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Background: Using an inpatient fall risk assessment tool helps categorize patients into risk groups which can then be targeted with fall prevention strategies. While potentially important in preventing patient injury, fall risk assessment may unintentionally lead to reduced mobility among hospitalized patients. Here we examined the relationship between fall risk assessment and ambulatory status among hospitalized patients. Methods: We conducted a retrospective cohort study of consecutively admitted adult patients (n = 48,271) to a quaternary urban hospital that provides care for patients of broad socioeconomic and demographic backgrounds. Non‐ambulatory status, the primary outcome, was defined as a median Johns Hopkins Highest Level of Mobility <6 (i.e., patient walks less than 10 steps) throughout hospitalization. The primary exposure variable was the Johns Hopkins Fall Risk Assessment Tool (JHFRAT) category (Low, Moderate, High). The capacity to ambulate was assessed using the Activity Measure for Post‐Acute Care (AM‐PAC). Multivariable regression analysis controlled for clinical demographics, JHFRAT items, AM‐PAC, comorbidity count, and length of stay. Results: 8% of patients at low risk for falls were non‐ambulatory, compared to 25% and 54% of patients at moderate and high risk for falls, respectively. Patients categorized as high risk and moderate risk for falls were 4.6 (95% CI: 3.9–5.5) and 2.6 (95% CI: 2.4–2.9) times more likely to be non‐ambulatory compared to patients categorized as low risk, respectively. For patients with high ambulatory potential (AM‐PAC 18–24), those categorized as high risk for falls were 4.3 (95% CI: 3.5–5.3) times more likely to be non‐ambulatory compared to patients categorized as low risk. Conclusions: Patients categorized into higher fall risk groups had decreased mobility throughout their hospitalization, even when they had the functional capacity to ambulate. [ABSTRACT FROM AUTHOR]

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]

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]

Hoyer EH, Brotman DJ, Chan KS, Needham DM: Barriers to early mobility of hospitalized general medicine patients: survey development and results. Am J Phys Med Rehabil 201 5 ;94 :3 0 4 -3 1 2. Objective: Functional status decline commonly accompanies hospitalization making patients vulnerable to complications. Such decline can be mitigated through hospital-based early mobility programs. Success in implementing patient mobility quality improvement processes requires evaluating providers' knowledge, attitudes, and behaviors. Design: A cross-sectional, self-administered survey in two different hospital settings was completed by 1 20 nurses and physical and occupational therapists (rehabilitation therapists, 38; nurses, 82) from six general medicine units. The survey was developed using published guidelines, literature review, and provider meetings and refined through pilot testing. Psychometric properties were assessed, and regression analyses were conducted to examine barriers to early mobility by hospital site, provider discipline, and years of experience. Results: Internal consistency reliability, item consistency, and discriminant validity psychometric characteristics were acceptable. In multivariable regression analysis, overall perceived barriers were similar between the two hospitals (P = 0.25) and significantly higher for staff with less experience (P = 0.02) and for nurses vs. rehabilitation therapists (P < 0.001 ).The survey identified specific barriers common to both nurses and rehabilitation therapists and other barriers that were discipline specific. Conclusions: This novel survey identified important barriers to mobilizing medical inpatients that were similar across two hospital settings. These results can assist with the implementation of quality improvement projects for increasing early hospital-based patient mobility. [ABSTRACT FROM AUTHOR]

Objectives: A decline in functional status is common during acute care hospitalization and may make patients vulnerable to further complications. This decline can be mitigated through hospital-based early activity and mobility programs. An important component of successful activity and mobility programs is systematic documentation of patient function, which can be an important barrier to program implementation in the acute care setting. Herein, we present a new nursing-based documentation system created as part of an early activity and mobility quality improvement (QI) project. Design: This project was undertaken, using a structured QI process, on two 24-bed general medicine units in an academic hospital. Our performance measure was based on a mobility scale currently-used in the ICU setting, known as "highest level of mobility" (HLM). HLM served as a daily "vital sign" and is an ordinal scale ranging from 1 to 8 (example scores: 1 = bed rest, 6 = ambulating >10 steps, 8 = ambulating >250 feet). We present prospective data on 440 consecutive patients with a length of stay (LOS) >2 days, admitted between 3/1/2013 and 6/7/2013. We analyzed the association between the average HLM during the first 2 days of admission for each patient and our two primary outcomes, hospital LOS and discharge to home. After logarithmic transformation, LOS was analyzed using linear regression. Discharge to home was analyzed using logistic regression. These models were adjusted for 7 relevant variables (age, gender, race, marital status, payer, expected LOS, and the AHRQ comorbidity index). Results: Mean (T standard deviation) LOS was 6.9 (±5.1), with 385 (88%) patients discharged home. Compared to non-ambulatory patients (HLM <6), patients who were able to ambulate >10 steps or more (HLM ≥6) during their first two days on admission had significantly shorter mean hospital LOS (6.4 (±5.3) versus 7.4 (±4.9) days, p=0.03), and higher rates of discharge home (98% versus 77%, p<0.001). In our adjusted analysis, a 1 point increase in HML was associated with a significantly shorter LOS by 0.6 (95% CI 0.3-0.8, p<0.001) days and an increased odds of discharge to home (OR 1.8, 95% CI 1.5-2.2, p<0.001). Conclusions: When implemented within a structured QI project, nursing-based documentation of patients' physical function shortly after acute care hospital admission may be helpful in identifying general medicine patients requiring a longer length of stay and institutionalization at discharge. [ABSTRACT FROM AUTHOR]