A Novel Approach of Enhanced, Multidisciplinary Rehabilitation Services in the Hospital to Facilitate Home Discharge: The Rehab2Home Program.

Objective: To evaluate the effectiveness of an early, targeted, individualized, intensive rehabilitation program called Rehab2Home, designed to transition surgical patients directly from acute care to home.

Design: The Rehab2Home program was implemented using a quality improvement (QI) approach between March 2023 and June 2023. The outcomes of the program were compared with a historical cohort of similar patients.

Are Your Patients Safe to Mobilize Alone in Their Room? The Johns Hopkins Hospital In-Room Independence Scale.

Objective: Given the stigma of falls while hospitalized, inpatient rehabilitation facilities often restrict the independent room mobility of their patients. We assessed the psychometric properties of a new tool, the Johns Hopkins In-Room Independence Scale, to evaluate its effectiveness at identifying independence for in-room mobility.

Design: Construct validity was assessed by comparing the Johns Hopkins In-Room Independence Scale to its "gold standard" counterparts, The Johns Hopkins Falls Risk Assessment Tool, the Activity Measure for Post-Acute Care Mobility and Activity, and the Centers for Medicare Quality Indicators.

Activities of Daily Living Assessment Early in Hospitalization Is Associated With Key Outcomes.

Importance: Assessing patients' activities of daily living (ADLs) function early in hospitalization may help identify patients at risk for poor outcomes.

Objective: To investigate the association between patients' ADL function at hospital admission and length of stay, inpatient falls, hospital-acquired pressure injuries, and discharge disposition.

Design: Retrospective cohort study using scores collected on the Activity Measure for Post-Acute Care Inpatient Activity Short Form (AM-PAC IASF) in routine care at admission.

Using Nursing Assessments of Mobility and Activity to Prioritize Patients Most Likely to Need Rehabilitation Services.

Objective: To identify nursing assessments of mobility and activity associated with lower-value rehabilitation services.

Design: Retrospective cohort analysis of admissions from December 2016 to September 2019 SETTING: Medicine, neurology, and surgery units (n=47) at a tertiary hospital.

Participants: We included patients with a length of stay ≥7 days on units that routinely assessed patient function (n=18,065 patients).

Identifying Cognitive Impairment in the Acute Care Hospital Setting: Finding an Appropriate Screening Tool.

Importance: Identifying cognitive impairment in adults in acute care is essential so that providers can address functional deficits and plan for safe discharge. Occupational therapy practitioners play an essential role in screening for, evaluating, and treating cognitive impairment.

Objective: To test and compare the psychometrics and feasibility of three cognitive screens and select the ideal screen for use in acute care.

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.

A Learning Health System Infrastructure for Precision Rehabilitation After Stroke.

Functional recovery and the response to rehabilitation interventions after stroke are highly variable. Understanding this variability will promote precision rehabilitation for stroke, allowing us to deliver targeted interventions to the right person at the right time. Capitalizing on large, heterogeneous data sets, such as those generated through clinical care and housed within the electronic health record, can lead to understanding of poststroke variability.

Development and Implementation of a Standard Assessment Battery Across the Continuum of Care for Patients After Stroke.

Stroke rehabilitation occurs across the continuum of care starting in the acute hospital and through the inpatient and outpatient settings. Rehabilitation aims to minimize impairments and maximize function in individuals after stroke. Because patients often undergo rehabilitation for extended periods, longitudinal assessment of impairment, activity, and participation can facilitate the evaluation of patients' progress toward recovery, as well as communication and decision making to guide clinical practice regarding the intervention(s) to be used and may also be leveraged for clinical research.

Feasibility of an Enhanced Therapy Model of Care for Hospitalized Stroke Patients.

Introduction: The aim of this study was to determine the safety and feasibility of an enhanced therapy model for hospitalized stroke patients.

Methods: This was a quasi-experimental cohort study of acute stroke patients from a single hospital. In the intervention group, all hospitalized patients on the acute stroke service were seen by at least two therapy disciplines daily in addition to routine stroke care.

Development and Implementation of a New Model of Care for Patients With Stroke, Acute Hospital Rehabilitation Intensive SErvices: Leveraging a Multidisciplinary Rehabilitation Team.

The optimal timing and intensity of early rehabilitation remain uncertain. The literature has stated that too early high-intensity mobility within 24 hours can result in poor outcomes as compared with the 24- to 48-hour poststroke (Stroke 2012;43:2389-94. Stroke 2004;35:1005-9).

Perceived barriers to early goal-directed mobility in the intensive care unit: Results of a quality improvement evaluation.

Background: A multicentre randomised trial demonstrated improved outcomes for intensive care unit (ICU) patients using early, goal-directed mobility implemented by nurses.

Objectives: The aim of the study was to evaluate barriers to nursing mobility, using a validated survey, during an ongoing quality improvement (QI) project (2019) in a medical ICU and determine changes from the pre-QI (2017) baseline.

Methods: Nurses, nurse practitioners, physician assistants, and clinical technicians completed the 26-item Patient Mobilization Attitudes and Beliefs Survey for the ICU (PMABS-ICU).

Cognitive Stimulation in an Intensive Care Unit: A Qualitative Evaluation of Barriers to and Facilitators of Implementation.

Background: Delirium in the intensive care unit is associated with poor patient outcomes. Recent studies support nonpharmacological therapy, including cognitive stimulation, to address delirium. Understanding barriers to cognitive stimulation implemented by nurses during clinical care is essential to translating evidence into practice.

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.

Managing the Rehabilitation Wave: Rehabilitation Services for COVID-19 Survivors.

The coronavirus disease 2019 (COVID-19) pandemic is having a profound effect on the provision of medical care. As the curve progresses and patients are discharged, the rehabilitation wave brings a high number of postacute COVID-19 patients suffering from physical, mental, and cognitive impairments threatening their return to normal life. The complexity and severity of disease in patients recovering from severe COVID-19 infection require an approach that is implemented as early in the recovery phase as possible, in a concerted and systematic way.

Measuring Mobility in Low Functioning Hospital Patients: An AM-PAC Replenishment Project.

Objective: To expand an existing validated measure of basic mobility (Activity Measure for Post-Acute Care [AM-PAC]) for patients at the lowest levels of function.

Design: Item replenishment for existing item response theory (IRT) derived measure via (1) idea generation and creation of potential new items, (2) item calibration and field testing, and (3) longitudinal pilot test.

Setting: Two tertiary acute care hospitals.

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.

Perceived Barriers to Mobility in a Medical ICU: The Patient Mobilization Attitudes & Beliefs Survey for the ICU.

Purpose: Early mobilization in the intensive care unit (ICU) can improve patient outcomes but has perceived barriers to implementation. As part of an ongoing structured quality improvement project to increase mobilization of medical ICU patients by nurses and clinical technicians, we adapted the existing, validated (PMABS) for the ICU setting and evaluated its performance characteristics and results.

Materials And Methods: The 26-item PMABS adapted for the ICU (PMABS-ICU) was administered as an online survey to 163 nurses, clinical technicians, respiratory therapists, attending and fellow physicians, nurse practitioners, and physician assistants in one medical ICU.

Identifying Barriers to Nurse-Facilitated Patient Mobility in the Intensive Care Unit.

Background: Nurse-facilitated mobility of patients in the intensive care unit can improve outcomes. However, a gap exists between research findings and their implementation as part of routine clinical practice. Such a gap is often attributed, in part, to the barrier of lack of time.

Increasing patient mobility through an individualized goal-centered hospital mobility program: A quasi-experimental quality improvement project.

Background: Hospital-acquired functional decline due to decreased mobility has negative impacts on patient outcomes. Current nurse-directed mobility programs lack a standardized approach to set achievable mobility goals.

Purpose: We aimed to describe implementation and outcomes from a nurse-directed patient mobility program.

Choosing Wisely Together: Physical and Occupational Therapy Consultation for Acute Neurology Inpatients.

Background: Although many hospitalized neuroscience patients have physical and occupational therapy (rehabilitation) needs, patients with none or minimal physical impairments frequently receive rehabilitation consultation, diverting from patients with greatest need.

Methods: A multidisciplinary team on the general and cerebrovascular neurology acute inpatient services mapped the rehabilitation consultation process, resulting in multiple implemented interventions including physician education on appropriate acute rehabilitation consultations, modification of multidisciplinary rounds, and discussion of patient rehabilitation needs throughout hospitalization. Nurses used the same functional impairment measurement tool used by physical and occupational therapists, the Activity Measure for Post-Acute Care Inpatient Short Forms (Basic Mobility and Activity domains).

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.

Optimizing an Enhanced Recovery Pathway Program: Development of a Postimplementation Audit Strategy.

Background: Enhanced recovery pathways (ERPs) are bundled best-practice process measures associated with reduction of preventable harm, decreased length of stay (LOS), and increased overall value of care. An auditing procedure was developed to assess compliance with 18 ERP process measures and establish a system for identifying and addressing defects in measure implementation.

Methods: For a one-year period, the electronic health records of 413 consecutive patients treated on a multidisciplinary ERP for colorectal surgery at an academic medical center were evaluated with the audit procedure.