Implementing a Mobility Scale to Increase Postoperative Mobility Levels

Abstract

Problem: Gynecologic oncology treatment plans often involve invasive surgeries that put patients at risk for complications and long hospital admissions. Enhanced Recovery After Surgery protocols improves outcomes for gynecologic oncology patients, especially when patients are compliant with getting out of bed on postoperative day zero. At an urban Mid-Atlantic hospital, 3% of gynecologic oncology patients got out of bed on postoperative day zero and the average length of stay was 2 days between February 2018 and January 2020. Delaying postoperative mobility increases the risk for longer hospital stays. Purpose: The purpose of this quality improvement project is to implement the Johns Hopkins Highest Level of Mobility (JH-HLM) scale with defined goals to increase postoperative mobility levels and decrease the length of hospital stay for postoperative gynecologic oncology patients. Methods: Quantifiable mobility goals were defined for postoperative patients based on the JH-HLM scale. The nursing staff was educated about the mobility goals and JH-HLM scale through unit presentations, email communication, and annual competencies. Mobility documentation was standardized in the electronic health record. Education materials were disseminated to the inpatient oncology unit, post-anesthesia care unit, rehabilitation department, and patients. Patient age, diagnosis, type of surgery, mobility levels, and length of stay were collected through chart reviews for 3 weeks before implementation and during the 12-week implementation period. Run charts were used to analyze the data. Results: Results showed that average mobility documentation increased (10% to 46%). There was an increase in mobility levels on postoperative day zero (6% to 33%) and by discharge (13% to 45%). The average length of stay during the 3-week pre-implementation period was 1.6 days and after implementation it was 1.8 days. These results were not statistically significant. Conclusion: Findings suggest that quantifying and standardizing mobility goals may increase postoperative mobility levels. However, more investigation is needed to demonstrate statistical significance. Length of stay was not decreased and was likely impacted by a variety of factors. Further investigation of improving mobility documentation, decreasing data variability, and increasing compliance is warranted.