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Published on June 11, 2019

Doing this after surgery will help you get out of the hospital faster

Getting out of hospital faster

It’s no surprise that moving around after surgery can help with your rehabilitation process, but a recent study shows it makes more of a difference than previously thought.

Conducted by the Cedars-Sinai Department of Surgery, the study showed that each step taken toward a goal of 1,000 steps the day after surgery helped cut the odds of a lengthy hospital stay. Just how much can moving help? For every 100 steps, the length of stay decreased by 4 percent.

Johnathan Corsino, PT, DPT, inpatient physical therapist at Cape Cod Hospital, is a firm believer in patient mobility.

“Whether patients are post-surgical or admitted with medical problems, keeping them moving and helping them maintain strength and endurance is a foundational part of good patient care,” he said.

“In terms of hospital outcomes, it reduces length of stay, as shown in the Cedars-Sinai study. It reduces the likelihood of needing rehab on discharge and reduces readmissions from home. In short, it’s just plain good for them.”

To better evaluate patient mobility, Cape Cod Hospital recently began using the Johns Hopkins Highest Level of Mobility Scale.

“In most hospitals, the physician activity order is four really broad buckets. There’s bedrest, out of bed to chair, ambulate with assist, and ambulate ad lib [as much as desired].

To make sure that patients are moving the amount they need to, CCH recently started using the eight-point Johns Hopkins scale, Corsino said. For instance, a score of one is just lying in bed and a score of eight is walking 250 feet or more.

On every shift, nurses use the scale to document each patient’s activity. During daily rounds, the mobility scores are part of patients’ clinical snapshot.

“We use standardized language, and nurses assess mobility for every patient, every single shift,” he said. “If I know Mr. Jones was a seven on the scale yesterday and today he’s only a six, that signals to us either there’s a status change that we need to investigate or there’s some other reason that we’re not mobilizing this patient the amount that he should be.”

Deciding on the right amount of mobility for a patient takes a team approach. There’s no exact figure and a fair amount of judgement is involved.

“There is an amount of mobility that a patient should achieve every day or every shift, and our shared responsibility is to get them as close to that amount as possible.” This amount can’t be realistically stratified by diagnosis, by age, or by comorbidity alone; it’s highly dependent upon patients’ baseline functional capacities.

The mobility goals are in place no matter what the patient’s clinical condition, Corsino said.

“If you’re a very sick and impaired patient in Intensive Care, there’s an optimal amount of activity for you. If you’re in a different unit in the hospital, there might be a different amount, but as a care team, we’re going to achieve that activity together,” he said.

That’s especially important on Cape Cod, he added.

“With our older population, our patients can be affected to a greater degree by the strength and endurance that they lose during hospitalization. We want to avoid deconditioning.”

One big factor in whether a patient meets his mobility target is his motivation.

“We know that patients can influence their outcomes when they leave the hospital,” he said. “Most patients want to return directly home on discharge, so if we make it clear how their effort might translate to a better outcome, we can help them find motivation more effectively.”