Patient Ambulation & Staff Safety

Patient Ambulation & Staff Safety

Helping Hospitals Reduce Costs With Patient Ambulation

Early mobility (patient ambulation) protocols are first implemented, there is an increased cost in time for both the nursing and support staff. However, when early mobility protocols are implemented systemically, the overall improvement in patient independence, reduction in secondary complications (including delirium), and reduced patient length of stay actually save time and reduce the burden for hospital staff. There are many sustainable benefits to implementing patient ambulation protocols.

Improved patient coordination and the reduction of ICU-acquired weakness also reduces the risk of falls, which are both dangerous and costly events. Ambulation platforms are an important part of this process because they help patients to help themselves, reducing the risk of injury for both patients and hospital staff. More importantly during a pandemic, mobility platforms dramatically increase patient independence, which limits risky interactions between patient and staff. The net improvement in staff efficiency, staff safety, and patient turnover all contribute toward greater hospital efficiency and significant cost savings associated with early and safe patient ambulation.

Key Facts:

• Early patient mobility (patient ambulation) promotes patient independence and improves nurses’ ability to assess patient strength, ability, and psychological status. (Krupp 2019)
• 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)
• On average, patients who employed mobile IV pole walkers required one fewer staff members to support early patient mobilization. (Nesbitt 2012)
• 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)
• The implementation of a progressive mobility protocol in a cardiothoracic surgery unit reduced patient length of stay (in ICU and overall), reduced ICU readmission rates, and decreased the risk of pressure ulcers. Overall the new protocol had positive implications for both staffing and cost-savings. (Floyd 2016)
• Programs that reduce the number of patient falls by even a small margin result in significant net savings at hospitals, largely due to the decline in time that RNs must spend in fall-related activities. (Nuckols 2017)
• 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)

Bibliography

Krupp A, Ehlenbach W, King B. Factors nurses in the intensive care unit consider when making decisions about patient mobility. Am J Crit Care. 2019 Jul;28(4):281-289.

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. 2015;94:304-312.

Nesbitt JC, Deppen S, Corcoran R, et al. Postoperative ambulation in thoracic surgery patients: standard versus modern ambulation methods. Nurs Crit Care. 2012;17(3):130-137.

Corcoran J, Herbsman JM, Bushnik T, et al. Early rehabilitation in the medical and surgical intensive care units for patients with and without mechanical ventilation: an interprofessional performance improvement project. PM R. 2017 Feb;9(2):113-119.

Floyd S, Craig SW, Topley D, Tullmann D. Evaluation of a progressive mobility protocol in postoperative cardiothoracic surgical patients. Dimens Crit Care Nurs. 2016 Sept-Oct;35(5):277-282.

Nuckols TK, Needleman J, Grogan TR, et al. Clinical effectiveness and cost of a hospital-based fall prevention intervention: the importance of time nurses spend on the front line of implementation. J Nurs Adm. 2017 Nov;47(11):591-580.

Letzkus I, Hengartner M, Yeago D, Crist P. The immobile pediatric population: can progressive mobility hasten recovery? J Pediatr Nurs. 2013;28(3):296-299.

Fraser D, Spiva LA, Forman W, Hallen C. Original research: implementation of an early mobility program in an ICU Am J Nurs. 2015;115(3):49-58.

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