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Background: Greater mobility and activity among hospitalized patients has been linked to key outcomes, including decreased length of stay, increased odds of home discharge, and fewer hospital-acquired morbidities. Systematic approaches to increasing patient mobility and activity are needed to improve patient outcomes during and following hospitalization. Problem: While studies have found the Johns Hopkins Activity and Mobility Promotion (JH-AMP) program improves patient mobility and associated outcomes, program details and implementation methods are not published. Approach: JH-AMP is a systematic approach that includes 8 steps, described in this article: (1) organizational prioritization; (2) systematic measurement and daily mobility goal; (3) barrier mitigation; (4) local interdisciplinary roles; (5) sustainable education and training; (6) workflow integration; (7) data feedback; and (8) promotion and awareness. Conclusions: Hospitals and health care systems can use this information to guide implementation of JH-AMP at their institutions. [ABSTRACT FROM AUTHOR]

Purpose: Early mobilization in the intensive care unit (ICU) can improve patient outcomes but has perceived barriers to implementation. As part of an ongoing structured quality improvement project to increase mobilization of medical ICU patients by nurses and clinical technicians, we adapted the existing, validated Patient Mobilization Attitudes & Beliefs Survey (PMABS) for the ICU setting and evaluated its performance characteristics and results. Materials and Methods: The 26-item PMABS adapted for the ICU (PMABS-ICU) was administered as an online survey to 163 nurses, clinical technicians, respiratory therapists, attending and fellow physicians, nurse practitioners, and physician assistants in one medical ICU. We evaluated the overall and subscale (knowledge, attitude, and behavior) scores and compared these scores by respondent characteristics (clinical role and years of work experience). Results: The survey response rate was 96% (155/163). The survey demonstrated acceptable discriminant validity and acceptable internal consistency for the overall scale (Cronbach a: 0.82, 95% confidence interval: 0.76-0.85), with weaker internal consistency for all subscales (Cronbach a: 0.62-0.69). Across all respondent groups, the overall barrier score (range: 1-100) was relatively low, with attending physicians perceiving the lowest barriers (median [interquartile range]: 30 [28-34]) and nurses perceiving the highest (37 [31-40]). Within the first 10 years of work experience, greater experience was associated with a lower overall barrier score (-0.8 for each additional year; P = 0.02). Conclusions: In our medical ICU, across 6 different clinical roles, there were relatively low perceived barriers to patient mobility, with greater work experience over the first 10 years being associated with lower perceived barriers. As part of a structured quality improvement project, the PMABSICU may be valuable in assisting to identify specific perceived barriers for consideration in designing mobility interventions for the ICU setting. [ABSTRACT FROM AUTHOR]

Aim: Characterize the relationship between patient ambulatory status and in‐hospital call bell use. Background: Although call bells are frequently used by patients to request help, the relationship between physical functioning and call bell use has not been evaluated. Methods: Retrospective cohort study of 944 neuroscience patients hospitalized in a large academic urban medical centre between April 1, 2014 and August 1, 2014. We conducted multiple linear regression analyses with number of daily call bells from each patient as the primary outcome and patients' average ambulation status as the primary exposure variable. Results: The mean number of daily call bell requests for all patients was 6.9 (6.1), for ambulatory patients 5.6 (4.8), and for non‐ambulatory patients, it was 7.7 (6.6). Compared with non‐ambulatory patients, ambulatory patients had a mean reduction in call bell use by 1.7 (95% CI 2.5 to −0.93, p <.001) calls per day. In a post hoc analysis, patients who could walk >250 feet had 5 fewer daily call bells than patients who were able to perform in‐bed mobility. Conclusion: Ambulatory patients use their call bells less frequently than non‐ambulatory patients. Implications for Nursing Management: Frequent use of call bells by non‐ambulatory patients can place additional demands on nursing staff; patient mobility status should be considered in nurse workload/patient assignment. [ABSTRACT FROM AUTHOR]

Aim: To characterize resources to safely mobilize different types of hospitalized patients. Background: Current approaches to determine nurse–patient ratios do not always include information regarding the specific demands of patients who require extra resources to mobilize. Workflows must be designed with knowledge of resource requirements to integrate patient mobility into the daily nursing team care plan. Methods: Nurse‐led mobility sessions were evaluated on two adult hospital units, which consisted of nurse–patient encounters focused on patient mobility only. The resources assessed for each session were time‐to‐mobilize patient, time‐to‐document, need for additional staff support, and the need for assistive devices. Mobility sessions were also categorized by patient ambulation status, level of mobility limitations (low, medium and high) and diagnosis. Results: In 212 total mobility sessions, the median time‐to‐mobilize and time‐to‐document were 7.75 and 1.27 min, respectively. Additional staff support was required for 87% and 92% of patients with medium and high mobility limitations, respectively. All patients with low mobility limitations ambulated, and only 14% required additional staff. Ambulating patients with high mobility limitations was the most time‐intensive (median 12.55 min). Ambulating stroke patients required one additional staff and an assistive device in 92% and 69% of the sessions, respectively. Conclusion: This study describes the resources associated with mobilizing inpatients with different levels of mobility impairments and diagnoses. Implications for Nursing Management: These results could assist nursing management with facilitating appropriate daily nurse–patient ratios and justify the need for assistive devices and staff support to safely mobilize patients. [ABSTRACT FROM AUTHOR]

Background: Hospital performance on the 30-day hospital-wide readmission (HWR) metric as calculated by the Centers for Medicare and Medicaid Services (CMS) is currently reported as a quality measure. Focusing on patient-level factors may provide an incomplete picture of readmission risk at the hospital level to explain variations in hospital readmission rates.Objective: To evaluate and quantify hospital-level characteristics that track with hospital performance on the current HWR metric.Design: Retrospective cohort study.Setting/patients: A total of 4785 US hospitals.Metrics: We linked publically available data on individual hospitals published by CMS on patient-level adjusted 30-day HWR rates from July 1, 2011, through June 30, 2014, to the 2014 American Hospital Association annual survey. Primary outcome was performance in the worst CMS-calculated HWR quartile. Primary hospital-level exposure variables were defined as: size (total number of beds), safety net status (top quartile of disproportionate share), academic status [member of the Association of American Medical Colleges (AAMC)], National Cancer Institute Comprehensive Cancer Center (NCI-CCC) status, and hospital services offered (e.g., transplant, hospice, emergency department). Multilevel regression was used to evaluate the association between 30-day HWR and the hospital-level factors.Results: Hospital-level characteristics significantly associated with performing in the worst CMS-calculated HWR quartile included: safety net status [adjusted odds ratio (aOR) 1.99, 95% confidence interval (95% CI) 1.61-2.45, p < 0.001], large size (> 400 beds, aOR 1.42, 95% CI 1.07-1.90, p = 0.016), AAMC alone status (aOR 1.95, 95% CI 1.35-2.83, p < 0.001), and AAMC plus NCI-CCC status (aOR 5.16, 95% CI 2.58-10.31, p < 0.001). Hospitals with more critical care beds (aOR 1.26, 95% CI 1.02-1.56, p = 0.033), those with transplant services (aOR 2.80, 95% CI 1.48-5.31,p = 0.001), and those with emergency room services (aOR 3.37, 95% CI 1.12-10.15, p = 0.031) demonstrated significantly worse HWR performance. Hospice service (aOR 0.64, 95% CI 0.50-0.82, p < 0.001) and having a higher proportion of total discharges being surgical cases (aOR 0.62, 95% CI 0.50-0.76, p < 0.001) were associated with better performance.Limitation: The study approach was not intended to be an alternate readmission metric to compete with the existing CMS metric, which would require a re-examination of patient-level data combined with hospital-level data.Conclusion: A number of hospital-level characteristics (such as academic tertiary care center status) were significantly associated with worse performance on the CMS-calculated HWR metric, which may have important health policy implications. Until the reasons for readmission variability can be addressed, reporting the current HWR metric as an indicator of hospital quality should be reevaluated. [ABSTRACT FROM AUTHOR]