Background: Despite 80 years of documentation of the “evil sequellae”(1) of immobility for inpatients, lack of ambulation remains prevalent and deleterious. Hospitalized patients have been shown to spend an average of 83% of their stay in bed(2), leading to complications including loss of independence in activities of daily living, higher rates of discharge to facility, worsening length of stay, and increased mortality(3). A review paper by Covinsky, et al. carried the subtitle, “She was probably able to ambulate, I’m not sure.”(4) This highlights the lack of knowledge of a patient’s ambulatory capacity or achieved ambulation as a driver of immobility harm.
Purpose: We aimed to institute a culture of mobility at our academic medical center through a stepwise approach that included standardized daily mobility assessment, implementation of an interprofessional mobility curriculum, and utilization of health professional students to increase our hospital interprofessional workforce capability to mobilize hospitalized patients.
Description: Step 1 of our hospital-wide mobility project was to implement daily nursing evaluation and documentation of mobility using the validated Activity Measure for Post-Acute Care (AMPAC) 6-clicks assessment. During Step 2, we launched a health professional student education curriculum designed to train and empower physical therapy and occupational therapy students to mobilize patients with AMPAC >17 on a pilot nursing unit. Step 3 focused on identifying a target patient population that would most benefit from additional ambulation with measurement of distance ambulated.From September 2023 to April 2024, there were 5781 unique adult hospitalizations with initial AMPAC score >17. Of these, at least one AMPAC score was documented on 87% of hospital patient-days (35,687/41,031) indicating adherence to the AMPAC 6-clicks initiative. During Step 2, our interprofessional health profession education curriculum was provided to 12 students in the College of Health Professions. After successful completion of the curriculum with confirmation of the ability to safely mobilize patients by a physical therapist, the students performed 503 ambulation events with 0 reported falls in the two-month pilot. Lastly, in our target population of patients with an AMPAC >17, we assessed documentation of distance ambulated and found ambulation was only documented 3.8% of the time suggesting significant opportunity for improvement.
Conclusions: Our multi-staged mobility quality improvement project demonstrated excellent uptake of mobility evaluation via AMPAC 6-clicks and the ability to empower health professional students to safely increase an interprofessional team of mobilizers. Recording distance ambulated remains an opportunity for improvement. Based on our preliminary analyses, we hypothesize ambulation initiatives similar to our quality improvement project can be implemented at other hospitals.