From the 2023 HVPA National Conference
Jeremy Barner DPT, Graduate (UNC Health), Emily Hoke MHA, Graduate
Patient activity and mobilization is a critical component of healing and recovery. After identifying resource limitations that impacted daily activity opportunities in a large university hospital, a team of entry-level patient care support personnel was created to facilitate increased patient mobilization on selected target units and physician service lines. The development and implementation of the Rehab Mobility Team (RMT) at UNC Hospitals serves as a prime example of an innovative improvement effort. Using a new approach to solve an age-old problem, this novel pilot program united the multidisciplinary team around a central goal of improving throughput by increasing patient activity during hospitalization. This is a demonstration of adaptation in a complex hospital environment where a breakthrough was achieved by redesigning the way our team collectively cares for our patients. We believe others face similar challenges and sharing this experience may provide valuable insight to potential solutions.
The primary objective was to observe a reduction in length of stay (LOS) by increasing the frequency of mobility opportunities and successful encounters for hospitalized patients.
The RMT received specific training on patient mobilization by licensed physical and occupational therapists. These individuals were deployed to target nursing units and physician service lines to focus on tasks related to activity and mobilization. Using a PDSA approach, workflows were revised to maximize opportunities for patient encounters and individual coaching was conducted to improve the rate of successful encounters. Process measures included: number of attempted encounters, number of successful encounters, staff satisfaction, and patient satisfaction.
Patients on target units and services paired with the RMT experienced a reduction in LOS by 0.3 days. Patients on the same services cared for on units without the RMT experienced an increase in LOS by 0.4 days. The RMT has added an average of 300 activity or mobilization opportunities per week across approximately 80 beds. Nursing staff and patients report high rates of satisfaction with the program.
Embedding support staff with specific mobility training reduces barriers to activity and mobilization, including task prioritization and efficiency. The RMT is most effective on units with lower acuity where skilled mobilization is needed with less frequency (such as Occupational or Physical Therapy). Creating this role has also provided a critical access point for individuals interested in pursuing healthcare careers to gain experience and exposure to the hospital setting.
The deployment if the RMT improved day-to-day consistency of patient mobilization, independent to the staffing challenges of nursing. This allowed patients to meet Enhanced Recovery After Surgery (ERAS) milestones at a greater frequency, improved early identification of skilled physical or occupational therapy needs, and increased patient safety via the accompaniment of a trained staff member. Subjective reports from patients demonstrate increased satisfaction during their admission, citing a benefit from regular contact with a staff member outside of medical interventions.