Background: Over 35 million patients are hospitalized annually in the United States, with patients experiencing functional deconditioning due to acute illness and hospital acquired limitations on their mobility such as bed rest orders and lack of timely assessment of their functional status. Other contributing factors include medical devices such as chest tubes, drains, IV lines, limited availability of mechanical devices and staff resources in the hospital. Functional deconditioning leads to impairment in basic activities of daily living (ADL), increase in utilization of hospital resources (i.e. physical therapy) with negative impact on patient experience and hospital throughput. Studies (cite) have shown that early patient mobilization reduces length of stay (LOS), costs and improves patient’s physical, psychological outcomes and overall satisfaction.
Purpose: Our Early Ambulation Program aimed to assess the impact of an early patient ambulation on the number of falls, hospital LOS, disposition and utilization of home care services on a 40 bed medical surgical unit at a quaternary hospital.
Description: The Early Ambulation Program was comprised of the unit patient care associate (PCA) champions, physical therapists, nurses and the lead hospitalist. Patients over the age of 19 who were able to ambulate safely with or without an assistive device were included in the program. If a medical assistive device was required, the patient brought their own or the device was loaned by the physical therapy department. Patient who were bedbound, required more than 1 person assist to safely ambulate, or those with non-weight bearing status and acute fractures were excluded. The nurse assessed the patient’s functional status using the “6-Clicks” validated scoring system and any prospective patients were subsequently identified during our daily interdisciplinary rounds (IDR) led by the lead hospitalist. The unit PCA champions were trained by physical therapists on the safety and use of ambulation assistive devices. They were then responsible for assisting other unit PCAs to walk 1 to 2 patients per shift during day and night. Each encounter was recorded in a log and monitored by the unit nurse manager to ensure compliance with the program.
Conclusions: 769 patient ambulation encounters were recorded over an 8 month period and data was compared to the same time period one year prior. Length of stay did not change from an average of 4.6 days to 4.5 days. Discharge to Subacute rehab reduced from 13% to 11%, home care utilization decreased from 22% to 17% and the percentage of patients who went home independently increased from 53% to 56%. Unit level falls also reduced significantly from 13 to 2. There is established evidence that patient mobilization reduces LOS and hospital costs which improves patient satisfaction and physical and psychological outcomes. Our study adds to this body of literature suggesting that an early ambulation program can reduce unit level falls, increase the amount of patients who are able to return home independently and reduces the amount of home care and subacute rehab utilization.