title: Promoting mobility and reducing length of stay in hospitalized general medicine patients: A quality-improvement project.
abstract: To determine whether a multidisciplinary mobility promotion quality-improvement (QI) project would increase patient mobility and reduce hospital length of stay (LOS).
  
  
  
  Implemented using a structured QI model, the project took place between March 1, 2013 and March 1, 2014 on 2 general medicine units in a large academic medical center. There were 3352 patients admitted during the QI project period. The Johns Hopkins Highest Level of Mobility (JH-HLM) scale, an 8-point ordinal scale ranging from bed rest (score = 1) to ambulating ≥250 feet (score = 8), was used to quantify mobility. Changes in JH-HLM scores were compared for the first 4 months of the project (ramp-up phase) versus 4 months after project completion (post-QI phase) using generalized estimating equations. We compared the relative change in median LOS for the project months versus 12 months prior among the QI units, using multivariable linear regression analysis adjusting for 7 demographic and clinically relevant variables.
  
  
  
  Comparing the ramp-up versus post-QI phases, patients reaching JH-HLM's ambulation status increased from 43% to 70% (P < 0.001), and patients with improved JH-HLM mobility scores between admission and discharge increased from 32% to 45% (P < 0.001). For all patients, the QI project was associated with an adjusted median LOS reduction of 0.40 (95% confidence interval [CI]: -0.57 to -0.21, P < 0.001) days compared to 12 months prior. A subgroup of patients expected to have a longer LOS (expected LOS >7 days), were associated with a significantly greater adjusted median reduction in LOS of 1.11 (95% CI: -1.53 to -0.65, P < 0.001) days. Increased mobility was not associated with an increase in injurious falls compared to 12 months prior on the QI units (P = 0.73).
  
  
  
  Active prevention of a decline in physical function that commonly occurs during hospitalization may be achieved with a structured QI approach. In an adult medicine population, our QI project was associated with improved mobility, and this may have contributed to a reduction in LOS, particularly for more complex patients with longer expected hospital stay. Journal of Hospital Medicine 2016. © 2016 Society of Hospital Medicine.
authors: Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland.|Division of General Internal Medicine, Johns Hopkins University, Baltimore, Maryland.
authors: Erik H
authors: EH
authors: Hoyer
authors: Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland.|Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, Maryland.
authors: Michael
authors: M
authors: Friedman
authors: Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, Maryland.
authors: Annette
authors: A
authors: Lavezza
authors: Department of Nursing, Johns Hopkins Hospital, Baltimore, Maryland.
authors: Kathleen
authors: K
authors: Wagner-Kosmakos
authors: Department of Nursing, Johns Hopkins Hospital, Baltimore, Maryland.
authors: Robin
authors: R
authors: Lewis-Cherry
authors: Department of Nursing, Johns Hopkins Hospital, Baltimore, Maryland.
authors: Judy L
authors: JL
authors: Skolnik
authors: Department of Nursing, Johns Hopkins Hospital, Baltimore, Maryland.
authors: Sherrie P
authors: SP
authors: Byers
authors: Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland.
authors: Levan
authors: L
authors: Atanelov
authors: Department of Biostatistics, Johns Hopkins School of Public Health, Johns Hopkins University, Baltimore, Maryland.
authors: Elizabeth
authors: E
authors: Colantuoni
authors: Division of General Internal Medicine, Johns Hopkins University, Baltimore, Maryland.
authors: Daniel J
authors: DJ
authors: Brotman
authors: Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland.|Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland.
authors: Dale M
authors: DM
authors: Needham
mesh_terms: D005260:Female; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D058996:Quality Improvement; D016138:Walking / Q000706:statistics & numerical data*