Ambulation Nation

Massachusetts General Hospital (Boston, Massachusetts)

CSI Summary

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CSI Presentation

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CSI Toolkit

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Project Topic

Patient mobility

Hospital Unit

Adult General Medicine Floor – Bigelow 11

CSI Participants

Caity Mundt, BSN, RN
Haley Ralph, BSN, RN
Angelia Tan, BSN, RN

Project Goals/Objectives

  1. To mobilize 75% of patients daily
  2. To achieve 70% of nurses accurately documenting mobility
  3. To improve patient mobilization 30%
  4. To reduce average length of stay (LOS) 10%
  5. To improve access to equipment for optimal mobilization
  6. To create a sustainable change in nursing practice and documentation

Project Outcomes

  1. Decreased nurses’ documenting time and activity as tolerated in the electronic health record
  2. Decreased LOS 8.32%
  3. These outcomes resulted in an estimated annual fiscal impact of $22,800,897.

Project Overview

In 2018, our floor noticed an increase in patient falls, which lead to us holding a Fall Prevention Week intended to raise awareness to the issue.

During this week, we observed that our nurses were not making mobilization a priority, which was causing increased deconditioning of our patients and leading to falls. We decided to create “Ambulation Nation,” an initiative to improve patient outcomes by encouraging RNs to make patient mobilization a priority in their daily practice.

Ambulation Nation was developed to coincide with our professional baseball team’s catch phrase, “Red Sox Nation.” This fun, interactive baseball theme got our staff excited about our project and allowed our CSI team to have a cohesive plan for the entirety of our project. We decorated the unit like Fenway Park and offered great incentives, such as multiple sets of box seats for Red Sox games, to get all our nurses on board. From there, we saw our nurses take charge, getting their patients out of bed for each meal, or ambulating them around the “baseball bases” on the unit.

The next step was to track the progress of the increased mobilization. We asked the nurses to document whatever specific activity the patient achieved in the patient’s chart each shift. If the patient walked, that was documented; or, if the patient could only get up to the chair or back and forth to a commode, that was documented. We audited nursing documentation of patient activity weekly to track our progress.

As nurses continued mobilizing their patients and documenting the activity, we began to see our patient’s outcomes improving. The biggest outcome we saw was a reduction in the average length of a patient’s hospital stay. Over the course of the project, we decreased the length of stay 16 hours, which is an 8.32% reduction. This reduction translates into saving approximately $2,550 per patient, which represents an annualized reduction in cost of $20,898,897.

In addition to the decreased length of stay, we saw improvement in other patient outcomes. We helped them regain more of their independence, experience improved moods and sleep better at night, which, ultimately, helped them leave the hospital sooner. We also noticed a shift in the types of falls from unwitnessed falls to lowered-to-the-ground falls. We attribute this change to the fact that so many of our nurses were present with the patient for mobilization, they were able to help ease the patient down in the event of a fall.

Because of this project, mobilization is now a standard part of our nursing practice, and as we grow and train new nurses, we plan to continue this prioritization and achievement of positive patient outcomes.

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The AACN CSI Academy program supports change projects based on quality improvement methods. Although CSI teams seek to ensure linkage between their project and clinical/fiscal outcomes, data cannot be solely attributed to the project and are estimations of impact.