Standardizing Early Ambulation Practices to Improve Mobility across Military Treatment Facilities

Area of Science:

• Healthcare Management
• Patient Care
• Evidence-Based Practice

Background:

• Hospital-acquired immobility leads to functional decline and extended hospital stays.
• The Military Health System (MHS) faces challenges with inconsistent mobility practices and lack of standardized protocols.
• Effective patient mobility management is crucial for preventing complications and improving recovery.

Purpose of the Study:

• To implement and evaluate the Johns Hopkins Activity and Mobility Promotion program at Tripler Army Medical Center.
• To standardize patient mobility practices across adult inpatient units.
• To enhance interdisciplinary collaboration and improve patient outcomes through a structured mobility program.

Main Methods:

• A four-phase approach: planning, education, implementation, and sustainment.
• Integration of the Activity Measure Post-Acute Care (AM-PAC) "Six Clicks" Score and Johns Hopkins Hospital - Highest Level of Mobility (JHH-HLM) into MHS GENESIS.
• Establishment of training protocols and performance metrics for mobility assessment documentation.

Main Results:

• Initial documentation compliance for AM-PAC and JHH-HLM was low (0-22%) but increased over time, exceeding 90% in ICU/PCU by month 12.
• Medical Surgical Unit 1 consistently maintained high AM-PAC compliance (89-99%).
• AM-PAC/JHH-HLM reconciliation improved by 15-22% across most units.

Conclusions:

• The implementation of a scalable, interdisciplinary mobility program is feasible within a military hospital setting.
• Standardized mobility assessment and promotion can improve documentation and patient care.
• Expansion of the program across military healthcare facilities and development of practice guidelines are recommended.