Promoting mobility and reducing length of stay in hospitalized general medicine patients: A quality-improvement project

Erik Hans Hoyer, Michael Friedman, Annette Lavezza, Kathleen Wagner-Kosmakos, Robin Lewis-Cherry, Judy L. Skolnik, Sherrie P. Byers, Levan Atanelov, Elizabeth Ann Colantuoni, Daniel Brotman, Dale Needham

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: To determine whether a multidisciplinary mobility promotion quality-improvement (QI) project would increase patient mobility and reduce hospital length of stay (LOS). PATIENTS AND METHODS: Implemented using a structured QI model, the project took place between March 1, 2013 and March 1, 2014 on 2 general medicine units in a large academic medical center. There were 3352 patients admitted during the QI project period. The Johns Hopkins Highest Level of Mobility (JH-HLM) scale, an 8-point ordinal scale ranging from bed rest (score = 1) to ambulating ≥250 feet (score = 8), was used to quantify mobility. Changes in JH-HLM scores were compared for the first 4 months of the project (ramp-up phase) versus 4 months after project completion (post-QI phase) using generalized estimating equations. We compared the relative change in median LOS for the project months versus 12 months prior among the QI units, using multivariable linear regression analysis adjusting for 7 demographic and clinically relevant variables. RESULTS: Comparing the ramp-up versus post-QI phases, patients reaching JH-HLM's ambulation status increased from 43% to 70% (P <0.001), and patients with improved JH-HLM mobility scores between admission and discharge increased from 32% to 45% (P <0.001). For all patients, the QI project was associated with an adjusted median LOS reduction of 0.40 (95% confidence interval [CI]: -0.57 to -0.21, P7 days), were associated with a significantly greater adjusted median reduction in LOS of 1.11 (95% CI: -1.53 to -0.65, P <0.001) days. Increased mobility was not associated with an increase in injurious falls compared to 12 months prior on the QI units (P = 0.73). CONCLUSIONS AND RELEVANCE: Active prevention of a decline in physical function that commonly occurs during hospitalization may be achieved with a structured QI approach. In an adult medicine population, our QI project was associated with improved mobility, and this may have contributed to a reduction in LOS, particularly for more complex patients with longer expected hospital stay.

Original languageEnglish (US)
Pages (from-to)341-347
Number of pages7
JournalJournal of Hospital Medicine
Volume11
Issue number5
DOIs
StatePublished - May 1 2016

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Quality Improvement
Length of Stay
Medicine
Architectural Accessibility
Confidence Intervals
Bed Rest
Walking
Linear Models
Hospitalization
Regression Analysis
Demography

ASJC Scopus subject areas

  • Health Policy
  • Assessment and Diagnosis
  • Care Planning
  • Fundamentals and skills
  • Leadership and Management

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Promoting mobility and reducing length of stay in hospitalized general medicine patients : A quality-improvement project. / Hoyer, Erik Hans; Friedman, Michael; Lavezza, Annette; Wagner-Kosmakos, Kathleen; Lewis-Cherry, Robin; Skolnik, Judy L.; Byers, Sherrie P.; Atanelov, Levan; Colantuoni, Elizabeth Ann; Brotman, Daniel; Needham, Dale.

In: Journal of Hospital Medicine, Vol. 11, No. 5, 01.05.2016, p. 341-347.

Research output: Contribution to journalArticle

Hoyer, Erik Hans ; Friedman, Michael ; Lavezza, Annette ; Wagner-Kosmakos, Kathleen ; Lewis-Cherry, Robin ; Skolnik, Judy L. ; Byers, Sherrie P. ; Atanelov, Levan ; Colantuoni, Elizabeth Ann ; Brotman, Daniel ; Needham, Dale. / Promoting mobility and reducing length of stay in hospitalized general medicine patients : A quality-improvement project. In: Journal of Hospital Medicine. 2016 ; Vol. 11, No. 5. pp. 341-347.
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AU - Friedman, Michael

AU - Lavezza, Annette

AU - Wagner-Kosmakos, Kathleen

AU - Lewis-Cherry, Robin

AU - Skolnik, Judy L.

AU - Byers, Sherrie P.

AU - Atanelov, Levan

AU - Colantuoni, Elizabeth Ann

AU - Brotman, Daniel

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N2 - OBJECTIVE: To determine whether a multidisciplinary mobility promotion quality-improvement (QI) project would increase patient mobility and reduce hospital length of stay (LOS). PATIENTS AND METHODS: Implemented using a structured QI model, the project took place between March 1, 2013 and March 1, 2014 on 2 general medicine units in a large academic medical center. There were 3352 patients admitted during the QI project period. The Johns Hopkins Highest Level of Mobility (JH-HLM) scale, an 8-point ordinal scale ranging from bed rest (score = 1) to ambulating ≥250 feet (score = 8), was used to quantify mobility. Changes in JH-HLM scores were compared for the first 4 months of the project (ramp-up phase) versus 4 months after project completion (post-QI phase) using generalized estimating equations. We compared the relative change in median LOS for the project months versus 12 months prior among the QI units, using multivariable linear regression analysis adjusting for 7 demographic and clinically relevant variables. RESULTS: Comparing the ramp-up versus post-QI phases, patients reaching JH-HLM's ambulation status increased from 43% to 70% (P <0.001), and patients with improved JH-HLM mobility scores between admission and discharge increased from 32% to 45% (P <0.001). For all patients, the QI project was associated with an adjusted median LOS reduction of 0.40 (95% confidence interval [CI]: -0.57 to -0.21, P7 days), were associated with a significantly greater adjusted median reduction in LOS of 1.11 (95% CI: -1.53 to -0.65, P <0.001) days. Increased mobility was not associated with an increase in injurious falls compared to 12 months prior on the QI units (P = 0.73). CONCLUSIONS AND RELEVANCE: Active prevention of a decline in physical function that commonly occurs during hospitalization may be achieved with a structured QI approach. In an adult medicine population, our QI project was associated with improved mobility, and this may have contributed to a reduction in LOS, particularly for more complex patients with longer expected hospital stay.

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