Background: Many hospitalized patients spend most of their time in bed leading to increased complications. For elderly patients, hospitalization results in decreased post-hospital independence up to 1 month after discharge, which can be prevented with inpatient mobility programs. Many patients lament their inability to return home after an admission due to decreased functioning. With increasing focus on hospitals to control costs of admissions (length of stay) and post-acute care (skilled nursing facility (SNF) use), increasing inpatient mobility is a promising method to providing safer and cost-effective care. We aimed to safely increase the activity of medicine inpatients to prevent worsening and reduce existing debility, and thus facilitate more patients to return home after hospitalization.
Methods: A multidisciplinary intervention was implemented on two inpatient medicine units of an academic hospital to a) maximize the time & expertise of physical therapists (PT) and b) improve communication and training of non-PT staff to facilitate patient mobility. The Activity Measure for Post Acute Care (AMPAC) 6-clicks was completed on admission to identify those who would benefit from PT evaluation (score <20 on either Mobility or Activity scores) and limit over-use of PT due to cautious clinicians. Focused patient mobility training of non-PT staff, adoption of daily ‘mobility rounds’, and common staff terminology (Johns Hopkins Highest Level Mobility) facilitated increased mobility by non-PT staff. No additional PT resources were committed as part of pilot. Data analysis excluded patients with an ICU stay during their admission, to reduce confounding factors.
Results: During the pilot period (14 unit-months), patients discharged from the pilot inpatient units (n=1491), and non-pilot general medicine units of same hospital (n=2998) were of similar age, (mean, years: pilot 54.7, versus 57.6), gender distribution (percent female: pilot 58.3%, versus 53.2%), and length of stay (mean, days: pilot 4.65, versus 4.5). Using the AMPAC scoring, the percent of patients who were evaluated by PT was lower on the pilot units (pilot 27%, versus non-pilot 37%, p<0.01). As a result, pilot unit PTs were able to spend a greater amount of time with those patients who needed frequent treatment. On pilot units, 48% of patients received PT treatment 3 or more times per 5 days compared to 42% on non-pilot units (p<0.05). Of inpatient admissions, we noted fewer patients discharged to SNF from our pilot units (pilot 89/926, 9.6%, versus non-pilot 378/ 2137, 17.9%; p<0.001), and a small but not equal, increase in those discharged with home health services (24.7% versus 21.9% respectively). We noted no difference in frequency of falls or readmissions between these two patient cohorts.
Conclusions: Our mobility pilot program allowed for a re-allocation of the time & expertise of PTs from low-yield screening evaluations to patients with need for skilled physical therapy. This, along with enhanced training of non-PT staff, facilitated a greater number of our patients to return home after discharge. Our pilot program is limited in its single-site nature. We are currently deploying our program to non-medicine & non-teaching units at other hospitals to determine reproducibility.