Can Mobility Technicians Provide Value to Hospitalized Patients?

Vanderbilt University Medical Center

Status: Withdrawn

Conditions: Lung Transplant; Hip Fractures; Lower Extremity Fracture

Treatments: Behavioral: Patient Mobility

Study type: Interventional

Funder types: Other

Identifiers

NCT03874767

000000000

Details and patient eligibility

About

The specific aim of this study is to determine the impact of the addition of a dedicated mobility technician to the care team on specialty specific outcomes for patients recovering from surgical treatment for a hip or lower extremity long bone fracture or a lung transplant.

The practice of post-operative early ambulation has been shown to improve outcomes by promoting enhanced recovery after surgery in a variety of patients. To that end, VUMC is establishing a "Culture of Mobility". To do so, additional personnel are being hired to help ambulate patients with traumatic hip and femur fractures, other fractures of the lower extremity long bones, as well as those post-lung transplant or readmitted post-lung transplant based upon the best available evidence supporting mobility programs. The added personnel are needed as the currently available resources have insufficient bandwidth to ensure complete early ambulation for all patients. The relative effectiveness of adding a dedicated resource is assumed. Although the literature suggests adding person-hours increases the amount of mobility achieved, there is an opportunity to evaluate whether this is really the case.

The goal of this study is to evaluate the impact of adding the mobility technician to the existing care team. The mobility technician will be assisting patients who could benefit from early ambulation after surgery. We hypothesize that by adding this staffing resource, more patients will get the appropriate level of usual care. Specifically, we expect that adding the resource increases the proportion of those patients who are receiving the prescribed amount of early ambulation post-surgery, with subsequent improvements in functional independence at discharge, and decreases length of stay since patients achieve readiness for discharge sooner.

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• All traumatic fractures of the hip or a lower extremity long bone
• Post-lung transplant patient
• Patient readmitted following a lung transplant

Exclusion criteria

• Non-traumatic joint replacements
• Patients with ankle fractures
• Pre-lung transplant patients
• Patients readmitted to the orthopedics unit following a traumatic injury

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Crossover Assignment

Masking: None (Open label)

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0 participants in 2 patient groups

10th floor south

Active Comparator group

Description:

The unit in this arm will be assigned physical therapists plus mobility technicians in the first month and only physical therapists in the following month. During months where a unit has been assigned the mobility technicians, the mobility technician, along with nursing staff, will deliver additional prescribed mobility as well as standard-of-care prescribed therapy provided by physical therapy staff: 1. On evaluation, a PT will assign a JH-HLM scale rating to the patient 2. If the score is 4 or higher, the PT will add the patient to the mobility technician patient list 3. The mobility technician will then see that patient daily, unless the score is \<4 4. Each PT session will involve a re-assessment by the PT of the JH-HLM scale rating as well as the Function Independence Measurement (FIM) score, and subsequently will update the recommended therapy if appropriate 5. The mobility technician will work with PT and nursing to determine the best time to deliver mobility

Treatment:

Behavioral: Patient Mobility

6th floor Round Wing

Active Comparator group

Description:

The unit in this arm will be assigned only physical therapists in the first month and physical therapists plus mobility technicians in the following month. During months where a unit has been assigned the mobility technicians, the mobility technician, along with nursing staff, will deliver additional prescribed mobility as well as standard-of-care prescribed therapy provided by physical therapy staff: 1. On evaluation, a PT will assign a JH-HLM scale rating to the patient 2. If the score is 4 or higher, the PT will add the patient to the mobility technician patient list 3. The mobility technician will then see that patient daily, unless the score is \<4 4. Each PT session will involve a re-assessment by the PT of the JH-HLM scale rating as well as the Function Independence Measurement (FIM) score, and subsequently will update the recommended therapy if appropriate 5. The mobility technician will work with PT and nursing to determine the best time to deliver mobility

Treatment:

Behavioral: Patient Mobility