Patient-Specific Mobilization: A Structured, Systemwide Model of Mobility Care

Area of Science:

• Geriatrics
• Hospital Medicine
• Quality Improvement

Background:

• Hospital-associated functional decline is a significant complication of immobility and prolonged bed rest.
• Lack of standardized mobility care programs leads to variable practices driven by informal decision-making rather than evidence-based protocols.
• This decline results in reduced independence, diminished quality of life, and impaired activities of daily living (ADLs) post-discharge.

Purpose of the Study:

• To implement and evaluate a systemwide, structured mobility care model to address hospital-associated functional decline.
• To integrate patient-specific mobility goals into electronic health records (EHRs) and nursing workflows.
• To establish a transparent and shared priority for patient mobilization among the entire care team.

Main Methods:

• Implementation of the Patient-Specific Mobilization (PSM) model across 21 Kaiser Permanente Northern California (KP NCAL) hospitals in December 2023.
• Assignment of individualized daily mobility goals based on standardized bedside functional assessments integrated into EHRs.
• Development and implementation through a multidisciplinary regional structure with input from clinical, operational, and quality stakeholders.

Main Results:

• Sustained improvements in mobility assessments, increasing by 8 percentage points (from 87% to 95%).
• Significant increase in appropriate patient mobilization, rising by 12 percentage points (from 60% to 72%).
• Consistent mobilization was associated with reduced odds of intensive care unit transfer, functional decline, and discharge to skilled nursing facilities.

Conclusions:

• Structured, systemwide mobility care models like PSM can be effectively delivered at scale.
• PSM facilitates clearly defined, actionable mobility objectives, making patient movement a transparent priority.
• This initiative offers a replicable model for embedding function-preserving care into hospital systems nationwide.