Queen Elizabeth University Hospital Emergency Laparoscopic and Laparotomy Scottish Audit early mobility project

Purpose

ELLSA is the Emergency Laparoscopic and Laparotomy Scottish Audit. The aim of this audit is to reduce morbidity and mortality in a high risk group. The aim of this project was to ensure that ELLSA patients at Queen Elizabeth University Hospital (QEUH) Glasgow were mobilised at the earliest opportunity post operatively.

By targeting early mobility in ELLSA patients
the proportion that mobilise POD 1 increased to 80%. By increasing early mobility, LOS and bed days have reduced.
The number of patients mobilised POD 1
increased by 20% during the study period.

Approach

Baseline data showed < 60% of ELLSA patients were managing to mobilise out of bed on post operative day 1 (POD 1).

In February 2019 ELLSA patients were targeted by the nursing and physiotherapy staff to mobilise out of bed at the earliest opportunity - ideally POD 1. The post operative day that the patient first mobilised out of bed, length of hospital stay (LOS) and barriers to early mobility were recorded.

Frailty and risk were recorded using the Canadian Study of Health and Aging Frailty Scale and the National Emergency Laparotomy Audit (NELA) risk score. The NELA risk score provides an estimate of the risk of death within 30 days of surgery. High risk is > 5%.

Outcomes

20 ELLSA patients were admitted to QEUH in February 2019. The mean frailty score was 2. The mean frailty score for patients requiring physiotherapy was 3.

The mean NELA score was 4.8% and the mean NELA score for patients requiring physiotherapy was 6.59%.

81% mobilised out of bed on POD 1.

11 patients (55%) required physiotherapy during their hospital stay, and 9 of these patients were > 65 years.

Four patients requiring physiotherapy started their post operative recovery in critical care. The mean day of starting physiotherapy was 3.75 days post operatively.

Mobility was delayed in 7 patients due to uncontrolled pain, sedation and ventilation, cardiovascular instability, and leaking wound.

Mean LOS was 13 days and mean LOS for patients requiring physiotherapy was 18.8 days.

In March 2019 post operative mobility returned to baseline levels of < 60% of patients mobilising POD 1.

 

The number of patients mobilised POD 1 increased by 20% during the study period.

ELLSA patients who required physiotherapy at QEUH were frailer pre operatively and had higher risk scores than the ELLSA group as a whole.

 

Criteria for immediate physiotherapy referral post operatively have been identified:

1) NELA score of > 5

2) Frailty score 3 or above

3) Age 65 or above.

 

By mobilising more patients out of bed quicker LOS and bed days have reduced.

Implications

By targeting early mobility in ELLSA patients the proportion that mobilise POD 1 increased to 80%. By increasing early mobility, LOS and bed days have reduced.

All patients who are high risk, have frailty scores > 3 and are elderly should be referred for physiotherapy. This should be incorporated into a care pathway (which is in development) to trigger early physiotherapy referral.

Future development projects include increasing nursing staff confidence in early mobility and pain control in ELLSA patients.

Funding acknowledgements

This work has not been funded. 

Additional notes

This work was presented at Physiotherapy UK 2019