By Rebecca Clark, Institute for Healthcare Improvement
If you’ve seen how quickly a relatively mobile older adult can turn into a frail and bedbound patient — not because of a primary illness, but because of a lack of movement — then you can appreciate how dramatically different care is at Saint Joseph Mercy Health System in southeast Michigan, and Anne Arundel Medical Center in Annapolis, Maryland.
In both hospitals, a plan for mobility is developed for each patient and implemented when appropriate. Both Saint Joseph Mercy and Anne Arundel are organizations taking part in the Age-Friendly Health Systems (AFHS), an initiative of the John A. Hartford Foundation and the Institute for Healthcare Improvement (IHI) in partnership with the American Hospital Association (AHA) and the Catholic Health Association of the United States (CHA).
Saint Joseph Mercy and Anne Arundel — like the other Age-Friendly Health Systems — have pledged to use an “age-friendly” approach to measurably improve the quality of care for older adults and optimize value for health systems. To provide older adults with the best care possible, they focus on four high-level interventions (referred to as the “4Ms”):
- What Matters: Know and act on each older adult’s specific health outcome goals and care preferences across settings.
- Medications: If medications are necessary, use age-friendly medications that do not interfere with What Matters, Mobility, or Mentation.
- Mentation: Identify, treat, and manage dementia, depression, and delirium across care settings.
- Mobility: Ensure that older adults move safely every day to maintain function and do What Matters.
Teams from both Saint Joseph Mercy and Anne Arundel have incorporated learning what matters most to their patients into their efforts to improve mobility. They share below how getting their elderly patients up and moving has become an essential part of daily care, changing patients’ lives and defying staff members’ expectations.
Saint Joseph Mercy Hospital
The staff on the Saint Joseph Mercy observation floor created a slogan — Mobility Optimizes Virtually Everything (MOVE) — to raise awareness of their goal to keep patients’ bodies, minds, and spirits moving to prepare them for discharge home. Posters with the word MOVE are on the walls and staff, patients, and families wear MOVE buttons to demonstrate their commitment to work together to meet this goal. Patients also receive shorts to wear during their mobility exercises.
On the Saint Joseph Mercy’s observation floor — where the length of stay is minimal and the primary focus is on the mobility part of the 4Ms — the manager got excited when she heard other Age-Friendly Health Systems participants talk about the value of learning what matters most to patients. She and her staff now ask patients on admission what matters most to them and document their answers. Staff incorporate this information into their care plan and follow up with a card at discharge wishing patients success on their goal.
Anne Arundel Medical Center
A 95-year-old woman fell in the yard with her walker and broke her hip. When she was admitted to Anne Arundel, the initial plan was for her to go to rehab after surgery. When staff asked what mattered most to her, they learned she didn’t want to go to rehab. Two days post-op, she was unable to walk. With help from a mobility tech, she walked four feet on the third day, and walked 8 feet on the fourth day. With help from her family, she reached her goal of returning home.
Daily mobility is now the norm at Anne Arundel Medical Center. More patients are ambulated every day than ever before, often two or three times a day. Many patients who in the past would have gone to rehab now go home because that’s their preference. Encouraging mobility has created opportunities for conversation with staff that help them better understand what matters most to their patients.
Says one Anne Arundel Medical Center staff member: “Thousands of Anne Arundel Medical Center patients have benefited from the work we’re doing to create Age-Friendly Health Systems with IHI and the John A. Hartford Foundation. It has profoundly changed our culture and our care model. Our CLABSI and CAUTI rates are at zero. On a unit where the average age is 84, we have not had a fall in three months. Patient satisfaction scores are 83 percent this quarter, up from the 50s.”
Join the Age-Friendly Health Systems Action Community
Would you like to be one of 100 teams from health systems across the US taking part in an Age-Friendly Health Systems Action Community? The Age-Friendly Action Community will begin in September 2018 and conclude in March 2019. There is no fee for participation.
Enroll now by emailing your name and health system to AFHS@IHI.org. Throughout the summer, IHI will work with you to identify your team and other activities to prepare for participation.