Early Mobilization in Cardiovascular Units
- Conditions
- Cardiovascular Diseases
- Interventions
- Behavioral: Applying the Early Mobilization Program
- Registration Number
- NCT06393829
- Lead Sponsor
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal
- Brief Summary
Insufficient mobility contributes to functional decline in hospitalized cardiac patients. Early mobilization programs were shown to improve functional status, increase the likelihood of home discharges, and reduce the length of stay \[1\]. Therefore, there is a need to adapt and implement early mobilization programs in Quebec hospitals. The overall goal of this study is to adapt and implement an early mobilization program in the Cardiovascular units of the Jewish General Hospital (JGH).
- Detailed Description
Background: Insufficient mobility contributes to functional decline in cardiovascular units. Early mobilization programs were shown to improve functional status, increase the likelihood of home discharges, and reduce the length of stay \[1\]. One example is the Level of Function (LOF) Mobility Scale implemented in the Cardiovascular units at the Jewish General Hospital, an academic tertiary care centre in Montreal, Quebec \[2\]. Despite evidence supporting the benefits of early mobilization programs, hospitalized individuals in cardiovascular units spend most of the day in bed \[1-6\]. Therefore, there is a need to adapt and implement early mobilization programs in Quebec hospitals. This project is research nested in a quality improvement initiative for the Jewish General Hospital Cardiovascular units.
Objectives: 1) Adapt an early mobilization program in a hospital setting; 2) Develop strategies to overcome individual and organizational barriers to implementing an early mobilization program; 3) Assess the reach, acceptability, and fidelity of implementing an early mobilization program; and 4) Assess the program's impact on patients and the organization.
Methods: A 3-phase study using an iterative participative approach. Phase 1: a qualitative design to adapt an early mobilization program. Phase 2: mixed methods repeated measures design to assess barriers and facilitators to implementing the program and develop implementation strategies.
Phase 3: An interrupted time series design to assess the implementation and the impact of the program.
Expected contribution: Early mobilization programs in the Cardiovascular units can improve the quality of care provided to these patients and promote further clinician-researcher partnerships, contributing to improved uptake of best practices in this clinical context.
Recruitment & Eligibility
- Status
- NOT_YET_RECRUITING
- Sex
- All
- Target Recruitment
- 350
- All healthcare professionals working in the cardiovascular unit at the Jewish General Hospital.
- All patients admitted to the cardiovascular unit at the Jewish General Hospital.
- Patients who don't speak English or French.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SEQUENTIAL
- Arm && Interventions
Group Intervention Description Implementation Applying the Early Mobilization Program The proportion of patients mobilized during the intervention implementation period
- Primary Outcome Measures
Name Time Method Number of patients discharged to home versus number discharged to an institutional care. 3 months Number of patients discharged to home versus number discharged to an institutional care used to evaluate the Effect of early monbilization on the discharge destination (home or institutional care).
Number of patients mobilized divided by the total number of admitted patients during the evaluation period. 3 months Reach of the early mobilization program among patients will be measured with the following indicator: the number of patients mobilized (defined as the patient not being in bed during direct observation) divided by the total number of admitted patients during the evaluation period.
Number of implementation strategies developed to overcome the identified individual and organizational barriers and leverage the facilitators to implement an early mobilization program in this hospital setting. 3 months Investigators will develop strategies to overcome identified barriers and leverage the facilitators to implement the early mobilization program using data obtained from a mixed methods repeated measures design, including:
A) Shadowing: an observational grid will be developed, including frequency of mobilization, length of mobilization activity, Health care professionals (HCPs) performing mobilization intervention, type of mobilization intervention, patient and caregiver acceptance and reaction, environmental barriers, available equipment, communication strategies among HCPs, reporting of mobilization interventions in the medical charts, clinicians' comment and observers' impressions and thoughts.
B) HCPs will be invited to respond to a survey and participate in a focus group to assess perceived barriers and facilitators to early mobilization.
C) Patients and caregivers will participate in a focus group to better understand barriers and facilitators to early mobilization.Change in mobility levels during the unit's stay. 3 months Change in in mobility levels according to the LOF mobility scaleoccurring during the unit's stay.
Change in Length of stay 3 months Change in organizational outcomes measured by change in number of days the patient stay in the hospital.
Number of fall incidents occurring in the unit' during the evaluation period. 3 months Change in rate of falls occurring in the unit' during the evaluation period.
Number of Patients refused being mobilized compared to number of admited patients during the evaluation period. 3 months Acceptability of the early mobilization program among patients will be measured with the refusal rate of being mobilized using the site's administrative data and a file audit that will include a form developed for this purpose.
Number of days between admission and the development of a mobilization plan, between admission and first mobilization and number of patients with at least 3 mobilizations per day per week. 3 months Fidelity of intervention among HCPs will be measured with the following indicators:
* Number of days between admission and the development of a mobilization plan
* Number of days between admission and first mobilization
* Number of patients with at least 3 mobilizations per day per week.Change in number of Pressure ulcers occurance in the unit during the evaluation period. 3 months Change in Pressure ulcers rate in the unit during the evaluation period.
- Secondary Outcome Measures
Name Time Method
Trial Locations
- Locations (1)
Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal/Centre de rech interdisciplinaire en réadaptation du Montréal métropolitain
🇨🇦Montreal, Quebec, Canada