Functional decline and loss of mobility for hospitalized patients can lead to increases in length of stay, fall risk, and hospital-acquired conditions.
In addition, research suggests that mobility impairment during hospitalization can result in adverse post-discharge outcomes such as increased rates of readmission and long-term care placement, and even death.
The overall impact on society is considerable. At least 50% of disability in seniors begins with a functional decline during hospitalization, and nearly 50% of total Medicare spending on seniors is attributable to those with a disability.
We partnered with clinical teams at Penn Presbyterian Medical Center (PPMC) led by nurse managers Jennifer Nelson, RN, MSN, CCRN, Nurse Manager and Staci Pietrafesa, MSN, RN, NE-B, to further explore the problem.
The team interviewed and observed interactions between care team members, patients, and their families. Several themes emerged about the barriers to mobility in the hospital setting; a lack of clear incremental goals, an intangible sense of progress, and a culture of bed rest.
The team piloted early mobility care pathways for moderate and high-risk populations that leveraged gamification to address barriers to mobility.
By gamifying mobility, the team believed that could improve patient and staff understanding of daily goals and encourage movement by delivering variable rewards based on progress. Perhaps most importantly, by making mobility fun, they hoped to change the perception that patients belong in their hospital beds.
Get Up & Go challenged patients to walk to geography-themed regions and collect tickets, while the 3 East Safari engaged both patients and nurses by challenging patients to find an animal sticker the nurse had hidden for them, and then, in turn, hide it from their nurse before returning to bed.
In initial pilots, patients who participated in a mobility game ambulated 80% farther than their peers and 48% more patients met their pathway goal for discharge.
The team seeks to build on the promising results of these pilots by conducting a more extensive study of approximately 200 patients to determine if a gamified mobility program significantly increases the rate of discharge to home for lower-extremity joint replacement and open heart surgery patients.
Secondary outcomes include reducing readmissions, reducing length of stay, reducing falls, and improving quality metrics.