Introduction: The detriments of prolonged bedrest are well described, yet most hospitals fail to provide enough ambulation to their patients to prevent significant deconditioning and patient harm. One potential strategy for overcoming this problem is the use of an ambulation orderly (AO), an employee whose primary responsibility is to walk patients up to 3-4 times per day. In May 2013, our hospital instituted an AO program among post-operative cardiac surgical patients. We hypothesized that the introduction of an AO program would be associated with improved patient outcomes.
Methods: We evaluated all patients undergoing either coronary artery bypass and/or cardiac valve surgery between September 2012 and March 2014. We evaluated the impact of the AO program on post-operative length of stay (LOS), hospital complications, discharge disposition, and 30-day hospital readmission with both a pre-post study design and an interrupted time-series analysis.
Results: We identified 925 patients (68.3 years, 68% male, 92% white) during the study period, with no major shifts observed in patient demographics over the study period. Compared to the pre-AO group, the median post-operative LOS (IQR) decreased from 8 (6 to 11) to 7 (6 to 10) days, p < 0.001 for the post-AO group. Additionally, variability around the median length of stay decreased significantly (Brown-Forsythe p = 0.05). See Figure. Time series analysis found that there was no significant baseline trend in LOS (+0.07, p =0.53), but that initiation of the AO program was associated with decreased post-operative LOS (-1.1 ±0.8 days, p =0.16), and a favorable change in the post-AO slope (- 0.30 ± 0.15 days, p = 0.048). Other outcomes were unaffected.
Conclusions: The institution of an AO program at our hospital was associated with both a significantly reduced LOS as well as reduced LOS variability, without a change in the rate of hospital complications or 30-day readmission. These results suggest that an AO program is a promising strategy for improving quality and decreasing costs.