Metrics Definition - Patient Mobility
Patient Mobility
Inpatient mobility is defined as movement associated with changing body position or location or by transferring from one place to another, by carrying, moving or manipulating objects, by walking, running or climbing, and by using various forms of transportation. A mobility event is associated with a subdomain of mobility, such as rolling over in bed, act of sitting, transferring or walking. These events occur when patients participate in physiotherapy, nursing care, exercise and activities of daily living in the hospital context.
Mobility Promotion and Documentation
Early mobilization of inpatients helps prevent deconditioning and has been shown to shorten hospital encounters while improving outcomes. Loss of muscle strength and function begins within the first 24 hours of immobility, immediately accelerating frailty-exacerbated risks for complications such as lung atelectasis, deep vein thrombosis, skin breakdown, delirium and hospital-acquired infections.
Mobilizing inpatients at least three times a day is an expected best practice. It is also expected that mobilization activities are documented and trended throughout a hospital stay.
Mobility Promotion for Patients with Frailty
Mobilizing patients with frailty is essential for maintaining their physical health, functional abilities, psychological well-being, and overall quality of life. It helps prevent complications associated with immobility and promotes faster recovery and better long-term outcomes.
Note: tracking mobility for patients with frailty should be preceded by completing the Frailty Screening. Unless patients at risk have been identified, mobility cannot be reliably tracked for this cohort of patients.
Workflow
Patient Mobilization Tracking
Nursing daily care flowsheets include rows for recording what mobility events were promoted at what times. These are typically used on mobile workstations as a nurse is doing patient rounds.
Data
Patient Mobility Tracking
A "Daily Care/Safety" nursing flowsheet (FLT 226) is used as the record of mobility documentation for current measures. This flowsheet has a subsection focusing on "Activity/Mobility" with a row for recording the current activity level for a patient as well as the patient's response to a mobilization intervention.
Activity level row (FLO 3041602055) has categorical options where anything except "bedrest" and "other" indicates an observed mobility event.
Repositioning row (FLO 400604) has any non-null option indicating a mobility intervention.
Transfer row (FLO 1500004118, binary) reflects mobility interventions associated with a transfer in patient position or location.
Physical Therapy, Occupational Therapy, Recreational Therapy, Therapy Assistant Visits
Interactions with these allied health disciplines is captured in the Attendance/Visit activity if a visit is face-to-face and lasts 5 minutes or longer. Such visit events are proxies for structured patient mobility activities.
Metrics
Patient Mobility Tracking
Description
Proportion of qualifying inpatient days in which patient(s) experienced documented mobility events 3 or more times in the day.
Denominator
Number of Patient Encounters where:
Inpatient (EPT 10110 = Inpatient) AND
Observation occurs between admission instant (ADT 59) and discharge instant (EPT 18855 and EPT 18856)
Exclude
patient days where patient admitted after 0900
patient days where patient discharged during day
Numerator
Number of unique* Patient Mobility Events per day for patient encounters in denominator where:
For nursing/HCA, one mobility event = single flowsheet row documentation instant:
EPT ID (I FSD 200) = Patient in denominator
AND Instant Taken (I FSD 1010) = Within date and time range of denominator
AND {Flowsheet ID (I FSD 1000) = 3041602055 WHERE Flowsheet Value (I FSD 1050) <> Bedrest OR Other OR Flowsheet ID (I FSD 1000) = 400604 WHERE Flowsheet Value (I FSD 1050) = NOT NULL OR Flowsheet ID (I FSD 1000) = 1500004118 WHERE Flowsheet Value (I FSD 1050) = Yes
For PT/OT/RecT/TA, one mobility event = single attendance (i.e., charge code) of Visit with Allied Health or Specialty Encounter:
Patient CSN (I HTR 62) = Patient in denominator
AND Service Date (I HTR 45) = Within date range of denominator
AND Time of Service (I HTR 260) = Within time range of denominator
AND Revenue Code (I HTR 150) = Stat Provider and Workload [1009]
*Note: If multiple flowsheet rows were documented on the same column (i.e., same time), these are counted as single mobility event. If both attendance charge code and flowsheet rows share the same timestamp, they are counted as single event.
Calculation
Numerator DIVIDED INTO Denominator expressed as PERCENTAGE rounded up to nearest integer percentage point
Filters
Hospital Specialty Service: ADT 70 - CATEGORY - (e.g., General Internal Medicine [106])
Hospital Unit: EPT 18880 - CATEGORY - inpatient unit/ward (e.g., EDM UAH WMC 5D4 GIM [101094229])
Hospital Facility: EPT 18883 - CATEGORY - (e.g., EDM WMC University of Alberta Hospital [101094])
Analytics Definition
Mobility Tracking - Patients with Frailty
Description
Proportion of inpatient days for frail (Clinical Frailty Scale >=5 or Edmonton Frail Scale >=6) older adults (65+) in which patient(s) experienced documented mobility events 3 or more times in the day.
Denominator
Number of Patient Encounters where:
Inpatient (EPT 10110 = Inpatient) AND
Observation occurs between admission instant (ADT 59) and discharge instant (EPT 18855 and EPT 18856) AND
Age at Encounter (I EPT 120) >= 65 AND
Clinical Frailty Scale >=5: Flowsheet ID (I FSD 1000) = 10306 WHERE Flowsheet Value (I FSD 1050) >= 5 OR
Edmonton Frail Scale (Acute Care) >=6: Flowsheet ID (I FSD 1000) = 210770348 WHERE Flowsheet Value (I FSD 1050) >= 6 OR
Edmonton Frail Scale (Bedside) >=6: Flowsheet ID (I FSD 1000) = 22361 WHERE Flowsheet Value (I FSD 1050) >= 6
Numerator
Same as above
Calculation
Same as above
Filters
Same as above
Analytics Definition
Limitations
Documentation Activity
The measured activity is a documentation task, not actual patient mobility events. The associated nursing workflows are supported with Connect Care Navigators that help to remind about tasks that should be performed at particular times and in particular contexts.
There are a number of ways by which a patient mobility metric can mis-represent actual patient mobility interventions or actions:
When patient basic or instrumental activities of daily living assessments are recorded, there are ambulation and transfer components which are not captured unless the clinician documents them on separate flowsheet rows.
Some mobility events will be reported twice when a patient is assessed jointly by two or more clinicians who then need to document individually to comply with professional practice guidelines.
Mobility events documented in notes often are not included in flowsheets.
Current flowsheet-based indicators do not reflect the level of assistance required to complete the mobility event, yet this requirement for assistance may be key to discharge readiness.
Documentation Norms
Nursing and allied health care professions heed documentation norms that promote "charting by exception" to streamline documentation. This approach assumes that a patient has displayed a normal (expected) response for all assessment components and documentation focuses on abnormal or unexpected responses. As this is the way that most nursing flowsheets are used, there is a good chance that the mobility section of the Daily Care/Safety flowsheet will be biased towards reporting of variance from expected mobility at a particular stage of an inpatient encounter.
Other Measures
Physiotherapy, occupational therapy and recreational therapy health care professionals have their own documentation tools where mobility events associated are recorded. These can be much more specific about offered interventions, patient capacity and compliance and indicators of meaningful progress. Important information can be recorded as unstructured text, with no associated flowsheet or other data points. Currently, this information is not incorporated into the base patient mobility documentation metric.