April 1, 2014
“Erik Hoyer crafted this puzzle graphic to show how activity promotion intersects many aspects of care. “The time is now,” he says, “for mobility initiatives.””
It’s now well-known that promoting even minimal mobility early to patients in intensive care units brings better outcomes. Indeed, Johns Hopkins Medicine’s hospitals have embraced the practice, with impressive results. So why not apply the same principle to all hospital patients?
Erik Hoyer, deputy director for patient safety in the Department of Physical Medicine and Rehabilitation and a member of Johns Hopkins’ Armstrong Institute for Patient Safety, is doing just that through a project called activity and mobility promotion (AMP). The program, which is being piloted on two non-ICU inpatient units at The Johns Hopkins Hospital, aims to get people out of bed at least three times a day from the outset of their care.
Most hospitalized patients, says Hoyer, spend the bulk of their time in bed, which has been linked to mortality and complications. “There’s undeniable evidence that mobile people are much less likely to suffer harm from pressure ulcers, deep vein thrombosis and, falls,” he says.
Since the AMP project launched last February, Hoyer has already seen a strong relationship between patient function and lower rates of readmission.
To track progress, Hoyer and his team created an eight-point mobility scale in which 1 means the patient is lying in bed and 8 means the patient can walk 250 feet. The team also incorporated a daily huddle to review the “ABC’s” on each patient: A, for activity; B, for barriers; and C, for continue to progress mobility.
Key is buy-in from nurses and doctors involved in patient care. Among the barriers they have identified is the perception that patients are too sick to be mobilized. Nurses report being uncomfortable moving patients, citing a lack of proper equipment or adequate training.
Another hurdle, says Hoyer, is that most caregivers believe that physical therapists should take the lead, but there aren’t enough of them to move patients daily. So Hoyer is creating educational materials to pinpoint “who the right provider is at the right time to mobilize patients.” There may be a subset of patients, he says, who need only minimal assistance to be mobile, which nurses or other unit staff could provide.
“If we know the function level early on,” says Hoyer, “we can predict length of stay and the resources a patient needs to do well at home.” Patients appear to agree. On a recent Press-Ganey survey, patients said they were encouraged to get out of bed and to use a toilet or commode instead of a bedpan, which also enhanced patients’ dignity.
Patient function and mobility, says Hoyer, touch all medical disciplines. “In the past, the role of PM&R may not have been as well-understood. Now we’re at the forefront in helping to reduce readmissions and other preventable harms in the acute hospital setting.”