Move it or lose it: Mobility improves patient wellbeing and length of stay

By Laura Hoffman, Vizient Senior Program Director, Performance Improvement Programs

You've likely heard the expression, "Move it or lose it." There is no truer statement when talking about patient mobility. Mobilizing hospitalized patients prevents hospital-acquired disability. In the year following discharge, patients who lose the ability to perform activities of daily living during their hospitalization experience a two- and-a-half-fold increased risk of death and a two-fold increased risk of further functional decline. Studies show that mobility programs increase the rate of discharges to home and decrease length of stay.

Fifty-four hospitals participated in a recent Vizient PI Programs collaborative, Creating a Culture of Mobility. The goal was to improve processes making patient mobilization a high priority and embedding it into all aspects of patient care. The teams worked to improve mobility assessments, front-line staff engagement, including mobility during interdisciplinary rounds and patient education. The benefits of these efforts extended far beyond patients' physical wellbeing. Several collaborative participants shared that mobilization also had positive mental and emotional impacts on their patients.

Shorter length of stay

One participant's patient said, "Strengthening my body and getting mobile were major factors in my ability to be discharged sooner rather than later, and to my home, as opposed to a therapy facility."

Patients who have surgery for joint replacements spend less time in the hospital, which makes early ambulation so important. Another patient who had two knee-replacement surgeries — one pre- and the other post-mobility program implementation — noted stark differences in speediness of recovery, better pain control and less pain medication. With the second surgery, the approach to ambulation was organized and monitored more closely. The education far exceeded her prior hospitalization, and she had the opportunity to demonstrate exercises with the staff.

Emotional impact

Mobilized patients felt a strong emotional connection to the healthcare team. One patient said, "The positivity, accessibility and constant support from my healthcare team helped me progress through each step, increasing movement around the unit as appropriate and through learning new exercises. I have the utmost appreciation for the mobilization team."

For another patient, mobilization meant he could go home instead of to a rehabilitation facility following a month-long hospitalization. The mobilization team reported that "both the patient and his wife were in tears as they left the building in the car heading home instead of in a wheelchair-accessible van heading to a facility for another six weeks of rehabilitation."

Culture of mobility

Historically, nurses have relied on rehabilitation staff to assess patients prior to mobilizing them. However, implementing standardized mobility programs learned through the collaborative helped nurses feel confident assessing patients upon admission. Nurses worked together with unlicensed staff to expedite patient mobility. Helping patients succeed in reaching mobility goals resonated with hospital staff and ingrained mobility into their organizational culture.

Teams shared that personal relationships between patients, nurses and mobility technicians are growing stronger, which not only creates better teamwork leading to improved workforce, but more quality care for their patients. One team shared, "The biggest reaction has come from the nursing assistants. They see their mobility technician colleagues helping to build confidence in mobilizing patients, and they're seeking to bring mobility techniques into their own practice." Mobility technicians have been described as "The commander in chief for mobility goals."

Standardizing processes has helped to shift the culture of mobility. Teams stated that patient mobility goals are consistently incorporated into the daily interdisciplinary rounds. Now, preliminary discharge dispositions are based on nurses' mobility assessments versus waiting for physical therapy to evaluate patients, which helps reduce overall length of stay.

There are several successful strategies that can enhance patient mobility, decrease the length of stay and improve their physical and mental wellbeing:

• Obtain buy-in from patients and families and encourage family or caregiver support in mobility activities
• Adopt a nurse-driven mobility assessment tool and align patient activities with assessment findings
• Discuss mobility goals for each patient at team huddles and interdisciplinary rounds
• Collaborate between nurses, mobility technician and nurses' aides to improve role clarity and expectations

On the surface, mobility might seem trivial. But mobilizing patients has profound impacts on their mental, emotional and physical wellbeing as well as an improved organizational culture among staff who play a crucial role in teaching, encouraging, coaching and assisting patients with their mobility and long-term recovery.