December 2, 2015
Erik Hoyer works with physical therapist Jessalyn Ciampa. As the result of a quality improvement project, the number of consultations therapists had with patients who were not functionally impaired decreased from 14 to 6.6 percent.
Patients who are active and walking while in the hospital have better outcomes, so the question is, how do we get people moving?” says Johns Hopkins physiatrist Erik Hoyer. “Sometimes the first answer that springs to mind is to get therapy involved—but that’s a limited resource.”
In fact, a previous study by Hoyer showed that 14 percent of initial therapy consultations in the hospital’s neurology unit were with patients who did not have any functional impairment. To decrease the number of patients being seen for therapy when there is no functional impairment, Hoyer and a multidisciplinary team at The Johns Hopkins Hospital conducted a quality improvement project in the adult neurology units.
The team—including nurse managers, bedside nurses, neurologists such as John Probasco, rehabilitation therapists such as Annette Lavezza and physical therapy director Michael Friedman—addressed the language barrier to describe mobility across disciplines by implementing a common lexicon to describe physical function.
“When clinicians document patients’ function, it may not be clear whether a rehabilitation therapy consultation is needed,” says Hoyer. “They might write: ‘patient out of bed.’ But other clinicians don’t know how to quantify that.”
The project incorporated the Activity Measure for Post-Acute Care (AM-PAC) to assess basic mobility and limitations with performing daily activities. Nurses assessed patients and communicated the amount of assistance a patient needed with activities based on the AM-PAC. If a patient had no functional impairments but had orders for a consultation with rehabilitation therapy, the nurse could contact the physician and the rehabilitation therapy team to consider canceling the order.
As a result, the number of consultations therapists had with patients who were not functionally impaired decreased from 14 percent to 6.6 percent.
Because the therapists saw less-impaired patients less frequently, they were able to see functionally impaired patients more frequently. “Using a common tool helps to frame conversations about mobility in a hospital setting,” says Hoyer. “We want to set goals for patients, and, using a common language, we can do that.”
Since implementing AM-PAC to communicate about patient mobility, the team has been working on using the scores to inform therapy activities to maintain or increase patients’ highest level of mobility. Adapted from a mobility scoring scale from the intensive care unit of The Johns Hopkins Hospital, the team customized a new tool to prescribe activities for patients based on their AM-PAC scores.
“Compared with other functional assessment tools, it doesn’t take long—only about a minute—and can be incorporated into a clinician’s workflow,” says Hoyer. “It’s easy to use and doesn’t require a lot of training.”
A new tool prescribes activities for patients based on their AM-PAC scores.