Outcomes of Mobilisation of Vulnerable Elders in Ontario (MOVE ON): a multisite interrupted time series evaluation of an implementation intervention to increase patient mobilisation

Abstract

Backgroundolder patients admitted to hospitals are at risk for hospital-acquired morbidity related to immobility. The aim of this study was to implement and evaluate an evidence-based intervention targeting staff to promote early mobilisation in older patients admitted to general medical inpatient units.Methodsthe early mobilisation implementation intervention for staff was multi-component and tailored to local context at 14 academic hospitals in Ontario, Canada. The primary outcome was patient mobilisation. Secondary outcomes included length of stay (LOS), discharge destination, falls and functional status. The targeted patients were aged ≥ 65 years and admitted between January 2012 and December 2013. The intervention was evaluated over three time periods—pre-intervention, during and post-intervention using an interrupted time series design.Resultsin total, 12,490 patients (mean age 80.0 years [standard deviation 8.36]) were included in the overall analysis. An increase in mobilisation was observed post-intervention, where significantly more patients were out of bed daily (intercept difference = 10.56%, 95% CI: [4.94, 16.18]; P < 0.001) post-intervention compared to pre-intervention. Hospital median LOS was significantly shorter during the intervention period (intercept difference = −3.45 days, 95% CI: [−6.67,−0.23], P = 0.0356) compared to pre-intervention. It continued to decrease post-intervention with significantly fewer days in hospital (intercept difference= −6.1, 95% CI: [−11,−1.2]; P = 0.015) in the post-intervention period compared to pre-intervention.Conclusionsthis is a large-scale study evaluating an implementation strategy for early mobilisation in older, general medical inpatients. The positive outcome of this simple intervention on an important functional goal of getting more patients out of bed is a striking success for improving care for hospitalised older patients.

Prevalence and Costs of Discharge Diagnoses in Inpatient General Internal Medicine: a Multi-center Cross-sectional Study

“…Our findings suggest that GIM care should be guided by broad metrics that can be applied across diseases. Quality improvement in GIM may have greater impact by focusing on common processes such as transitions in care, 13 medication safety, 14 or functional status, 15 rather than on individual diseases.…”

“…The heterogeneity of conditions cared for in GIM poses important challenges for healthcare delivery. Initiatives that cut across individual diseases and address processes of care, 18 patient experience, 25 and functional outcomes 15 will be more likely to improve care for all GIM patients.…”

Predictors of physical activity in older adults early in an emergency hospital admission: a prospective cohort study

“…Unnecessarily reduced physical activity during hospitalisation may be part responsible for hospitalassociated functional decline and acute sarcopenia in older patients [1,2]. Higher levels of physical activity whilst in hospital have been shown to correlate negatively with risk of death [3], length of stay [4], and functional decline [5], and positively with likelihood of discharge home [6].…”

Mobilização Precoce Em Crianças Criticamente Doentes: Uma Revisão Integrativa

“…Um estudo recente feito em larga escala (n=12.490) por Liu et al (2017), intitulado "MOVE ON", objetivou implementar e avaliar uma estratégia para promover a mobilização precoce de pacientes idosos hospitalizados em unidades de internação em 14 hospitais de Ontário/Canadá. Os critérios definiam que os pacientes deveriam ser avaliados quanto à mobilidade dentro das primeiras 24h de internação, a mobilização deveria ocorrer 3 vezes ao dia, ser progressiva e adaptada às capacidades de cada paciente.…”