Documenting Patient Mobility: Design of Electronic Tools for a Team Approach

More than 35 million patients in the United states are hospitalized each year, with many of these patients concurrently experiencing hospital-acquired impairments related to their physical mobility during their hospitalization (Hoyer et al., 2016). Hoyer et al. (2014) demonstrated that adults admitted to the medical service with low levels of physical mobility are at an especially high rate of readmission and lengthier hospital stays. Additionally, physicians may not recognize low mobility at admission or subsequent declines in mobility status during hospitalization thus leading to delayed placement in post-acute facilities upon discharge (Hoyer et al., 2018). The Activity Measure for Post-Acute Care (AMPAC) scoring tool is an accurate reflection of patient mobility status across a wide variety of patients in post-acute settings (Haley et al., 2004) and has excellent inter-rater reliability (Hiser et al., 2020), making it the recommended choice for clinician use in the inpatient setting. Sandel et al. (2013) validated that integrating the use of AMPAC scoring into clinical workflows and the electronic medical record (EHR) has the potential to assist clinicians in both medical decision making and discharge planning. Additionally, the AMPAC scoring tool has the ability to assist in prediction of the discharge destination (home, post-acute facility, long-term care facility, etc.) with remarkable accuracy (Jette et al., 2014). Young et al. (2019) combined the AMPAC scores with the patient's age, and was able to predict 73% of hospital discharges accurately thus leading to tools that create a more efficient discharge planning process. A second and similar tool, the John's Hopkins Highest Level of Mobility (JH-HLM), quantifies the patient's highest level of mobility in terms that are understood across multiple disciplines using a scale from one to eight, or lying in bed to walking 250 feet or more respectively. Each score on the JH-HLM tool corresponds to a range of AMPAC scores; these ranges suggest what level of mobility the patient is capable of achieving based on their AMPAC score. Hiser et al. (2020) demonstrated that the JH-HLM scoring has high inter-rater reliability for patients throughout the hospital, including the intensive care units (Hiser et al., 2020). The JH-HLM also provides tangible goals for patient mobility that are easily understood by both patient and nurse which increases the likelihood of accomplishing the defined goals.