Journal
AGE AND AGEING
Volume 47, Issue 1, Pages 112-119Publisher
OXFORD UNIV PRESS
DOI: 10.1093/ageing/afx128
Keywords
mobilisation; frail; acute care hospital; older people; implementation
Categories
Funding
- Council of Academic Hospitals of Ontario's (CAHO) Adopting Research To Improve Care (ARTIC) Program
- Innovation Fund of the Alternative Funding Plan for the Academic Health Sciences Centres of Ontario
- Department of Medicine at the University of Toronto
- Regional Geriatric Program of Toronto
- Knowledge Translation Program of the Li Ka Shing Knowledge Institute of St. Michael's
- Tier 1 Canada Research Chair in Knowledge Translation
- Baycrest Health Sciences
- Hamilton Health Sciences
- Health Sciences North
- Kingston General Hospital
- London Health Sciences Centre
- Montfort Hospital
- Mount Sinai Hospital
- North York General Hospital
- Ottawa Hospital
- St. Joseph's Healthcare Hamilton
- Thunder Bay Regional Health Sciences Centre
- University Health Network
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Background: older patients admitted to hospitals are at risk for hospital-acquired morbidity related to immobility. The aim of this study was to implement and evaluate an evidence-based intervention targeting staff to promote early mobilisation in older patients admitted to general medical inpatient units. Methods: the early mobilisation implementation intervention for staff was multi-component and tailored to local context at 14 academic hospitals in Ontario, Canada. The primary outcome was patient mobilisation. Secondary outcomes included length of stay (LOS), discharge destination, falls and functional status. The targeted patients were aged >= 65 years and admitted between January 2012 and December 2013. The intervention was evaluated over three time periods-pre-intervention, during and post-intervention using an interrupted time series design. Results: in total, 12,490 patients (mean age 80.0 years [standard deviation 8.36]) were included in the overall analysis. An increase in mobilisation was observed post-intervention, where significantly more patients were out of bed daily (intercept difference = 10.56%, 95% CI: [4.94, 16.18]; P < 0.001) post-intervention compared to pre-intervention. Hospital median LOS was significantly shorter during the intervention period (intercept difference = -3.45 days, 95% CI: [-6.67,-0.23], P = 0.0356) compared to pre-intervention. It continued to decrease post-intervention with significantly fewer days in hospital (intercept difference= -6.1, 95% CI: [-11,-1.2]; P = 0.015) in the post-intervention period compared to pre-intervention. Conclusions: this is a large-scale study evaluating an implementation strategy for early mobilisation in older, general medical inpatients. The positive outcome of this simple intervention on an important functional goal of getting more patients out of bed is a striking success for improving care for hospitalised older patients.
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