Implementing an Activity and Mobility Promotion Approach to Improve Patient Mobility.

Abstract

Background: A decline in patient mobility is a common occurrence following hospital admission, even with short, uncomplicated stays. Low mobility is known to result in a variety of adverse outcomes, including functional decline, especially for the vulnerable older population.

Purpose: Strategies to promote mobility in hospitalized patients are crucial to improving outcomes and reducing associated costs. The aim of this quality improvement project was to implement the Johns Hopkins Activity and Mobility Promotion (JH-AMP) program at a large safety-net hospital, assess the feasibility of implementing this program, and examine the preliminary impact of the program on patient mobility.

Methods: A pre- and postimplementation design was used on medical and surgical units, and in ICUs. The JH-AMP program was implemented using eight key strategies based on the Translating Research into Practice implementation science framework. The intervention was designed to provide all patients with a daily mobility goal during their stay in the hospital and ensure that frontline staff utilized this goal as a metric to move patients every day. Measures of mobility capacity and performance, the Activity Measure for Post-Acute Care "6-Clicks" Short Form (AM-PAC) and the Johns Hopkins Highest Level of Mobility (JH-HLM) scale, were integrated into the electronic health record to facilitate generation of a mobility goal. An iterative process was used to improve the thematic analysis of qualitative focus group discussions. Within-group comparisons of JH-HLM scores were performed for all units before and after implementation of the JH-AMP program using Mann-Whitney U tests.

Results: Following program implementation, the frequency of patients scoring 4 (transfer to a chair) or higher on the JH-HLM scale was significantly greater compared to baseline (z = 2.02, P = 0.043). Similarly, all units demonstrated a significant decrease in the proportion of patients scoring 1 (lying in bed) compared to baseline (z = 2.03, P = 0.031).

Conclusion: Large-scale, hospital-wide implementation of an activity and mobility promotion program is feasible when performed systematically and can significantly reduce hospital immobility.