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“The Fourth Aim: Care of the Provider” President's Message—Making Work More Satisfying by Advancing Clinical Practice No abstract available

Implementation of an Activity-Monitoring System in Hospital-Based COPD Patients: A Retrospective Cohort Study Introduction: Patients with chronic obstructive pulmonary disorder are at risk of complications after hospitalization, including readmissions. The purpose of this study was to assess the effects of an activity-monitoring device on the outcomes of patient with chronic obstructive pulmonary disorder during and after a hospital admission. Methods: During a hospitalization, 52 patients (experimental group) diagnosed with chronic obstructive pulmonary disorder were provided with an activity monitor (Tractivity; (Kineteks Corporation, Vancouver, British Colombia, http://tractivity-online.squarespace.com/)) and 99 usual care patients were chosen as controls. Following hospital discharge, retrospective chart analysis examined patient demographics including falls, length of stay, discharge disposition, and hospital readmissions. Results: No difference in number of falls, length of stay, discharge disposition, and hospital readmissions could be found between groups (P > .05). Within the experimental group, those who were discharged home (n = 45) displayed a greater daily activity, number of steps, and ambulation distance as compared with patients who were discharged to another facility (n = 7, P < .05). Discussion: Readmissions are multifactorial and activity during a hospitalization may not be the primary cause of readmissions. Activity monitoring can help quantify ambulation and may be useful as a means to predict discharge disposition. Conclusion: No clear effect of using an activity monitor could be found on length of stay, readmission rates, and discharge disposition between the 2 groups. However, less activity and shorter ambulation distance were associated with discharge to another facility instead of home.

The Process of Implementing a Mobility Technician in the General Medicine and Surgical Population to Increase Patient Mobility and Improve Hospital Quality Measures: A Pilot Study Background: Hospital-associated disability (HAD) has been linked to prolonged and inappropriate immobility. HAD and increased postacute care (PAC) rehabilitation spending are also associated. Purpose: This pilot aims to describe the implementation processes of a designated mobility technician (MT), providing daily mobility on a medical and surgical acute care unit. During the MT implementation, we explore the resulting effects on patient length of stay (LOS), PAC utilization, patient satisfaction, falls, and hospital cost. Methods: A quality improvement pilot study was created comparing the percentage of PAC discharge locations before and during the mobility pilot (MP) on 1 general medical (GM) unit (37 beds) and 1 general surgical (GS) unit (27 beds). Following the nursing assessment of medical stability and mobility with a progressive mobility algorithm, patients were assigned a Johns Hopkins Highest Level of Mobility (JH-HLM) score and placed on the MT schedule. The MT mobilized each selected patient to the next appropriate level of mobility, with a goal of at least 1 JH-HLM level of increase and recorded the score. Patient discharge location was recorded at the end of the inpatient stay. Patient satisfaction scores, LOS, and incidence of falls were also monitored throughout the pilot. Outcomes: Eighty-nine percent of GM compared with 83% of the baseline data group patients and 83% of the GS compared with 90% for the baseline data group patients discharged to home with an average increase in JH-HLM score of 1.22 per mobility session. In addition, during the MP both units decreased the LOS by 5.84% to 9.03%, the GS unit experienced increased patient satisfaction scores by 9.19%, and both units improved Press Ganey ratings of Responsiveness of Staff by 16.47% to 37.00%. No falls were associated with the MT or MP and the GM unit decreased overall falls by 53.3%. Discussion: The MP is a promising tool for increasing patient mobility in the nonintensive care GM and GS setting, while potentially decreasing the need for PAC rehabilitation for many patients with minimal mobility deficits. Although not all of the results were statistically significant, positive effects on hospital ratings show promise toward helping to improve the overall patient experience during admission, decreasing LOS, decreasing overall fall rate, and an associated decrease in GM patient PAC spending in those most likely to be affected by HAD related to immobility. These positive effects can potentially improve hospital profit margins through the Centers for Medicare & Medicaid Services' value-based purchasing reimbursement program.

A Systematic Review Examining the Exercise Parameters Required to Induce the Repeated Bout Effect: Implications for Acute Care Physical Therapists Background: Acute care physical therapists regularly use therapeutic exercise to target body structures and functions as a supplement to or even replacing activity-based interventions. Interestingly, little is known regarding the mechanism of action explaining how exercise enables future activity and participation. One potential mechanism of action is the repeated bout effect (RBE), which is the phenomenon that a single bout of exercise provides protective adaptations for future exercise/physical activity. Purpose: To perform a systematic review examining the exercise parameters required to induce the RBE and explore how the results apply to acute care physical therapists. Data Sources: Academic Search Complete, CINAHL, MasterFILE Premier, MEDLINE, PsycINFO, and SPORTDiscus. Study Selection: The search included articles appearing before January 1, 2017. The following were the inclusion criteria: human subjects, randomized controlled trial design, published in English, treatment and control group engaged in exercise, lower extremity exercise intervention, and pre- and postintervention creatine kinase blood marker measurement. Data Extraction and Quality Assessment: Three reviewers extracted data and then assessed the methodological quality of the included articles. Results: Of the 1780 potential studies, seven were included. The RBE can be induced with exercise that includes an eccentric component, as well as with maximal voluntary isometric contractions at elongated muscle lengths. Concentric-only exercise does not induce the RBE and could instead blunt it. Stretching does not induce the RBE; however, it does not blunt it. Conclusion: The RBE enhances a person's tolerance for future exercise/physical activity. Consequently, the use of exercise to induce the RBE would be advantageous during initial and subsequent acute care physical therapist interventions. Future research is needed to specifically address the precise dose needed to induce the RBE in middle-aged and older adults, those with acute and chronic diseases, and women of all ages.

Early Postoperative Physical Therapy Evaluation After Total Hip and Knee Arthroplasty Reduces Hospital Length of Stay Purpose: To evaluate whether the timing of physical therapy (PT) after total hip arthroplasty (THA) and total knee arthroplasty (TKA) is associated with inpatient length of stay (LOS), patients with PT initiated on postoperative day (POD) 0 versus POD 1 were compared. Methods: For this evidence-based quality improvement project, a total of 260 patients were studied, with 122 patients receiving THA and 138 receiving TKA. Of the patients receiving THA, 85 received PT POD 0, and of the patients receiving TKA, 91 received PT POD 0. Data were compared with patients receiving THA and TKA who had PT on POD 1 during the same timeframe. Results: The average LOS for patients undergoing THA with PT on POD 0 versus POD 1 was 2.78 (standard deviation [SD] = 1.084) and 3.68 (SD = 2.484) days, respectively, and 2.95 (SD = 1.068) and 3.26 (SD = 0.920) days for patients undergoing TKA. Pearson χ2 analysis demonstrated a statistically significant shortened LOS for the POD 0 group (THA and TKA combined, χ2 = 16.535, P < .001). Patients in the POD 0 group were 3 times more likely to be discharged within 3 days compared with the POD 1 group (THA and TKA combined, 32% vs 11%). A greater proportion of the POD 0 group were discharged home compared with the POD 1 group (75% vs 46%). Conclusions: Our preliminary results show that providing PT evaluations on POD 0 is associated with a decreased LOS for patients following THA and TKA, which contributes to a considerable cost savings.

Interrater Reliability of the Functional Status Score for the Intensive Care Unit: Erratum No abstract available