Background:
It is widely accepted that hospitalized patients warrant risk assessment for venous thromboembolism (VTE) upon hospital admission. Although many VTE risk assessment models include a patient mobility element for calculating risk, a standardized method of determining mobility is lacking. We sought to determine if physician assessment of anticipated patient mobility upon hospital admission using the Padua risk assessment model correlates with a widely used nursing assessment of mobility – the activity component of the Braden Scale.
Methods:
The Michigan Hospital Medicine Safety Consortium is a multihospital quality collaborative that assessed VTE risk and prophylaxis strategies among medical patients in 52 Michigan hospitals. Trained abstractors at 3 of the participating hospitals collected patient mobility data for a sample of hospitalized medical patients from September to November 2015. Patients were excluded if they were: <18 years of age; pregnant; admitted for VTE, surgery, or comfort care; or directly admitted to the ICU. Data collection included all documented Braden scores for the first two days of hospitalization from nurses, and a mobility assessment (as determined by assignment of “immobility points”) in the Padua risk assessment model from physicians. The Braden Scale is scored by the patient’s nurse via direct observation and includes four categories of mobility: 1) bedfast; 2) chairfast; 3) walks occasionally; and 4) walks frequently. The Padua risk score is assigned on admission and defines immobility as anticipated bedrest with bathroom privileges for at least 3 days, and is scored in a dichotomous manner. For this analysis, the definition of nurse observed immobility included only Braden scores of 1 and 2, as well as a more liberal definition of scores of 1, 2, or 3. The proportions of overall agreement, as well as positive agreement (the probability that both physician and nurse assess the patient as immobile) and negative agreement (the probability that both assess the patient as not immobile) were computed.
Results:
A total of 330 patients had data abstracted for mobility as determined by the admitting physician using the Padua risk assessment model, and by nursing using the Braden Scale. When nursing assessment of immobility was defined as Braden scores of only 1 or 2 on hospital days 1 and 2, agreement was as follows: overall, 72.1%; positive, 45.2%; negative, 81.3%. When a more liberal nursing assessment of immobility was used, defined as Braden scores of only 1, 2, or 3, agreement was as follows: overall, 53.6%; positive, 50.2%; negative, 56.7%.
Conclusions:
Overall, there was limited agreement between physicians and nurses for mobility assessment in medical patients upon hospital admission. More specifically, the physician’s assessment of anticipated immobility, as required by the Padua risk scoring system, was often inconsistent with nursing assessment of observed immobility using the Braden Scale. A more standardized method to determine a patient’s mobility is needed to allow for optimal VTE risk assessment.