Association between ambulatory status and call bell use in hospitalized patients-A retrospective cohort study.

AIM: Characterize the relationship between patient ambulatory status and in-hospital call bell use. BACKGROUND: Although call bells are frequently used by patients to request help, the relationship between physical functioning and call bell use has not been evaluated. METHODS: Retrospective cohort study of 944 neuroscience patients hospitalized in a large academic urban medical centre between April 1, 2014 and August 1, 2014. We conducted multiple linear regression analyses with number of daily call bells from each patient as the primary outcome and patients' average ambulation status as the primary exposure variable. RESULTS: The mean number of daily call bell requests for all patients was 6.9 (6.1), for ambulatory patients 5.6 (4.8), and for non-ambulatory patients, it was 7.7 (6.6). Compared with non-ambulatory patients, ambulatory patients had a mean reduction in call bell use by 1.7 (95% CI 2.5 to -0.93, p < .001) calls per day. In a post hoc analysis, patients who could walk >250 feet had 5 fewer daily call bells than patients who were able to perform in-bed mobility. CONCLUSION: Ambulatory patients use their call bells less frequently than non-ambulatory patients. IMPLICATIONS FOR NURSING MANAGEMENT: Frequent use of call bells by non-ambulatory patients can place additional demands on nursing staff; patient mobility status should be considered in nurse workload/patient assignment.

Toward a Common Language for Measuring Patient Mobility in the Hospital: Reliability and Construct Validity of Interprofessional Mobility Measures.

Background: The lack of common language among interprofessional inpatient clinical teams is an important barrier to achieving inpatient mobilization. In The Johns Hopkins Hospital, the Activity Measure for Post-Acute Care (AM-PAC) Inpatient Mobility Short Form (IMSF), also called "6-Clicks," and the Johns Hopkins Highest Level of Mobility (JH-HLM) are part of routine clinical practice. The measurement characteristics of these tools when used by both nurses and physical therapists for interprofessional communication or assessment are unknown. Objective: The purposes of this study were to evaluate the reliability and minimal detectable change of AM-PAC IMSF and JH-HLM when completed by nurses and physical therapists and to evaluate the construct validity of both measures when used by nurses. Design: A prospective evaluation of a convenience sample was used. Methods: The test-retest reliability and the interrater reliability of AM-PAC IMSF and JH-HLM for inpatients in the neuroscience department (n = 118) of an academic medical center were evaluated. Each participant was independently scored twice by a team of 2 nurses and 1 physical therapist; a total of 4 physical therapists and 8 nurses participated in reliability testing. In a separate inpatient study protocol (n = 69), construct validity was evaluated via an assessment of convergent validity with other measures of function (grip strength, Katz Activities of Daily Living Scale, 2-minute walk test, 5-times sit-to-stand test) used by 5 nurses. Results: The test-retest reliability values (intraclass correlation coefficients) for physical therapists and nurses were 0.91 and 0.97, respectively, for AM-PAC IMSF and 0.94 and 0.95, respectively, for JH-HLM. The interrater reliability values (intraclass correlation coefficients) between physical therapists and nurses were 0.96 for AM-PAC IMSF and 0.99 for JH-HLM. Construct validity (Spearman correlations) ranged from 0.25 between JH-HLM and right-hand grip strength to 0.80 between AM-PAC IMSF and the Katz Activities of Daily Living Scale. Limitations: The results were obtained from inpatients in the neuroscience department of a single hospital. Conclusions: The AM-PAC IMSF and JH-HLM had excellent interrater reliability and test-retest reliability for both physical therapists and nurses. The evaluation of convergent validity suggested that AM-PAC IMSF and JH-HLM measured constructs of patient mobility and physical functioning.