THE MOBILITY INITIATIVE: USING QUALITY IMPROVEMENT METHODOLOGY IN A UAE-BASED ACUTE CARE SETTING

E. Steenbergen¹, C. Fagan¹

Background: The effects of prolonged immobilization and importance of early mobility have been widely described. The United Arab Emirates, as a relatively young nation, has a developing healthcare system with a diverse clinical workforce and mostly inactive patient population with significant health illiteracy. Gap analysis revealed poorly defined roles and lack of a safe multidisciplinary approach towards early and routine mobility in our institution.

Purpose: Our purpose was to increase patient mobility rates and hardwire mobility as an organizational key performance indicator (KPI) by using QI methodology to design and implement a standardized mobility process and foster an interdisciplinary culture of mobility on the acute care unit (ACU) and intensive care unit (ICU).

Methods: This QI project was undertaken in a tertiary acute care hospital in Abu Dhabi. The multidisciplinary taskforce consisted of nurses, doctors, physical therapists, administrative and executive leadership. A Plan-Do-Check-Act (PDCA) methodology was utilized. We incorporated four key QI principles: focus on 1) systems and processes, 2) patients, 3) multidisciplinary teamwork and 4) data. A battery of QI tools, including Pareto and Fishbone diagrams, identified lack of standardized work process for mobilization of patients as the root cause of immobility. After systematic review of nursing mobility assessment tools, the Bedside Mobility Assessment Tool (BMAT) was hypothesized as an effective intervention and the tool was tested on a 36 bed medical ACU. Daily audits calculated mobility rates based on percentage of medically stable patients who were mobilized (defined as those who passed the MOVES criteria on BMAT tool). The BMAT was initially tested on a small cohort of patients and then rolled out incrementally in keeping with the PDCA theory of small rapid tests of change for data-driven continuous improvement. The BMAT was proposed to be complemented by the Traffic Light System (TLS) for additional safety screening in ICU but this pilot was delayed due to the Covid-19 pandemic.

Results: Baseline data collected 2019-2020 suggested that 59% (n=99) of eligible ACU patients were mobilized daily by nursing staff. Of 218 encounters during the pilot, 83% (n=181) passed MOVES criteria deeming them eligible for mobilization. The average mobility rate for this cohort increased to 91% (n=181) with implementation of BMAT with an average of 12 patients tested per day. The qualitative feedback suggested that use of BMAT gave nursing staff clear direction on the appropriateness of mobilizing patients. As the project was suspended due to COVID-19 pandemic, organizational spread of BMAT was deferred and efforts to hardwire mobility as a KPI are ongoing.

Conclusion(s): Our early mobilization strategy, incorporating BMAT, increased patient mobility rates and addressed educational deficits related to mobility in our ACU. The multidisciplinary QI methodology endorsed by executive leadership allowed for successful implementation. Our project was limited by COVID-19 restrictions. A further pilot will determine the effectiveness of BMAT combined with TLS in the ICU setting.

Implications: Compliance with a defined QI protocol is an effective approach for structured data-driven change in clinical practice. Our project focused on mobility but our methodology can be applied to any QI project for organizational change.

Funding, acknowledgements: No funding disclosures

Keywords: Early Mobility, Continuous quality improvement, Change management

Topic: Professional issues: business skills, leadership, advocacy & change management

Did this work require ethics approval? No

Institution: Cleveland Clinic Abu Dhabi

Committee: Cleveland Clinic Abu Dhabi Research Ethics Committee

Reason: It is an innovative way in which established methods have been adapted to meet the changing needs of practice