Background: Increasing mobility in the hospital leads to better patient outcomes. However, published efforts to improve inpatient mobility report resulted increases in unnecessary physical/occupational therapy (PT/OT) consults. In our hospital we noted that physicians were ordering PT/OT on all patients in an effort to increase mobility. This meant very functional patients who did not need the skills of PT/OT as well as bed-bound patients who could not participate with PT/OT were all getting consults by PT/OT. This did not allow for the PT/OT skillset to focus on appropriate patients. Here, we describe a novel standardized mobility protocol with aims to increase mobility while reducing unnecessary PT/OT consults. This was addressed using five key objectives: (1) a standardized mobility assessment at admission using the Activity Measure for Post-Acute Care (AM-PAC) “6-Clicks” functional assessment tool, (2) a standard of three mobility occurrences per 24-hour period, (3) additional PT/OT consults identified through AM-PAC “6-Clicks” score for those patients who would most benefit from PT/OT, (4) continuous analysis of mobility occurrence reports, and (5) clear expectations among unit staff and PT/OT regarding interdisciplinary care team roles in mobility.
Purpose: Increase mobility protocol compliance on selected adult medicine pilot units to 75% by December 2023.
Description: This project implemented the AM-PAC “6-Clicks” functional assessment tool on admission. This is a measure which uses 6 questions to assess functional outcomes of patients. If the patient’s “6-Clicks” score is between 10 and 17 at admission, the option for the admitting nurse to consult PT/OT is triggered. Some patients are already ambulatory and will score over 17 and can have nurse-directed ambulation. Some patients are not able to participate in PT and they will score below 10 and can get nurse-assisted movement in the bed. If the patient scores outside of the protocol, they get mobility with nursing assistance. Mobility occurrences are defined based on the level of care of the unit.The protocol launched on May 10, 2023 on seven inpatient medicine units. Mobility occurrences and PT/OT consult data are auto-collected through the EPIC electronic health record and compiled into daily/monthly mobility reports. Preliminary data shows an increase in mobility compliance in June (+2.4%), followed by a decrease in July (-1.9%), an increase in August (+0.3%) and September (+1.1%), and a decrease in October (-0.5%). Mobility compliance is defined as the total number of mobility occurrences divided by the expected number of mobility occurrences. The current overall mobility compliance is 77.6%. From pre-protocol to October 2023, overall PT/OT caseloads have trended downwards (-4.6%, -4.9%). In the same timeframe, PT/OT consults placed in the emergency department upon admission (considered an unnecessary consult) have decreased by 82%. PT/OT consults placed by physicians outside of the mobility protocol have decreased by 3.2%.
Conclusions: Overall mobility compliance is meeting our stated aim, though changes in mobility compliance since protocol implementation have been minimal. In contrast, total and unnecessary PT/OT consults have seen decreases, allowing for a more focused application of skilled mobility resources. Future PDSA cycles embedding the mobility protocol into the existing workflow is expected to increase mobility events and discourage unnecessary PT/OT consults outside of the protocol.
