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Inpatient Mobility Program

Roger C. Anderson

LDR – 678 Research Practicum

Siena Heights University

June 10, 2013

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Organization

Host Site: St. John Macomb-Oakland Hospital, Macomb Campus

St. John Macomb-Oakland Hospital, Macomb Center, is a 376-bed facility offering a wide range of inpatient and outpatient services. Our Centers of Excellence include Behavioral Medicine Services, Cancer Care, Cardiology Services, Emergency Center, Physical Medicine and Rehabilitation Services, Surgical Services and Women’s Health Services and our state-of-the-art Webber Cancer Center.

Site Supervisor

Christine Fornal, MS, RNSite Nursing Director

-20+ Years Experience in Med-Surg Nursing and Leadership

-Currently Responsible for Nursing Services on both

campuses of SJMOH

-Reports directly to the SJPHS CNO, Maryann Barnes

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Practicum Overview

Beginning with a pilot in the summer of 2012, this project was designed to assess the impact of a targeted mobility protocol on those patients not otherwise receiving formal therapy services.  The primary focus to was to look at the impact on length of stay.  After the initial single unit pilot phase, finance was engaged to further assess costs, savings, LOS by unit and cost per day.

 

We have now moved into 4 pilot units for a 6-month period.  I have been directing my leaders and teams in hiring, training, communication, oversight, promotion of the program, and outcomes assessment/analysis.

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Practicum Objectives

1. Take a potential work re-design from concept to pilot to implementation and evaluation -Partially Achieved

2. Validate or disprove initial working assumptions; utilize research as needed -Achieved

3. Utilize resources to perform work within proper scope of various departments and team members in order to best match work to skills - Achieved

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Practicum Objectives

4. Mentor associates in project management, program evaluation, and various aspects of financial analysis. - Achieved5.Interact with senior leadership regarding further implementation within system – Achieved

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Final Outcomes – LOS & Cost

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Final Outcomes - LOS

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Final Outcomes - Falls

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Clock Hours - Final

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Lessons Learned & Next Steps

• Process improvement during the pilot phase can drive acceptance

• Amount of resources do not always align with magnitude of outcomes

• Can not always account for other influences – sometimes correlation and other supportive measures will make the case

• Next step is formal presentation to senior leadership for potential rollout to full hospital and/or entire system as ‘best practice’

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References

 

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Brown, C. J., Friedkin, R. J., & Inouye, S. K. (2004). Prevalence and outcomes of low mobility in hospitalized older patients. Journal of the American Geriatric Society, 52, 1263-1270.Brown, C. J., Roth, D. L., Allman, R. M., Sawyer, P. P., Ritchie, C. S., & Rossman, J. M. (2009). Trajectories of life-space mobility after hospitalization. Annals of Internal Medicine, 150 (6), 372-378.Callen, B. L., Mahoney, J. E., Grieves, C. B., Wells, T. J., & Enloe, M. M. (2004). Frequency of hallway ambulation by hospitalized older adults on medical units of an academic hospital. Geriatric Nursing, 25 (4), 212-217. doi:10.1016/j.gerinurse.2004.06.016.Convertino, V., Bloomfield, S., & Greenlief, J. (1997). An overview of the issues: physiological effects of bed rest and restricted physical activity. Medicine and Science in Sports Exercise , 29 (2), 187-190.Covinsky, K. E., Pierluissi, E. M., & Johnston, C. B. (2011). Hospitalization-associated disability "she was probably able to ambulate, but I'm not sure". Journal of the American Medical Association, 306 (16), 1782-1793. doi:10.1001/jama.2011.1556Fisher, S. R., Kuo, Y. F., Graham, J. E., Ottenbacher, K. J., Ostir, G. V., & Y. F. (2010). Early ambulation and length of stay in older adults hospitalized for acute illness. Archives of Internal Medicine, 170 (22), 1942-1943. doi:10.1001/archinternmed.2010.422Graf, C. M. (2006). Functional decline in hopsitalized older adults. American Journal of Nursing, 106 (1), 58-67.Inouye, S., Brown, C., & Tinetti, M. (2009). Medicare nonpayment, hospital falls, and unintended consequences. New England Journal of Medicine, 360 (23), 2390-2393. doi:10.1056/NEJMp0900963Moorhouse, P. K., & Rockwood, K. (2012). Function and frailty: the cornerstones of geriatric assessment. In J. M. Holroyd-Leduc, & M. M. Reddy (Eds.), Evidence-Based Geriatric Medicine: A Practical Clinical Guide (pp. 1-12). Oxford: Blackwell Publishing, Ltd. doi:10.1002/978118281796/ch1Rukstele, C. D., & Gagnon, M. M. (2013). Making strides in preventing ICU-acquired weakness. Involving family in early progressive mobility. Critical Care Nursing Quarterly, 36 (1), 141-147. doi: 1007.CNQ0b013e31827539cc

ReferencesTucker, D., Molsberger, S. C., & Clark, A. (2004). Walking for wellness: A collaborative program to maintain mobility in

hospitalized older adults. Geriatric Nursing, 25 (4), 242-245.

Wojciechowski, M. (2012, May). PTs developing innovative delivery care models. PT in motion. Retrieved from http://www.apta.org/PTinMotion/2012/5/Feature/InnovativeCareDeliveryModels/

Zisberg, A., Shadmi, E., Sinoff, G., Gur-Yaish, N., & Admi, H. (2011). Low mobililty during hospitalization and functional decline in older adults. Journal of the American Geriatric Society, 59 (2), 266-273. doi:10.111/j.1532-5415.2010.03276.x

 

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QUESTIONS?

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