Abstract
Background: Immobility in hospitalized patients presents numerous physical and physiological complications. Evidence suggests circadian variation negatively impacts various bodily functions and overall quality of life. Interventions such as waking patients during the day and keeping them active can help maintain a normal sleep-wake cycle. This early-to-rise and mobility project builds on a successful pilot in the hospital’s stroke unit that demonstrated a decrease in the length of stay (LOS) of stroke patients after three months.
Purpose: To prevent complications and improve efficiency, the project aims to increase patients’ mobility, decrease patients’ LOS, and lower the LOS index.
Methods: The Plan, Do, Check, Act (PDCA) model was used to manage and improve the project. An organizational meeting was held with managers and designated early-to-rise and mobility champions from six acute care units and covered the following topics: The project’s alignment with the hospital’s strategic plan for patient care, mobility interventions, patients will be encouraged to be out of bed starting at 6:30 a.m. to stimulate circadian rhythm, and roles and responsibilities of the champions in education, implementation, and data collection. The target population included all patients aged 18 and above in the six acute care medical-surgical units. Baseline data on patient mobility, LOS, and LOS index were collected from July to September 2023. Compliance with patient mobility was tracked, and monthly meetings were held to discuss progress and challenges. Patients and their families were educated on the early-to-rise and mobility interventions upon admission. Visual cues, such as laminated flyers, were posted in patient rooms to reinforce the interventions. Data on patient mobility were collected from the Epic electronic medical record and aggregated in the hospital’s Mobility Tableau dashboard.
Results: In 13 months, results showed patient mobility increased 100% from 0.9 to 1.8 times, decreased patient stays by 0.38, and LOS index dropped by 0.06.
Conclusion/Implications: Key factors for the project’s success included the engagement of leaders and unit champions, a clear implementation plan, and structured monthly meetings to address progress and challenges. Given the favorable outcomes, the hospital continues to implement and monitor the project. Monthly meetings ensure continuous improvement, and the results were shared with other hospitals within the system for potential adoption.
Notes
References: Bergbower, E., Herbst, C., Cheng, N., Aversano, A., Pasqualini, K., Hartline, C., Hamby-Finkelstein, D., Brewer, C., Benko, S., & Fuscaldo, J. (2020). A novel early mobility bundle improves the length of stay and rates of readmission among hospitalized general medicine patients. Journal of Community Hospital Internal Medicine Perspectives, volume 10 (5), 419-425. https://doi.org/10/20009666.2020.180373
Chippewa Valley Technical College. (2021). Christman, E., & Ernstmeyer, K. (Eds.). Nursing fundamentals: Open resources for nursing (pp. 791-849). Eu Claire (WI). https://www.ncbi.nlm.nih.gov/books/NBK591828/table/ch13mobility.T.effects_of_immobility_on/
Duss, S. B., Brill, A.K., Bargiotas, P., Facchin, L., Alexiev, F., Marconi, M., Bassetti, C.L. (2018, September) Sleep-wake disorders in stroke-increased stroke risk and deteriorated recovery? An evaluation of the necessity for prevention and treatment. Current Neurology and Neuroscience Report, 18(10), 72. https://doi/10.1007/s11910-018-0879-6.
Lo, E.H., Albers, G.W., Dichgans, M., Donnan, G., Esposito, E., Foster, R., Howells, D. W., Huang, Y., Ji, X., Klerman, E.B., Lee, S., Li, W., Liebeskind, D.S., Lizasoain, I., Mandeville, E., Moro, M., Ning, M., Ray, D., Sakadzic, S., Saver, J.L., Sheer, F.., Selim, M., Tiedt, S., & Zhang, F., Buchan, A. M. (2021). Circadian biology and stroke. Stroke, 52(6), 2180-2190. Doi: 10.1161/STROKEAHA.120.031742
Wu, X., Li, Z., Cao, J., Jiao, J., Wang, Y., Liu, G., Liu, Y., Li, F., Song, B., Jin, J., Liu, Y., Wen, X., Cheng, S., & Wan, X. (2018). The association between major complications of immobility during hospitalization and quality of life among bedridden patients: A 3-month prospective multi-center study. The Public Library of Science, volume 13(10): e0205729. Doi: 10.1371/journal.phone.0205729
Sigma Membership
Non-member
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Other
Research Approach
Translational Research/Evidence-based Practice
Keywords:
Acute Care, Evidence-Based Nursing Implementation, Mobility, Physical Activity, Mental Activity, Circadian Rhythms, Circadian Variation, Length of Stay, Stroke Patients
Recommended Citation
Livelee, Opal and Baldo, Helen Grace, "Early-to-Rise and Mobility" (2025). Biennial Convention (CONV). 256.
https://www.sigmarepository.org/convention/2025/presentations_2025/256
Conference Name
48th Biennial Convention
Conference Host
Sigma Theta Tau International
Conference Location
Indianapolis, Indiana, USA
Conference Year
2025
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2025-12-16
Early-to-Rise and Mobility
Indianapolis, Indiana, USA
Background: Immobility in hospitalized patients presents numerous physical and physiological complications. Evidence suggests circadian variation negatively impacts various bodily functions and overall quality of life. Interventions such as waking patients during the day and keeping them active can help maintain a normal sleep-wake cycle. This early-to-rise and mobility project builds on a successful pilot in the hospital’s stroke unit that demonstrated a decrease in the length of stay (LOS) of stroke patients after three months.
Purpose: To prevent complications and improve efficiency, the project aims to increase patients’ mobility, decrease patients’ LOS, and lower the LOS index.
Methods: The Plan, Do, Check, Act (PDCA) model was used to manage and improve the project. An organizational meeting was held with managers and designated early-to-rise and mobility champions from six acute care units and covered the following topics: The project’s alignment with the hospital’s strategic plan for patient care, mobility interventions, patients will be encouraged to be out of bed starting at 6:30 a.m. to stimulate circadian rhythm, and roles and responsibilities of the champions in education, implementation, and data collection. The target population included all patients aged 18 and above in the six acute care medical-surgical units. Baseline data on patient mobility, LOS, and LOS index were collected from July to September 2023. Compliance with patient mobility was tracked, and monthly meetings were held to discuss progress and challenges. Patients and their families were educated on the early-to-rise and mobility interventions upon admission. Visual cues, such as laminated flyers, were posted in patient rooms to reinforce the interventions. Data on patient mobility were collected from the Epic electronic medical record and aggregated in the hospital’s Mobility Tableau dashboard.
Results: In 13 months, results showed patient mobility increased 100% from 0.9 to 1.8 times, decreased patient stays by 0.38, and LOS index dropped by 0.06.
Conclusion/Implications: Key factors for the project’s success included the engagement of leaders and unit champions, a clear implementation plan, and structured monthly meetings to address progress and challenges. Given the favorable outcomes, the hospital continues to implement and monitor the project. Monthly meetings ensure continuous improvement, and the results were shared with other hospitals within the system for potential adoption.
Description
The project aims to improve patient outcomes and hospital efficiency by increasing mobility and maintaining a normal sleep-wake cycle using specific interventions. Over 13 months, patient mobility doubled, the length of stay decreased by 0.38 days, and the LOS index dropped by 0.06. Key factors for success included leader engagement, a clear plan, and regular progress meetings. The hospital continues to monitor and share the project's results for potential adoption by other hospitals.