ABSTRACT
OBJECTIVE: The aim of this study was to examine the effect of nurses' mobility plan use on patients' length of stay, discharge destination, falls, physical therapy consults, and nurses' knowledge, attitudes, and beliefs regarding patient mobility. BACKGROUND: Functional decline due to decreased mobility during hospitalization results in diminished quality of life. Sixty-five percent of older inpatients lose the ability to ambulate during hospitalization and 30% do not regain that capability. METHODS: Using a quasi-experimental design, nurses' use of a mobility assessment on 4 patient outcome variables was examined before (n = 2,259) and after (n = 3,649) use. Nurses' attitudes, knowledge, and beliefs regarding mobility were also examined. RESULTS: Positive changes in patient variables occurred. Limited change occurred relative to nurses' knowledge, attitudes, and beliefs. CONCLUSIONS: Implementing a nurse-led mobility plan enhances therapy resource utilization through identification of appropriate consults and improves patients' discharge home. In addition, nurses' knowledge, attitudes, and beliefs toward patient mobility planning can be positively influenced.
Subject(s)
Health Knowledge, Attitudes, Practice , Home Care Services , Inpatients/statistics & numerical data , Nursing Staff, Hospital/organization & administration , Walking/statistics & numerical data , Aged , Female , Humans , Male , Patient Discharge/statistics & numerical data , Quality of Life/psychology , Surveys and Questionnaires , United StatesABSTRACT
OBJECTIVE: The aim of this study was to develop and test a tool, the Predictor of Appropriate Discharge Destination (PADD), used postoperative day zero by healthcare professionals to identify whether patients undergoing elective total knee arthroplasty or total hip arthroplasty should go directly home or to extended rehabilitation. A secondary objective was to examine the difference in readmissions pre and post use of the PADD. DESIGN: A two-phase methodological study. SETTING: This study was conducted in a 393-bed magnet re-designated community hospital. SUBJECTS: Adults undergoing a primary total knee or hip arthroplasty. METHODS: In Phase 1, retrospective data (n = 461) was analyzed to compare recommendations for discharge destination between the PADD and physical therapists. In Phase 2 (n = 521), the predictive validity of the PADD was assessed prospectively. RESULTS: In Phase 1, the PADD cut-off score of ⩽7 demonstrated good sensitivity (0.83) and specificity (0.68) in relation to the physical therapist's discharge destination recommendation. In Phase 2, sensitivity (0.75) and specificity (0.83) calculations were similar. Analysis of 30-day readmissions between the physical therapist's recommendation and the PADD score revealed 89.7% agreement. Readmission percentages among patients discharged to home and to rehabilitation facilities were 2.37% (n = 16) and 3.41% (n = 10), respectively. CONCLUSION: The PADD has good predictive validity in relation to appropriate discharge destination for patients undergoing a total knee or hip arthroplasty.
