Trial Outcomes & Findings for Improving Patient Walking During Hospitalization (NCT NCT04479943)

In this incomplete stepped-wedge design, Units were assigned randomly to Steps. Each Step contained exactly one Unit, and no Units dropped out. Within a Step, there was a Control period (pre-intervention); an Intervention run-in period, during which no Patients or Nursing Staff were enrolled (and therefore, this period is not shown in the Participant Flow table); and a Post-Intervention period. Patients and Nursing Staff were recruited in both Control and Post-Intervention periods.

Unit of analysis: Hospital Units

Improving Patient Walking During Hospitalization

Gait Speed is a physical performance measure identified as a sensitive clinical indicator of health, mortality, healthcare utilization, and independence in ambulation, and is feasible to test in hospitalized older adults. A 4 meter walk test will be conducted on admission to the study, discharge from the hospital and at 3 months post discharge in the subjects home or the hospital or clinic. A trained member of the research team will conduct the gait speed test. Interrater reliability for the 4 meter walk test will be conducted between all members of the research team prior to collecting gait speed data on study participants. Change scores will be calculated as the difference among gait speeds measured at each time points.

A trained member of the research team collected patients self-report of ADLs on admission to the study, discharge from the hospital, by phone at 1 month post intervention and 6 months post intervention, and in person at the 3 month post intervention visit using the Katz ADL Index. The Katz ADL Index is a self-report scale that measures six ADL on two levels (independent or requiring assistance of another). A score of 0-6 is possible, with higher scores indicating higher independence with ADLs and lower scores indicating higher dependence on others to perform ADLs. The scale demonstrates excellent reliability and predictive validity, and is sensitive to change in hospital settings. For the primary analysis, patients with a score of 6 were converted to a binary score of 1=Independent; all others were scored as 0=Dependent.

The University of Alabama at Birmingham (UAB) Life Space Assessment (LSA) is a self-report scale of ambulation that measures spaces patients' move in, the frequency of moving into those spaces, and dependency in moving into those spaces. This scale has demonstrated reliability and predictive validity and sensitivity to change after hospital stay. Level scores are calculated by multiplying the life-space level (higher numbers indicate farther distances moved, e.g., 1-inside the home to 5-places outside of the person's town), degree of independence (higher scores indicate greater independence), and frequency of movement (higher scores equal greater frequency). Total scores range from 0 (totally bed-bound) to 120 (moved out of town every day without assistance). A trained member of the research team will collect patients self-report on Life Space. Change scores will be calculated as the difference among LSA ambulation measured at each time point.

Hospital readmissions were collected via patient self-report and via medical record review by a trained researcher from the study team. Patient readmission was coded as 0=not readmitted, 1=readmitted. Reported value for each cell reflects a model-based estimate of the probability of readmission, a type of least squares mean appropriate for a binary variable.

Emergency department (ED) visits will be collected via patient self report. Patient ED usage was coded as 0=no ED visit, 1=any ED visit. Reported value for each cell reflects a model-based estimate of the probability of an ED visit, a type of least squares mean appropriate for a binary variable.

Length of hospital stay will be collected via patient medical record review by a nurse researcher from the study team.

Discharge destination (home, skilled nursing facility) was collected via patient medical record review by a nurse researcher from the study team. Patient discharge destination was coded as 1=discharged to home, 0=discharged to a skilled nursing facility. Reported value for each cell reflects a model-based estimate of the probability of discharge to home, a type of least squares mean appropriate for a binary variable.

Unit level data on ambulation. Each week, the total distance walked on that unit by all patients on the unit was recorded. We report the average total weekly distance walked, using a model-based least squares mean. The number of participants analyzed is large because this measure is unit-level and includes all patients observed on the unit during the study period, not only those enrolled in the full study, and will double count patients who were observed during more than one week.

Data collected from enrolled nursing staff via paper copies or online link before and after the intervention. The Barriers to Patient Ambulation Survey assesses the nurses opinions regarding ambulation of hospitalized patients within the past 2 weeks. It is scored from 0-100 with higher scores indicating increased barriers to ambulation.

Data collected from enrolled nursing staff via paper copies or online link before and after the intervention. The Ambulation Culture Survey asks for opinions on ambulation culture. We report responses to the item, "How would you rate your unit/work area on patient care related to ambulation?" This item has a minimum score of 1 (Poor) and a maximum score of 5 (Excellent). Higher values represent a better outcome.

Unit-level data on the percent of patients ambulated by nursing staff (as recorded in the electronic health record) out of the total number of ambulatory patients on the unit.

Data collected from enrolled nursing staff via paper copies or online link before and after the intervention. The Nurse Fatigue Survey measures experience of fatigue and strain at work and home. It is a 15 item survey scored on a 7 point likert scale from 0 (strongly disagree) to 6 (strongly agree) with the 3 subscales of 5 questions each (chronic fatigue, acute fatigue and intershift recovery) scored separately. Items for each subscale are aggregated into a percent of the total highest possible points (30) resulting in a range of scores from 0-100%, higher scores indicate higher fatigue.

Data collected from enrolled nursing staff via paper copies or online link before and after the intervention. The Nurse Fatigue Survey measures experience of fatigue and strain at work and home. It is a 15 item survey scored on a 7 point likert scale from 0 (strongly disagree) to 6 (strongly agree) with the 3 subscales of 5 questions each (chronic fatigue, acute fatigue and intershift recovery) scored separately. Items for each subscale are aggregated into a percent of the total highest possible points (30) resulting in a range of scores from 0-100%, higher scores indicate higher fatigue.

Data collected from enrolled nursing staff via paper copies or online link before and after the intervention. The Nurse Fatigue Survey measures experience of fatigue and strain at work and home. It is a 15 item survey scored on a 7 point likert scale from 0 (strongly disagree) to 6 (strongly agree) with the 3 subscales of 5 questions each (chronic fatigue, acute fatigue and intershift recovery) scored separately. Items for each subscale are aggregated into a percent of the total highest possible points (30) resulting in a range of scores from 0-100%, higher scores indicate higher fatigue.

Data collected from enrolled nursing staff via paper copies or online link before and after the intervention. The Professional Quality of Life Survey measures positive and negative experiences within the last 30 days in a 30-item survey scored on a 5 point likert scale from 1 (never) to 5 (very often). The Compassion Satisfaction subscale has a range of scores from 10-50, with higher scores indicative of higher compassion satisfaction. Please note that for this subscale, scores were transformed before analysis using a Box-Cox (squared) transformation in order to meet the assumption of normally distributed model residuals; in effect the square-scale score has a range from 100-2500, where higher scores are still better. This results in reported least squares means that are very large compared to the original scale.

Data collected from enrolled nursing staff via paper copies or online link before and after the intervention. The Professional Quality of Life Survey measures positive and negative experiences within the last 30 days in a 30-item survey scored on a 5 point likert scale from 1 (never) to 5 (very often). There are 3 subscales: Compassion Satisfaction, Burnout, and Secondary Traumatic Stress, each subscale has a range of scores from 10-50, with higher scores indicative of higher compassion satisfaction, higher burnout, and higher secondary traumatic stress.

Data collected from enrolled nursing staff via paper copies or online link before and after the intervention. The Professional Quality of Life Survey measures positive and negative experiences within the last 30 days in a 30-item survey scored on a 5 point likert scale from 1 (never) to 5 (very often). There are 3 subscales: Compassion Satisfaction, Burnout, and Secondary Traumatic Stress, each subscale has a range of scores from 10-50, with higher scores indicative of higher compassion satisfaction, higher burnout, and higher secondary traumatic stress.

Enrolled nursing staff will be interviewed and interviews will be coded for themes. Themes will be summarized to report by participant count.

Billing data will be used retrospectively to understand use of PT services on the intervention units at pre-intervention, intervention, and post-intervention data collection periods

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPHS) is a participant self-reported survey that measures patient satisfaction. Participants rank their hospital experience from 1-5, where 5 is the best possible experience.

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a participant self-reported survey that measures patient satisfaction. Reported here are the Participant Counts of Responses to Strongly disagree/Disagree/Agree/Strongly agree to the following questions: During this hospital stay, staff took my preferences and those of my family or caregiver into account in deciding what my health care needs would be when I left When I left the hospital, I had a good understanding of the things I was responsible for in managing my health When I left the hospital, I clearly understood the purpose for taking each of my medications Analysis will include shifts in the distribution of responses across response options, as well as changes in frequency/percentage of top-box responses (responses of "Strongly agree") relative to all responses.

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a participant self-reported survey that measures patient satisfaction. Reported here are the Participant Counts With Satisfaction Responses to Definitely no/Probably no/Probably yes/Definitely yes to the following question: Would you recommend this hospital to your friends and family? Analysis will include shifts in the distribution of responses across response options, as well as changes in frequency/percentage of top-box responses (responses of "Definitely Yes") relative to all responses.

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPHS) is a participant self-reported survey that measures patient satisfaction. Participants rank their hospital experience from 0-10, where 10 is the best possible hospital.

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPHS) is a participant self-reported survey that measures patient satisfaction. Reported here are the Participant Counts of whether they went home, to someone else's home, or another facility after discharge.

Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a participant self-reported survey that measures patient satisfaction. Reported here are Participant Counts to questions with response options: Never, Sometimes, Usually, Always. Analysis will include shifts of distribution across response options and changes in frequency/percentage of top-box responses ("Always") relative to all responses. Questions include: During this hospital stay, how often did nurses treat you with courtesy and respect? how often did nurses listen carefully to you? how often did nurses explain things in a way you could understand? after you pressed the call button, how often did you get help as soon as you wanted it? how often were your room and bathroom kept clean? how often was the area around your room quiet at night? How often did you get help in getting to the bathroom or in using a bedpan as soon as you wanted?

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPHS) is a participant self-reported survey that measures patient satisfaction. Reported here are the Participant Counts of those who answered "Yes" to the following Yes or No questions: * During this hospital stay, did you need help from nurses or other hospital staff in getting to the bathroom or in using a bedpan? * During this hospital stay, were you given any medicine that you had not taken before? * During this hospital stay, did doctors, nurses, or other hospital staff talk with you about whether you would have the help you needed when you left the hospital? * During this hospital stay, did you get information in writing about what symptoms or health problems to look out for after you left the hospital? * During this hospital stay, were you admitted to this hospital through the Emergency Room? * Were you visited by a member of our nursing leadership team during your stay?