Early Mobility Protocol in Postoperative Spine Patients

Background: Early mobilization after surgery has been beneficial to multiple groups of patients, but the compliance to mobilization targets has been low.
Purpose: The purpose of this project was to measure the effect of a nurse-driven early mobility protocol (EMP) on the length of stay (LOS) in patients following spine surgery.
Method: This was a quality improvement (QI) project with a before and after study design. The EMP was tested using Plan-Do-Study-Act (PDSA) cycles, modified and then implemented for 8 weeks. Education was provided to the nursing staff, and charge nurses acted as champions. The LOS was determined based on the patient's admission time to the neurosurgery unit and the time the discharge order was entered in the electronic medical record (EMR). The data and time of first mobilization was obtained manually from the EMR and the EMP worksheet for each patient.
Results: Fifty patients received the EMP, and the results were compared with fifty-six patients in the pre-EMP group. The staff’s compliance with the EMP was high at 92.6%. The mean LOS decreased by 11 hours between the two groups, 46.3 hours to 35.3 hours, although it was not statistically significant. The first time to out of bed significantly decreased by 5 hours from 8.9 hours in the pre-EMP group to 3.9 hours in the EMP group (U = 620, p < .001, r = .44).
Conclusion: Implementing a nurse-driven EMP was successful. This intervention was effective as shown by the decreasing LOS and the first time to out of bed. Feasibility was demonstrated by high compliance with the use of the EMP. It also showed an impact of a nurse-driven protocol by changing the process of care, designed by utilizing the Donabedian framework and PDSA cycles. Finally, sustaining a culture change that supports continuing the use of the EMP will depend on the use of champions, engaging nurses and management to ensure sustainability.