The Challenge and the Evidence
- Rates of mobilization in patients admitted to acute care hospitals are unacceptably low.
- Hospitalized older adults who were ambulatory 2 weeks prior to admission spent a median of only 43 minutes per day mobilizing in hospital.
- One-third of older adults develop a new disability in an activity of daily living (ADL) during hospitalization; half are unable to recover function.
- Without mobilization elderly patients lose 1% to 5% of muscle strength each day in hospital
- Early mobilization strategies have positive impacts on length of stay, delirium, independent functional status, risk of depression, rates of discharge to home, and hospital costs.
The MOVE Project
The Building Blocks of MOVEs
The Division of Geriatric Medicine at the University of Toronto and its teaching hospitals have been focused on meeting challenges related to quality improvement in geriatric care. Early mobilization in hospital was identified as a key challenge that could be addressed by knowledge translation (KT) initiatives. Through collaboration between investigators interested in geriatric medicine, MOVE iT (Mobilization of Vulnerable Elders in Toronto), a project focused on the implementation of an innovative, scalable strategy to promote early mobilization and prevent functional decline, was conceptualized.
In November 2011, the Council of Academic Hospitals of Ontario's (CAHO) Adopting Research to Improve Care (ARTIC) Program funded an expansion of MOVE iT to hospitals across Ontario. This iteration of the project was called MOVE ON (Mobilization of Vulnerable Elders in Ontario). With the addition of the CAHO ARTIC funding, MOVE iT was amalgamated with MOVE ON as one initiative. In 2011-2012, the MOVE ON project was implemented in 14 hospitals across Ontario.
Funded by ARTIC Spread and Scale, MOVE iT/ MOVE ON was expanded on to an additional 15 units in seven of the 14 MOVE ON hospitals
In January 2015, the MOVE initiative was implemented in 5 hospitals across Alberta
Based on the positive responses received from the project unit sites to date, this project has been expanded further to additional hospital units globally. The goal of MOVE remains consistent with the overall goal of MOVE iT/ON, which is to implement and evaluate the impact of an evidence-based strategy to promote early mobilization and prevent functional decline in older patients admitted to acute care facilities.
Through this project, we implemented an inter-professional, education-based intervention that focused on early and consistent mobilization of older patients admitted to the hospital. This strategy shifted mobilization from being a designated task assigned to a single professional group to a shared team responsibility, with team members having complementary roles.
Key Messages for MOVEs Intervention
- Encourage mobilization at least three times a day
- Mobilization should be progressive and scaled
- Mobility assessments should be implemented within 24 hours from admission on the unit
Participating hospitals include
- Baycrest Centre for Geriatric Care
- North York General Hospital
- Hamilton Health Sciences
- St. Joseph's Healthcare Hamilton
- Health Sciences North
- St. Michael's Hospital
- Kingston General Hospital
- Sunnybrook Health Sciences Centre
- London Health Sciences Centre
- The Ottawa Hospital
- Montfort Hospital
- Thunder Bay Regional Health Sciences Centre
- Mt. Sinai Hospital
- University Health Network