To facilitate interdisciplinary collaboration targeting specific quality improvement (QI) and patient safety goals, the Armstrong Institute of Johns Hopkins Medicine has facilitated development of “clinical communities”—interdisciplinary groups of clinicians and administrators from across the health system with a shared interest in a specific patient type or clinical issue. Within this framework, the hospitalist clinical community was formed to bring together clinicians from five academic and community hospitals with the goal of improving outcomes for hospitalized medical patients in a cost efficient manner. There was consensus that suboptimal inpatient mobility with associated deconditioning was likely contributing to longer lengths of stay, more readmissions, and worse patient outcomes. Given preliminary success (feasibility and sustainability) of a nurse-driven early mobility program initiated at Johns Hopkins Hospital, the group sought to disseminate similar early mobility programs across the health system via mentored implementation.
To show the approach of using a hospitalist clinical community model to disseminate early mobility QI research across multiple acute care settings.
A structured QI model used to develop a nurse-driven early mobility framework was disseminated across three of the sites participating in the hospitalist clinical community, and included key elements such as: 1) systematically assessing barriers to patient mobility, 2) incorporating a daily mobility assessment tool, the Johns Hopkins Highest Level of Mobility, into electronic medical record documentation workflows, 3) conducting hands-on mobility training sessions, and 4) incorporating mobility into daily discussions during care-coordination and bedside rounds to facilitate patient and family engagement. In addition to site-specific QI meetings, there were hospitalist community meetings to discuss outcomes, barriers, and strategies for improvement. This community also helped to support development of an analytics platform to generate reports on performance metrics related to patient mobility. Results supporting adoption of the early mobility QI framework in the project sites is evidenced by increased proportion of patients reaching ambulation status on a daily basis (Early QI phase: 44%, versus Late QI phase: 64%, p<0.001). The QI units were associated with a median LOS reduction of 0.28 days compared to 12 months prior to project initiation (p<0.001). Compared to 12 months prior, one community hospital site has seen a reduction in 30-day readmissions from 27% on the QI unit (compared to 9% in the rest of the hospital; difference in differences, p=0.09).
Use of a hospitalist clinical community has been an effective approach to disseminate early mobility QI research across multiple sites at our institution, and should be evaluated as a model to disseminate other QI efforts to improve value of hospitalist services.