A unit-based, multi-center evaluation of adopting mobility measures and daily mobility goals in the hospital setting.

BACKGROUND: Promoting patient mobility helps improve patient outcomes, but mobility status is not widely tracked nor do patients have specific individualized mobility goals. PURPOSE: We evaluated nursing adoption of mobility measures and daily mobility goal achievement using the Johns Hopkins Mobility Goal Calculator (JH-MGC), a tool to guide an individualized patient mobility goal based on the level of mobility capacity. METHOD: Built on a translating research into practice framework, the Johns Hopkins Activity and Mobility Promotion (JH-AMP) program was the vehicle to promote use of the mobility measures and the JH-MGC. We evaluated a large-scale implementation effort of this program on 23 units across two medical centers. FINDINGS: Units significantly improved documentation compliance to mobility measures and achieving daily mobility goals. Units with the highest documentation compliance rates had higher rates of daily mobility goal achievement, especially for longer distance ambulation goals. DISCUSSION: The JH-AMP program improved adoption of mobility status tracking and higher nursing inpatient mobility levels.

The Johns Hopkins Activity and Mobility Promotion Program: A Framework to Increase Activity and Mobility Among Hospitalized Patients.

BACKGROUND: Greater mobility and activity among hospitalized patients has been linked to key outcomes, including decreased length of stay, increased odds of home discharge, and fewer hospital-acquired morbidities. Systematic approaches to increasing patient mobility and activity are needed to improve patient outcomes during and following hospitalization. PROBLEM: While studies have found the Johns Hopkins Activity and Mobility Promotion (JH-AMP) program improves patient mobility and associated outcomes, program details and implementation methods are not published. APPROACH: JH-AMP is a systematic approach that includes 8 steps, described in this article: (1) organizational prioritization; (2) systematic measurement and daily mobility goal; (3) barrier mitigation; (4) local interdisciplinary roles; (5) sustainable education and training; (6) workflow integration; (7) data feedback; and (8) promotion and awareness. CONCLUSIONS: Hospitals and health care systems can use this information to guide implementation of JH-AMP at their institutions.

Models of Intermediate Care Organization and Staffing at an Academic Medical Center: Considerations of an Inpatient Planning Committee.

Rationale: Geographic co-localization of patients and provider teams (geography) may improve care efficiency and quality. Patients requiring intermediate care present a unique challenge to the geographic model. Objective: Identify the best organizational and staffing model for intermediate care at our academic medical center. Methods: A modified nominal group technique was employed to assess the benefits and limitations of an existing model of intermediate care, identify and review potential alternative models, and choose a new model. Results: In addition to the institution's current model, the benefits and limitations of six alternative organizational and staffing models were characterized. The anticipated impact of each model on nurse: provider communication, maintenance of nursing competencies, nurse satisfaction, efficient utilization of technical and human resources, triage of patients to the unit, care continuity, and the impact on trainee education are described. After considering these features, stakeholders ranked a closed provider staffing model on a unit dedicated to intermediate care highest of the six alternative models. Important outcomes to monitor following transition to a closed staffing model included patient outcomes, nursing job satisfaction and retention, provider and trainee experience, unexpected patient transfers to higher or lower levels of care, and administrative costs. Conclusions: After considering six alternative staffing models for intermediate care, stakeholders ranked a closed provider staffing model highest. Further qualitative and quantitative comparisons to determine optimal models of intermediate care are needed.

Air Force Executive Nurse Leadership Impact: Brigadier General Diann Hale O'Connor, Air Force Nurse Corps Chief From 1982 to 1985.

INTRODUCTION: In the 1980s, nurses became more recognized as interprofessional healthcare partners who actively participated in the advancement of patient care and the nursing profession. There is a significant gap in the nursing literature about the significant contributions of executive military nurse leaders. The purpose of the interview with Brigadier General (Brig Gen) Hale O'Connor was to explore the personal stories, experiences, leadership strategies, lessons learned, and impact of her leadership on the future development of nursing as a profession. METHODS: The oral history method provided a framework for the interview and the analysis. In compliance with the Oral History Association guidelines, the primary investigator obtained Institutional Review Board permission, participant informed consent, and an audiotaped interview. A graduate research assistant transcribed the 3-hour audiotaped interview verbatim. The participant reviewed the transcription, provided clarification, and validated accuracy. Three independent coders extracted prevalent themes and subthemes during analysis. Researchers compared findings and reached a consensus when resolving minor discrepancies. RESULTS: Two broad thematic qualities, commitment to duty and fairness, emerged from the data with their respective subthemes. Subthemes of trust, patriotism, loyalty, and assiduousness supported the main theme of commitment to duty. Pillars of alignment, equality, and advocacy supported the broad theme of fairness. CONCLUSION: Although the team did not use the Reina Trust Model as a framework, the trust-building behaviors emerged from the transcribed interview during the analysis. Surprisingly, many of the leadership strategies utilized by Brig Gen Hale O'Connor fit well into the Reina Trust Model, published 25 years following O'Connor's tenure as Chief, Air Force Nurse Corps. In addition, several of Brig Gen Hale O'Connor's leadership accomplishments are still relevant today, solidifying the observation that the foresight of Brig Gen Hale O'Connor was fundamental to the advancement of nursing during her tenure and for those who followed.

Using Systematic Functional Measurements in the Acute Hospital Setting to Combat the Immobility Harm.

Hospitalized patients often experience unnecessary immobility and inactivity leading to direct harms and poor outcomes. Despite growing evidence that early and regular mobility and activity are safe and helpful for patients in the hospital, there remains substantial room for improvement in clinical practice. Key to improvement is establishing an interdisciplinary approach to measurement and communication using a common language of function. Here we provide a framework for systematic functional measurement in the hospital. We also provide 3 specific examples of how this framework has been used to improve care: (1) targeting specialized rehabilitation providers to the patients most likely to need their services, (2) generating a daily mobility goal for all patients, and (3) identifying patients early who are likely to require postacute care.

A Perspective on the Baltimore Freddie Gray Riots: Turning Tragedy Into Civic Engagement and Culture Change in an Academic Department of Medicine.

PROBLEM: The Johns Hopkins University School of Medicine Department of Medicine (DOM) sought ways of enhancing community engagement after the death of Freddie Gray and consequent unrest in Baltimore City. APPROACH: The DOM launched a five-part noon lecture series in May 2015-"Journeys in Medicine"-to facilitate discussion among DOM faculty, staff, trainees, and community residents regarding the city's unrest. This evolved into a department-wide civic engagement initiative in July 2016 to enhance employee and community engagement. The civic engagement committee is composed of two collaborative steering committees: Staff Engagement and Community Engagement. OUTCOMES: The DOM has sponsored and/or participated in programs to address major concerns raised during the Journeys in Medicine series-improving the strained relationship between police and the community, mentoring young people, involving more DOM employees in community activities, sharing research results with the community, and addressing cultural differences to enhance relationships and communication. To enhance staff engagement, a Nursing Diversity Council, complementing the Faculty Diversity Council, has been established. DOM faculty and staff have participated in and championed several disease-focused physical activity endeavors (e.g., walks) that, collectively, have raised over $40,000. Community service projects include supporting registration and screenings at a local health fair, a professional clothing drive, and DOM Days of Service. NEXT STEPS: The Johns Hopkins University School of Medicine DOM is developing an administrator leadership program and continuing to participate in meaningful activities, leading to tangible outcomes designed to strengthen connections to the surrounding neighborhood and enhance engagement among all DOM employees.

Cardiac catheterization laboratory inpatient forecast tool: a prospective evaluation.

OBJECTIVE: To develop and prospectively evaluate a web-based tool that forecasts the daily bed need for admissions from the cardiac catheterization laboratory using routinely available clinical data within electronic medical records (EMRs). METHODS: The forecast model was derived using a 13-month retrospective cohort of 6384 catheterization patients. Predictor variables such as demographics, scheduled procedures, and clinical indicators mined from free-text notes were input to a multivariable logistic regression model that predicted the probability of inpatient admission. The model was embedded into a web-based application connected to the local EMR system and used to support bed management decisions. After implementation, the tool was prospectively evaluated for accuracy on a 13-month test cohort of 7029 catheterization patients. RESULTS: The forecast model predicted admission with an area under the receiver operating characteristic curve of 0.722. Daily aggregate forecasts were accurate to within one bed for 70.3% of days and within three beds for 97.5% of days during the prospective evaluation period. The web-based application housing the forecast model was used by cardiology providers in practice to estimate daily admissions from the catheterization laboratory. DISCUSSION: The forecast model identified older age, male gender, invasive procedures, coronary artery bypass grafts, and a history of congestive heart failure as qualities indicating a patient was at increased risk for admission. Diagnostic procedures and less acute clinical indicators decreased patients' risk of admission. Despite the site-specific limitations of the model, these findings were supported by the literature. CONCLUSION: Data-driven predictive analytics may be used to accurately forecast daily demand for inpatient beds for cardiac catheterization patients. Connecting these analytics to EMR data sources has the potential to provide advanced operational decision support.