Corona Update: SURGE CAPACITY SOLUTIONS – The mobi is a mobile headwall (equipment consolidator) that can be set up in any space that has an electrical outlet: next to a chair, a bed, a cot in a hallway, a cafeteria, or anywhere patients need to be located. Click here for more information.

Tag: reducing patient length of stay

Emotional Benefits of Early Patient Mobility

Posted on by Steve Villanueva

Emotion & Early PATIENT MOBILITY

There are many emotional benefits of early patient mobility. One critical factor in determining a patient’s capacity for early mobility is their mental state, which nurses judge on a case-by-case basis. But it turns out that early mobility can actually stimulate patients’ mental well-being and improve their emotional well-being, which immediately improves the patients’ quality of life, while reducing the serious risk of delirium and decreasing overall recovery time.    

Physical & Mental Benefits Linked

Key Facts:

ABCDEF Protocol

To improve patient outcomes and reduce hospital costs, the Society of Critical Care Medicine officially recommends that all intensive care units adopt the “ABCDEF” Protocol:

  • Assess, Prevent, and Manage Pain
  • Both Spontaneous Awakening Trials & Spontaneous Breathing Trials
  • Choice of Painkillers and Sedatives
  • Delirium: Assess, Prevent, and Manage
  • Early Mobility & Exercise
  • Family Engagement and Empowerment

Reducing Delirium in Patients

  • To decrease the incidence and duration of delirium, it is recommended that intensive care unit (ICU) staff perform early mobilization of adult patients whenever it is feasible. (Barr 2013)
  • To limit the incidence of physical, cognitive, and psychological disabilities that can result from critical illness, the Agency for Healthcare Research and Quality strongly endorses early mobilization for all patients, whenever it is feasible.
  • Early mobility decreases the occurrence, severity, and duration of delirium in patients. (Dirkes 2019, Krupp 2019, Taito 2016, Banerjee 2011, Schweickert 2009)
  • There is a very strong correlation between delirium, increased length of hospital stay, and increased chance of death in adult ICU patients. Delirium is also associated with a development of cognitive impairment after discharge from the ICU. (Barr 2013)
  • For patients who have experienced an acute stroke, early mobilization decreases the risk of depression and anxiety. (Cumming 2008)
  • While early mobility studies in pediatric units are still new, pediatrician Kristina Betters M.D. has gone on record to say: “Anecdotally, medical staff members are seeing their patients improve. Patients are less sedated and more interactive, and families are also engaging more with their children. Oftentimes parents feel helpless in the ICU, and this is one way they can help their child get better.”

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Solutions for Early Patient Mobility

Posted on by Steve Villanueva

Early Patient Ambulation: What Works Best

Solutions for early patient mobility. As far back as 1949, Dr. D.J. Leithauser wrote that: Ten years ago early ambulation was considered a “crackpot” idea. Today it is recognized and is rapidly approaching a “must” procedure following surgical operation. Seventy years later, Doctors, nurses, and administrators all agree that early patient mobility has tremendously beneficial outcomes, but making sure that early mobility happens requires resources, education, organization, and strategic coordination. How have hospitals and units successfully improved their early patient mobility rates?  The simplest answer is to increase staff numbers, but there are a variety of more cost-effective measures that have helped to dramatically improve early mobility outcomes.

Key Facts:

Improve Mobility: Equipment, Patient Awareness, Staff Efficiency, & Hospital Culture

Steps can be taken to improve efficient implementation of early mobility on all four fronts:

EQUIPMENT

  • It is important for hospitals to prioritize interventions that allow patient ambulation with less staff involvement. (Murphy 2011)
  • The use of an ambulation platform improves the number of ambulation attempts, distance of ambulation, and willingness of patients to attempt ambulation (assisted and unassisted), without increased risk of falls. (Henecke 2015)
  • The use of an IV pole walker improves both patient and nurse satisfaction during early patient mobilization of post-surgical patients. (Nesbitt 2012)

PATIENT AWARENESS & EDUCATION

  • The benefits of early mobility include better coordination and balance, as well as greater patient independence. (Morris 2010)
  • When patients are informed about the benefits of early ambulation before undergoing surgery, patients become more proactive about seeking opportunities for early mobilization after surgery. (Kibler 2012)

STAFF EFFECIENCY

  • Patients who have access to an ambulation platform have improved mobility outcomes and improved length of stay with fewer nurses and other staff required to implement ambulation. Nurses report that ambulation with an apparatus is easier for both staff and patients. (Henecke 2015)
  • Nurses report that early mobilization improves patient independence and preserves patient dignity, which reduces the number of patient requests for assistance and decreases staff workload. (Hoyer 2015)

MOBILITY AS A HOSPITAL CULTURE

  • Hospital-wide protocols and multidisciplinary teams dedicated to coordinating early mobility activities are important for improving ICU pediatric patient outcomes. (Piva 2019)
  • Unit culture (established goals and protocols, coordinated effort) is a critical factor that determines whether nurses will implement patient mobility to the full extent of each nurse’s training and ability. (Krupp 2019)
  • Incorporating early mobilization goals and achievements in electronic health records improves early mobilization coordination and improves early mobilization outcomes. The time required to achieve mobilization and the average length of stay decreased significantly, and the average patient ventilation time was decreased by 27 hours. (Anderson 2018)

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Barriers to Patient Mobility

Posted on by Steve Villanueva

Patient Ambulation

Barriers to patient mobility. Most medical practitioners are keenly aware of the benefits of early mobility—it improves patient recovery times, lowers the risk of complications, and shortens overall length of stay. So why has it been so difficult to implement? Why have there been so many barriers to patient mobility? The most common barriers to patient mobility can be grouped in four categories: equipment, patient availability, staff availability, and unit planning.

Why Aren’t Patients Being Mobilized

Key Facts:

Barriers to patient mobility include:

EQUIPMENT

  • In a survey of 500 U.S. ICUs, the number one listed barrier to early mobility was a lack of appropriate equipment. (Bakhru 2015)
  • If key pieces of mobility equipment (mobility platforms, ceiling lifts, etc.) are not readily available, multiple assistants will be required to support the patient, and mobility may be deferred due to staff unavailability. (Krupp 2019)

PATIENT AVAILABILITY

  • Patients who are called away for unscheduled procedures and tests aren’t present in the ward where nurses and physical therapists can implement early mobility.

STAFF AVAILABILITY

  • Understaffing physical therapists decreases the frequency and length of early patient mobilization. (Johnson 2019)
  • In an extensive study of community and academic hospitals, researchers determined that the greatest barrier to early patient mobility was the fear that “increasing mobilization of my inpatients will be more work for nurses.” Nurses directly reported that “they did not have enough time” to meet unit early mobilization goals (Hoyer 2015; Fontela 2018; Jolley 2014)

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Early Mobility-Length of Stay

Posted on by Sean Bryant

Early Mobility and Length of Stay

Helping Hospitals Reduce Costs

Early mobility-length of stay. For hospitals, especially ICUs, reducing patient length of stay results in dramatic cost savings for both the individual patient and the hospital itself. Surveys done in both ICUs and across different units universally found that early mobilization dramatically contributed to improved patient turnover, improved patient outcomes, and millions of dollars in savings for the hospital.

Key Facts:

  • When nurses and rehabilitation therapists were able to increase mobility by approximately 1 hour per ICU patient (for patients on ventilators and patients who were not), the average ICU length of stay decreased by almost 20%, floor bed average length of stay lowered by almost 40%, and twice as many patients were discharged without home services. Average cost per day in the ICU and floor bed decreased, resulting in an annualized net cost savings of $1.5 million. (Corcoran 2017)
  • Danish hospitals recently performed a comprehensive national cost-savings survey and found that conforming to best-practice protocols reduced hospital costs by reducing patient length of stay and the need for secondary treatment; early mobilization resulted in one of the largest adjusted cost differences ($3,300 per patient). (Kristensen 2019)
  • One hospital introduced a systematic schedule for their pediatric unit and found that patients experienced: shorter periods of bed rest, reduced pressure sores, fewer falls, decreased length of stay, improved family satisfaction, and improved staff satisfaction. Overall, early mobilization resulted in cost savings for both the patient and hospital. (Letzkus 2013)
  • A study conducted at a community acute care hospital found that patients who received mobility intervention had fewer falls, ventilator-associated events, pressure ulcers, CAUTIs, delirium days. They also had lower sedation levels, improved functional independence, and lower hospital costs. (Fraser, 2015)
  • A comprehensive review of studies regarding post-operative knee surgery found that early mobilization (“fast-track rehabilitation”) resulted in shortened hospital stays and significant cost saving. (Quack 2015)
  • For patients hospitalized with Parkinson’s Disease, early mobilization is critical for improving both cost savings and improve outcomes. (Aminoff 2010)
  • Patients who achieved full mobilization within four days of coronary bypass surgery were able to be safely discharged from the hospital, without increased health risks, maximizing hospital resources and reducing hospital costs by over $900/patient. (Loubani 2000)

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Beneficial Reading

Implementation of an Early Mobility Program

Early Discharge after Coronary Bypass Surgery

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ICU Physical Therapy

Posted on by Philip Crumpton

ICU Physical Therapy

Benefits of Physical Therapy in the ICU

Benefits of physical therapy in the ICU. You might ask yourself what a physical therapist does in the ICU. That is a great question. The role of a P.T. in the ICU will vary from facility to facility. Some facilities have a dedicated P.T. who spends the day mobilizing patients, doing progressive resistance exercises and acting as the expert for positioning and prevention of contractions. Other facilities order a P.T. consult only when a patient is extubated and active.

There are some important things that a P.T. needs to be knowledgeable about when working in the ICU. I would recommend brushing up on the following; cardiopulmonary physiology, ventilator and respiratory equipment, medications commonly used in the ICU, exclusion criteria for mobility, clinical implications of lab values, and monitoring systems. It is also beneficial to take 2-4 hours to shadow an ICU nurse and a respiratory therapist if your facility allows for this.

There are many P.T. activities that can be done while the patient is sitting edge of bed such as; PREs for lower extremities, therapeutic exercises, deep breathing, ADLs, trunk control and seated balance activities.

The ultimate goal of ICU P.T. is to get patients mobile which will inevitably help them wean off of a ventilator, become more independent and eventually transfer out of the ICU.

As a P.T. who has worked in the ICU I can tell you that it is rewarding, exciting and important. The evidence for early mobility is strong and it is “Best Practice” for ICU patients. I encourage you to get trained, get involved and get your patients moving.

Beneficial Reading

Implementation of an Early Mobility Program

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Implementing ICU Mobility Program

Posted on by Philip Crumpton

Implementing ICU Mobility Program

Safe Early Patient Mobility in the ICU

Implementing ICU mobility program. Are you looking to start an ICU early mobility program? If so, there are many factors that you’ll need to consider. One thing you need to think about is the current culture in your ICU. Is the culture to sedate all ICU patients, for patients to stay in bed? Is the staff ready for and supportive of a change? How well do the different departments work together? Are P.T.’s and O.T’s actively involved in the treatment of your ICU patients?

The next thing that I would advise would be to create a multi-disciplinary early mobility team, decide on a time frame, a start date, and start planning. You’ll need to create protocols, exclusion criteria and, add an early mobility line item to your pre-printed order sets.

It is important to have super-users or champions from each department who can then start training their coworkers and prepare them for your start date.

It is helpful to agree on the way that you will define mobility. I recommend using a system of 5 mobility stages. Stage1- bed in chair position, Stage 2- sitting edge of bed/dangling, Stage 3- Sitting in a chair, Stage 4- Standing/marching at bedside, Stage 5- Ambulation >10′. When documenting or discussing mobility in rounds, be sure that all team members are using the same grading system and language.

There are many resources out there and the evidence is strong in support of early mobility. The mobility will lead to better outcomes, improved cognitive status and improved patient satisfaction. Take the first step and get those patients moving!!

Beneficial Reading

Implementation of an Early Mobility Program

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Basic Needs – Mobility

Posted on by Philip Crumpton

Basic Needs – Mobility

A Basic Need for Recovery

Basic Needs – Mobility. On a recent trip to trial the LIVENGOOD mobi at Tulane Medical Center I had the pleasure of meeting Sarah. Sarah was a patient in the neurological ICU who had been on a ventilator for 3 weeks. During the placement of cervical traction she experienced heart failure. After being resuscitated she had to be intubated. The staff had good intentions of getting Sarah out of bed but equipment management was difficult. Consequently, she stayed in bed most days and occasionally, at best, made it to a chair. The staff agreed at an attempt to walk with Sarah on a portable ventilator, while mounting all of her equipment on the mobi. She sat at the edge of the bed and slowly regained her ability to sit unsupported with her feet on the floor. We all held our breath as she transitioned from sitting to standing and cheered as she stood there smiling. Sarah was able to walk 16 feet to the door of her room and then after sitting in her chair we wheeled her to the picture window where she sat basking in the warm Louisiana sun, the sun she had not seen in 21 days, as her hospital room did not have an exterior window. This session of mobility worked her muscles, her lungs, her cardiovascular system and it gave her an emotional boost. From this day forward mobility became part of her care plan and helped her progress towards a transfer out of the ICU. To thrive as humans we need to feed our basic needs. We need nourishment, sunlight, mobility and community. The sense of accomplishment Sarah felt that day was truly palpable in that room and I think we all slept better that night. *Patient’s name has been changed to protect her identity.

Beneficial Reading

Implementation of an Early Mobility Program

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Safe Patient Mobility

Posted on by Philip Crumpton

Safe Patient Mobility

Shaking up Hospital Practices with Safe Patient Mobility

Safe Patient Mobility. Please take a moment and read this article by InnovatioNews. Read Article

FORT COLLINS – Most people don’t want to stay in a hospital any longer than they absolutely have to. And while that’s primarily based on a person’s desire simply to be well again and get back home, there are other factors that weigh in favor of getting out of that hospital bed as soon as possible. Read Article

Overview

Faster recovery is one factor associated with early patient mobility, with patients who are able to get up and walk again after a treatment or surgery leaving the hospital sooner than those who remain bedridden. And there’s the reduced cost of a shorter hospital stay, which is actually good for both the patient and hospitals that receive a higher reimbursement from insurers for shorter stays.

Livengood, a Fort Collins company that’s developed a simple yet revolutionary bedside product, is helping get patients up and around sooner and cutting hospital stay expenses. Livengood’s PACE (PAtient Care Environment)–rebranded as mobi–is an evolution of the IV pole ambulatory patients push to get exercise and go to the bathroom while still attached to feeding tubes, pumps  and other hospital care paraphernalia.

Patients love it

And patients are loving the mobi.

Beneficial Reading

Implementation of an Early Mobility Program

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What Customers Say

Testimonials

“6 months ago we implemented 12 mobis into our early mobility program. We have a very diverse population on our ICU and having the option of mobilizing them in a way that is helpful and assistive to staff while instilling confidence in the patient and family is great. We’re still working to figure out our ideal workflow but it’s given us concrete examples of how even our sicker vented patients can get mobilized safely and efficiently.”

Mark Rohlfing
RN, BSN Clinical Operations Manager Intensive Care Unit
Indiana University Health Ball Memorial Hospital - Muncie, IN

“After completing a research study with the LIVENGOOD mobi on our post trauma/surgical floor, I realized its potential to decrease length of stay, help with staff efficiency and empower patients to be independent.”

Lorrie Henecke
MS, APRN, ACNS-BC, CNRN Clinical Nurse Specialist
Medical Center of the Rockies, Loveland, CO

“We are so excited that the mobi helped us ambulate our very first vented patient.”

Esther Vandermeulen
R.N.
University Health System - San Antonio, TX

“The LIVENGOOD mobi is very user friendly, safe and a great solution to use minimal staff and be able to contain all of the patient’s equipment.”

Michael Saccone
P.T.
Saint Joseph's Hospital - Syracuse, NY

“I think the LIVENGOOD mobi will revolutionize the way we mobilize patients in the ICU. I saw patients mobilize sooner and with less anxiety with the mobi. One young patient was even able to walk outside with the mobi and her portable vent. Having the mobi made mobility a real team effort, not just a P.T. activity.”

Terra Terwilliger
PT, DPT - Adult Inpatient Physical Therapist
Rehab Services University of Minnesota Medical Center, Fairview Health System

“The LIVENGOOD platform allows my patients to be active and independent without attention being diverted to multiple lines, an oxygen tank, and other medically necessary devices. It allows patients to have hope and a sense of “normalcy”, which so often is lost after trauma or surgery.”

Jessica Gilbert
DPT
Staff Physical Therapist - Medical Center of The Rockies -Loveland, CO

“Six years ago I was introduced to the LIVENGOOD mobi. This piece of equipment has been life changing for my patients. I am now able to consolidate all of the patient’s medical devices onto an easy to push mobile platform, therefore freeing up both of my hands to safely assist my patient.”

Tanya Kensley
P.T.
Poudre Valley Hospital -Fort Collins, CO

“Mobility is Life, the mobi platform will help patients move again.”

Blas Villa
CCRN
University Health System - San Antonio, TX

“I was at NTI in Boston (2013) and, during the exhibit portion, I wandered across the LIVENGOOD booth. At that moment, I knew our hospital needed this mobi for our open heart recovery program. I worked with a Clinical Nurse Specialist to write a grant for this product. I am so excited to bring the mobi to our program.”

Celina Adams
RN, MSN, CCRN (CVICU)
John C. Lincoln - Phoenix, AZ

“We walked a vented patient with the mobi and it was awesome! This helped her physically and emotionally.”

Natalie Hariel
R.N.
Tulane Medical Center - New Orleans, LA

“I am a nurse in a cardiovascular ICU… Our goal for patients is to ambulate to the chair 2 hours after extubation, often the evening of surgery day. Our patients are up and walking with central venous catheters, swan ganz catheters, chest tubes, foley catheters, and with IV medications infusing. The ambulation of these patients would not be possible without the mobi walker. Every bit of equipment that these patients need can be carried on the walker while providing the stability of a standard walker… It is an essential piece of equipment for us and we couldn’t provide the care and therapies we do without it.”

Katherine Whitfield
RN CCRN
Athens Regional Medical Center - Athens, GA

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