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Effects of an Ambulation Orderly Program Among Cardiac Surgery Patients - 01/11/17

Doi : 10.1016/j.amjmed.2017.04.044 
Saki Miwa, MD, MPH a, b, Paul Visintainer, PhD c, Richard Engelman, MD d, Amanda Miller, RN e, Tara Lagu, MD, MPH a, f, g, Erin Woodbury, MS h, i, Peter K. Lindenauer, MD, MSc a, f, g, Quinn R. Pack, MD, MSc a, e, f, g,
a Department of Internal Medicine, Baystate Medical Center, Springfield, Mass 
b Department of Cardiology, State University of New York Downstate Medical Center, Brooklyn 
c Office of Research, Baystate Health, Springfield, Mass 
d Department of Surgery, Baystate Medical Center, Springfield, Mass 
e Division of Cardiovascular Medicine, Baystate Medical Center, Springfield, Mass 
f Center for Quality of Care Research, Baystate Medical Center, Springfield, Mass 
g Tufts University School of Medicine, Boston, Mass 
h Department of Applied Exercise Science, Springfield College, Mass 
i Research Program in Men's Health, Brigham and Women's Hospital, Boston, Mass 

Requests for reprints should be addressed to Quinn R. Pack, MD, MSc, Department of Internal Medicine, Baystate Medical Center, 759 Chestnut Street, Springfield, MA 01089.Department of Internal MedicineBaystate Medical Center759 Chestnut StreetSpringfieldMA01089

Abstract

Background

Despite the known benefits of ambulation, most hospitalized patients remain physically inactive. One possible approach to this problem is to employ “ambulation orderlies” (AOs) – employees whose main responsibility is to ambulate patients throughout the day. For this study, we examined an AO program implemented among postcardiac surgery patients and its effect on patient outcomes.

Methods

We evaluated postoperative length of stay, hospital complications, discharge disposition, and 30-day readmission for all patients who underwent coronary artery bypass or cardiac valve surgery in the 9 months prior to and after the introduction of the AO program. In addition to pre-post comparisons, we performed an interrupted time series analysis to adjust for temporal trends and differences in baseline characteristics.

Results

We included 447 and 478 patients in the pre- and post-AO intervention groups, respectively. Postoperative length of stay was lower in the post-AO group, with median (interquartile range) of 10 (7, 14) days vs 9 (7, 13) days (P <.001), and also had significantly less variability in mean monthly length of stay (Levene's test P = .03). Using adjusted interrupted time series analysis, the program was associated with a decreased mean monthly postoperative length of stay (−1.57 days, P = .04), as well as a significant decrease in the trend of mean monthly postoperative length of stay (P = .01). Other outcomes were unaffected.

Conclusion

The implementation of an AO program was associated with a significant reduction in postoperative length and variability of hospital stay. These results suggest that an AO program is a reasonable and practical approach towards improving hospital outcomes.

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Keywords : Ambulation, Cardiac surgery, Hospital outcomes, Mobility


Esquema


 Funding: QRP was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health, Award Number KL2TR001063. TL is supported by the National Heart, Lung and Blood Institute, Award Number K01HL114745. PKL is supported by grant K24HL132008 from the National Heart Lung and Blood Institute.
 Conflict of Interest: None.
 Authorship: All authors had access to the study data and had a role in writing this manuscript.


© 2017  Elsevier Inc. Reservados todos los derechos.
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Vol 130 - N° 11

P. 1306-1312 - novembre 2017 Regresar al número
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