Standardizing Early Ambulation Practices to Improve Mobility across Military Treatment Facilities

Background: Hospital-acquired immobility contributes to functional decline, prolonged hospital stays, and preventable complications. Within the Military Health System (MHS), inconsistent mobility practices and lack of a standardized protocol hinder effective care. Purpose: This evidence-based practice project aimed to implement and evaluate the Johns Hopkins Activity and Mobility Promotion program across adult inpatient units at Tripler Army Medical Center to standardize mobility, improve outcomes, and enhance interdisciplinary collaboration. Methods: Using a four-phase approach-planning, education and training, implementation, and sustainment-an interdisciplinary team integrated mobility assessment tools (Activity Measure Post-Acute Care (AM-PAC) "Six Clicks" Score and Johns Hopkins Hospital - Highest Level of Mobility (JHH-HLM) into MHS GENESIS (the military-specific electronic health record) and established training and performance metrics. Data collection focused on documentation compliance and quality. Results: Across five adult inpatient units (n=11,565 patients), AM-PAC and JHH-HLM documentation compliance varied and was initially low across most units (0-22%), except for Medical Surgical Unit 1 (MS1) (49-60%), but generally increased over time. Initially, Intensive Care Unit (ICU) and Progressive Care Unit (PCU) AM-PAC compliance was 0% and 18%, respectively, but increased to >90% by month 12. Medical Surgical Unit 1 consistently maintained high AM-PAC compliance (89-99%). Medical Surgical Unit 2 (MS2) and Medical Surgical Unit 3 (MS3) also improved to >93% in the last five months. AM-PAC/JHH-HLM reconciliation improved across most units (15-22% increase), with MS1 showing minimal change (1% increase). Implications for Practice: This initiative illustrates the feasibility of implementing a scalable, interdisciplinary mobility program within a military hospital. Continued expansion across military healthcare treatment facilities and development of formal practice guidelines are recommended next steps.