Mobility Action Group: Using Quality Improvement Methods to Create a Culture of Hospital Mobility

Abstract

BACKGROUND/OBJECTIVES: To describe the Mobility Action Group (MACT), an innovative process to enhance implementation of hospital mobility programs and create a culture of mobility in acute care. DESIGN: Continuous quality improvement intervention with episodic data review. SETTING: Inpatient units including medical, surgical, and intensive care settings. PARTICIPANTS: A total of 42 hospitals of varying sizes across the United States. INTERVENTIONS: The MACT and Change Package were developed to provide a conceptual framework, road map, and step-by-step guide to enable mobility teams to implement mobility programs successfully and meet their mobilization goals. Participants were encouraged to select two to three change tactics to pursue during the first action cycle and select and implement additional tactics in subsequent cycles. Nine learning sessions were held via webinar from April 27, 2017, to October 5, 2017, during which faculty provided brief presentations, facilitation, and group discussion. MEASUREMENTS: Implementation of programs, walks per day, use of bed and chair alarms, and participant satisfaction. RESULTS: Successful implementation of mobility programs was achieved at most (76%) sites. The proportion of patients who received at least three walks per day increased from 9% to 19%. The proportion of patients who were placed on a bed or chair alarm decreased from 36% to 20%. On average, 69% of participants reported they were "strongly satisfied" with the learning sessions. Most participants found the Change Package (58%) and Toolkit (63%) "very helpful." Since the conclusion of the active initiative, the Change Package has been downloaded 1,200 times. Of those who downloaded it, 48% utilized it to establish a mobility program, and 58% used it at their organization at least once a month. CONCLUSION: The MACT and Change Package provides an innovative approach emphasizing systemwide change that can help catalyze a culture of mobility in hospitals across the nation, improving the quality of care for hospitalized older adults.

ED‐DEL: Development of a change package and toolkit for delirium in the emergency department

“…The change process for this initiative is adapted from the IHI Breakthrough Series 19 and has proven effective for the implementation of prior quality improvement initiatives. 20,22,23 The Change Package provides a step-by-step process to guide staff in setting up an ED delirium program, from selecting a team to spearhead the initiative to regularly testing and refining the program for continued success. The Toolkit accompanying the Change Package was created to provide resources to assist with implementing each step of the process and can be readily adapted to meet an ED's specific needs and considerations.…”

“…In developing the ED-DEL initiative, our team of expert researchers and clinicians at the Marcus Institute for Aging Research in Boston, MA, and West Health Institute in San Diego, CA, used a similar approach to that of the Mobility Action Group (MACT), in which Dr. Sharon Inouye and colleagues successfully created a step-by-step toolkit and guide for implementing an early mobility program in the hospital. 20 For MACT and the ED-DEL initiative, we adapted an innovative IHI approach, which provides a change package and toolkit, change tactics, and a framework for implementation that emphasizes engaging leaders and other key stakeholders to create systemwide, sustainable change. 21 Our approach for development of ED-DEL followed 5 general steps:…”

Optimization and Validation of a Classification Algorithm for Assessment of Physical Activity in Hospitalized Patients

“…Low amounts of PA and prolonged periods of uninterrupted sedentary activity during hospitalization have been associated with functional decline [ 29 , 30 ], a decline in physical performance [ 30 ], increased insulin resistance [ 30 ], increased length of stay [ 31 ] , increased risk of institutionalization [ 16 ], and mortality [ 29 , 32 , 33 , 34 ]. To reduce the risks of these negative effects, interventions aimed at increasing the amounts of PA and breaking up prolonged periods of sedentary activity are essential [ 30 , 35 , 36 , 37 , 38 , 39 ]. In order to support (i.e., perform and/or evaluate) such interventions, it is necessary to measure patients’ PA behavior in an objective and accurate way [ 2 , 40 , 41 ].…”

Limited Mobility to the Bed Reduces the Chances of Discharge and Increases the Chances of Death in the ICU

“…Even in an institution where there are early mobilization protocols and in the face of recommendations for the insertion of mobilization protocols at systematic levels of progression of postures and activities, studies have shown that the highest level of mobilization achieved by most individuals, prior to discharge from the ICU, has been turning over in bed, corresponding to 57.5% of the sample [ 1 , 3 , 4 ]. Furthermore, the incidence of activities outside the bed has been low (25%), with only 5% of individuals performing some activity away from the bed in the ICU [ 3 ].…”