Patients

Abstract

Background Despite the known benefits of ambulation, most hospitalized patients remain physically inactive. One possible approach to this problem is to employ Ambulation Orderlies (AOs) – employees whose main responsibility is to ambulate patients throughout the day. For this study, we examined an AO program implemented among post-cardiac surgery patients and its effect on patient outcomes. Methods We evaluated post-operative length of stay, hospital complications, discharge disposition, and 30-day readmission for all patients who underwent coronary artery bypass and/or cardiac valve surgery in the nine months before and after the introduction of the AO program. In addition to pre-post comparisons, we performed an interrupted time series analysis to adjust for temporal trends and differences in baseline characteristics. Results We included 447 and 478 patients in the pre- and post-AO intervention groups, respectively. Post-operative length of stay was lower in the post-AO group, with median (IQR) of 10 (7,14) days versus 9 (7,13) days (p<0.001), and also had significantly less variability in mean monthly length of stay (Levene’s test p=0.03). Using adjusted interrupted time series analysis, the program was associated with a decreased mean monthly post-operative length of stay (-1.57 days, p=0.04), as well as a significant decrease in the trend of mean monthly post-operative length of stay (p=0.01). Other outcomes were unaffected. Conclusion The implementation of an AO program was associated with a significant reduction in post-operative length and variability of hospital stay. These results suggest that an AO program is a reasonable and practical approach towards improving hospital outcomes.

Ambulation Orderlies and Recovery After Cardiac Surgery: A Pilot Randomized Controlled Trial

“…Second, less than half of the approached patients consented to participate in this trial, and this may have resulted in our recruiting a healthier population that was more able to ambulated and less likely to benefit from an AO. Indeed, functional status was relatively high, our trial population’s surgical LOS was shorter than our institutional norms (at median of 6.5 days vs 7.5 days (11)), and patients walked more than 2000 steps per day, a value higher than expected for a hospitalized surgical population. (14) Third, we did not track how often the AO visited patients because we assumed that measuring ambulation (3 minute bouts of exercise) with the accelerometer would be sufficient.…”

“…Our prior research found that, the institution of our AO program was associated with 1.3 day shorter hospital length of stay and a reduced risk of falls. (11) Although these results are promising, they could have been confounded due to other institutional trends or occurred though a mechanism other than increased ambulation.…”

Independencia funcional en la recuperación de pacientes sometidos a cirugía cardiaca.

“…La enfermedad cardiovascular es la primera causa de morbimortalidad en Colombia y en el mundo; su tratamiento se basa en terapias farmacológicas y en fases avanzadas mediante tratamiento quirúrgico o intervencionista. Los pacientes que son sometidos a cirugía cardiaca atraviesan una serie de alteraciones que afectan sus funciones fisiológicas y las motoras y/o cognitivas, lo que conlleva a una disminución en la capacidad para desarrollar las actividades de la vida diaria, generando así, un déficit de autocuidado (21,22). Adicionalmente, la escala utilizada en este estudio es útil para medir el estado funcional de las personas cuando son dadas de alta de un servicio de cuidado intensivo (23).…”

The Pathway to Low Outlier Status in Venous Thromboembolism Events: An Analysis of Pancreatic Surgery in the National Surgical Quality Improvement Program

“…[10][11][12] Furthermore, institutions with formal ambulation programs have reported enhanced adherence to ambulation protocols by patients and hospital staff. [13][14][15][16] Many guidelines regarding VTE prophylaxis include explicit recommendations stating that hospitals and surgical services should synthesize a formal VTE prophylaxis algorithm that includes a risk assessment tool and a specified regimen for VTE prevention. [17][18][19][20] Our surgical department is a member of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP), which releases semiannual rankings of each participating hospital and service on the basis of adverse event rates.…”