Author ORCID Identifier

https://orcid.org/0000-0003-1422-0867

Year of Publication

2018

Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation

College

Health Sciences

Department

Rehabilitation Sciences

First Advisor

Dr. Esther Dupont-Versteegden

Second Advisor

Dr. Dana Howell

Abstract

Early mobility quality improvement (QI) projects are leading the charge to shift the prevailing culture in acute care from a culture of immobility to a culture of mobility. Low mobility and hospital acquired functional decline is a persistent problem, especially for older adults, often leading to increased post acute care costs, increased risk of hospital readmission and increased mortality. Transition of care programs designed to improve care transitions and prevent hospital readmission exist but fail to include rehabilitation professionals or to adequately consider patient functional status during hospitalization. The goal of this research was to implement and evaluate an early mobility quality improvement (QI) project that added a physical therapist and mobility technician to an existing transition of care program (Project BOOST) to increase adult patients mobility and level of physical activity during hospitalization, using both quantitative and qualitative methods. The project was implemented from August 2, 2016 to February 4, 2017. A physical therapist rounded with one of two Project BOOST teams to promote increased patient mobility performed with a mobility technician daily. The physical therapist also recommended rehabilitation consultations (physical and occupational therapy) for appropriate patients. The AM-PAC “6 Clicks” Basic Mobility Short Form was used to set mobility tier levels for intervention group patients. Quantitative evaluation used observed hospital length of stay, 30 day same hospital all-cause readmission, and change in AM-PAC score from admission to discharge as outcome measures. Results showed that observed hospital length of stay decreased 0.9 days in the intervention group and 30 day same hospital all-cause readmission decreased 4.8%. Bivariate analysis of patient observed hospital length of stay was statistically significant for intervention group patients (p=0.07) but failed to reach statistical significance for same hospital readmission in intervention group patients (p=0.18). Qualitative evaluation used a phenomenological lens to explore the context of the early mobility quality improvement project and shared experience of patients and staff members exposed to more mobility and higher levels of activity during hospitalization. Twelve participants were interviewed during implementation of the project including four patients and eight staff members (physicians, nurses and a mobility technician). One overarching theme and four supporting themes were found from the data. The essential meaning was that mobility bridged a gap in care. Staff understood the benefits of early mobility for patients. Patients expressed how important mobility was for their discharge and quality of life. Patients with greater functional independence and higher mobility level reduced nursing burden of care. When patients were consistently presented with opportunities to be mobile and active during acute illness, they expected mobility to be a part of their daily care plan. This comprehensive evaluation of an early mobility quality improvement project found the intervention bridged a gap in care for patients. Adding a physical therapist to the Project BOOST team and promoting patient mobility during hospitalization resulted in improved patient outcomes. Early mobility quality improvement projects have the potential to transform clinical practice and improve quality of care.

Digital Object Identifier (DOI)

https://doi.org/10.13023/ETD.2018.011

Available for download on Tuesday, January 08, 2019

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