Kate E Klein1, James F Bena2, Malissa Mulkey3, Nancy M Albert4. 1. Cleveland Clinic, 9500 Euclid Avenue, Mail Code G20, Cleveland, OH 44195, USA. Electronic address: keklein@novanthealth.org. 2. Cleveland Clinic Health System, Quantitative Health Sciences, 9500 Euclid Avenue, Mail Code JJN3-01, Cleveland, OH 44195, USA. Electronic address: benaj@ccf.org. 3. Duke University Hospital, DUMC 3677, Mail Code DN Rm 4142, Durham, NC 27708, USA. Electronic address: malissa.mulkey@duke.edu. 4. Cleveland Clinic Health System, Office of Nursing Research and Innovation, 9500 Euclid Avenue, Mail Code J3-4, Cleveland, OH 44195, USA. Electronic address: albertn@ccf.org.
Abstract
OBJECTIVES: To determine sustainable impact of an early progressive mobility protocol on mobility level and clinical outcomes. DESIGN/ METHODS: Prospective, longitudinal, comparative study using three time points (pre-, immediate post-intervention and 12-month post-intervention sustainability). Analyses included comparative statistics and multivariable modelling. Data were collected by clinical nurses, from administrative databases. Psychological health data were collected using a valid, reliable tool. SETTING: Patients treated in a 22-bed Neurological Intensive Care Unit of a quaternary-care medical centre. OUTCOME MEASURES: Highest mobility level, length of stay, mortality, discharge disposition, quality metrics and psychological profile including depression, anxiety, and hostility. RESULTS: Amongst 260 pre-intervention, 377 post-implementation, and 480 twelve-month post-implementation patients (N = 1117) walking increased post-implementation and was sustained at the eight-month assessment, p < .001. After multivariable adjustment, unit and hospital length of stay and psychological distress were reduced compared to the pre-early mobility programmes (all p < .001). There were no differences in discharge disposition (i.e., home vs skilled nursing facility), mortality or quality metrics. CONCLUSION: Ongoing implementation of an early mobility programme in a neurological intensive care environment led to sustained improvement in patients' level of mobility, length of unit and hospital stay, depression, anxiety and hostility levels.
OBJECTIVES: To determine sustainable impact of an early progressive mobility protocol on mobility level and clinical outcomes. DESIGN/ METHODS: Prospective, longitudinal, comparative study using three time points (pre-, immediate post-intervention and 12-month post-intervention sustainability). Analyses included comparative statistics and multivariable modelling. Data were collected by clinical nurses, from administrative databases. Psychological health data were collected using a valid, reliable tool. SETTING:Patients treated in a 22-bed Neurological Intensive Care Unit of a quaternary-care medical centre. OUTCOME MEASURES: Highest mobility level, length of stay, mortality, discharge disposition, quality metrics and psychological profile including depression, anxiety, and hostility. RESULTS: Amongst 260 pre-intervention, 377 post-implementation, and 480 twelve-month post-implementation patients (N = 1117) walking increased post-implementation and was sustained at the eight-month assessment, p < .001. After multivariable adjustment, unit and hospital length of stay and psychological distress were reduced compared to the pre-early mobility programmes (all p < .001). There were no differences in discharge disposition (i.e., home vs skilled nursing facility), mortality or quality metrics. CONCLUSION: Ongoing implementation of an early mobility programme in a neurological intensive care environment led to sustained improvement in patients' level of mobility, length of unit and hospital stay, depression, anxiety and hostility levels.
Authors: Emily Anne Smith Bergbower; Cole Herbst; Nan Cheng; Alexander Aversano; Katherine Pasqualini; Cierra Hartline; Devorah Hamby-Finkelstein; Colin Brewer; Stephen Benko; Joseph Fuscaldo Journal: J Community Hosp Intern Med Perspect Date: 2020-09-03