Mobility matters: a protocol to improve mobility and reduce length of stay in hospitalised older adults

Functional decline in hospitalised older adults aged 65 and above is a significant clinical problem. Despite its adverse outcomes, the problem of not mobilising older adult patients in clinical settings remains. Existing evidence suggests that a mobility protocol can be effective in addressing this concern. The aims of this quality improvement project were to determine whether a nurse-driven, multidisciplinary collaborative mobility protocol would increase the daily out-of-bed episodes, improve mobility level and reduce hospital length of stay (LOS). A nurse-driven mobility protocol was implemented in three phases. This five-component protocol included mobility assessment using the Johns Hopkins Highest Level of Mobility (JH-HLM) scale, documentation of mobility score, implementation of out-of-bed activities three times per day, communication of mobility score and goal at daily huddle, and indication of mobility score and goal on the board at patient's bed. Data were collected before and after the implementation. 142 patients were recruited from an acute geriatric unit. There were 72 patients from the pre-implementation group and 70 patients from the post implementation group. Comparing the pre-implementation and post implementation groups, the mean out-of-bed episodes per patient day increased from 0.80 to 3.59 (p<0.001). JH-HLM scores at discharge with ambulation status increased from 51.4% to 71.4% (p<0.001). Patients had improved JH-HLM scores with a median 2.00 (B 2.00, 95% CI 1.35 to 2.65, p<0.001) higher at discharge in the post implementation group after adjusting for score at admission. Increased mobility did not lead to any fall incidents. The mean hospital LOS was reduced from 15.67 (SD 11.30) days to 13.07 (SD 7.18) days (p=0.069). In conclusion, the implementation of a nurse-driven mobility protocol resulted in increased frequency of out-of-bed episodes and improved mobility, and reduction in LOS.