Hospitalized cancer patients are at serious risk for functional decline due to bedrest and limited mobility, and many fail to return to previous levels of mobility. Increasing patients’ mobility during their hospital stay presents a key opportunity to prevent functional decline, according to Mark Liu, director of strategic initiatives at Mount Sinai Health System and the Tisch Cancer Institute.
“In addition to functional decline, mobility loss can also significantly alter a patient’s well-being, independence, and quality of life,” he said at the 2022 Association of Community Cancer Centers Annual Meeting & Cancer Center Business Summit (AMCCBS). “Hospital programs that rely on existing resources to address this challenge may not be enough.”
More than 33% of adults aged 70 and older were discharged from the hospital with a major disability they did not have before admission, according to one recent study. Other research has shown patients derive numerous benefits from mobility interventions during their hospital stay, including reduction in length of stay and excess days (the number of days beyond a predetermined length of stay), improved patient experience, improved patient satisfaction, improved utilization of physical therapy resources, and improved clinical outcomes, according to Mr. Liu.
“With all these documented benefits, it's clear that promoting early mobility may enhance outcomes of cancer patients who are at high risk of complications from their disease treatment,” he said.
For their mobility aide program, Mr. Liu’s inpatient oncology unit at the Mount Sinai Hospital used Activity Measure for Post-Acute Care (AM-PAC) scores to quantify patient mobility and then develop team-based, multidisciplinary plans of care in collaboration with physical therapy, nursing, and a mobility aide — a medical assistant with rehabilitation training.
“We worked with the multidisciplinary team to identify which patients would benefit most from this intervention,” said Mr. Liu. “AM-PAC scores then helped us standardize overall mobility for patients upon admission and discharge, which enabled us to demonstrate the effectiveness of this intervention.”
Starting in April of 2019, patients walked down the hallway, assisted or unassisted depending on their mobility needs twice per day, seven days per week. Physical therapists worked with patients with high mobility needs, while those with moderate-to-low mobility needs had the option of physical therapists or could ambulate independently. According to Mr. Liu, approximately 75% of patients in the study could be mobilized by non-licensed team members.
Mr. Liu and his colleagues evaluated the effects of the mobility aide program on quality of care and healthcare utilization. They observed significant improvement in both among nearly 1,000 patients. The intervention reduced excess days by 6%, and readmission rates dropped from 25% to 19%. Additionally, more than three-quarters of patients (76%) maintained or improved their mobility score.
“We saw improvements from day one,” said Mr. Liu. “I’m also proud to say that, despite the increased foot traffic in the hallway, we did not see an increased number of falls among our patients, and no falls were associated with the mobility aide intervention.”
Patient satisfaction went up as well, according to Mr. Liu. Patient willingness to recommend the hospital increased from 63% to 91% following the intervention.
“The initial data that we have from implementing this initiative are very encouraging, and the patient stories that come from this have been inspiring,” Mr. Liu concluded.