Dr. Sharon Straus is a geriatrician, general internist, clinical epidemiologist and Director of the Knowledge Translation (KT) Program at the Li Ka Shing Knowledge Institute of St. Michaels and the Division Director for Geriatric Medicine at the University of Toronto. She holds a Canada Research Chair in Knowledge Translation and Quality of Care.
CAHO Catalyst recently sat down with Sharon and asked her to reflect on the MOVE ON application and her research at St. Michaels.
Can you briefly describe to our readers what the MOVE ON project is and what inspired the research and development of this application?
Were interested in implementing and evaluating an evidence-based strategy to promote early mobilization and prevent functional decline in older patients admitted to acute care facilities in Ontario. We decided to tackle this issue because the rates of mobilization of patients admitted to acute care hospitals are very low. Studies show that hospitalized older adults who were ambulatory during the two weeks prior to admission spent a median of 43 minutes per day standing or ambulating.
And, there are downsides to immobility its hazardous to the well-being of the patient and can impact their ability to participate in normal activities of daily living like toileting themselves. It can also lead to longer length of hospital stay amongst other outcomes. Studies have shown that one-third of older adults develop a new disability in an activity of daily living during hospitalization and half of these are unable to recover function.
Randomized trials show that early mobilization (assessing people for mobility status within 24 hours of admission and encouraging appropriate activity immediately) can be effective. For example we know they can:
decrease acute care length of stay (adjusted absolute difference of 1.1 days [95% confidence interval [CI] 0.0 to 2.2 days]);
shorten duration of delirium (median of 2 days [inter-quartile range 0.0 to 6.0] versus 4 days [inter-quartile range 2.0 to 8.0]);
improve return to independent functional status (odds ratio [OR} 2.7 [95% CI 1.2 to 6.1]);
decrease risk of depression (OR 0.14 [95% CI 0.03 to 0.61]);
increase rates of discharge to home (26.2% versus 2.4% at 7 days); and,
decrease hospital costs by $300/patient/day
Can you share with us what the objective of the MOVE ON project is and what your team and CAHO is trying to achieve?
We will use an integrated KT approach to tackle this challenge this refers to a collaborative process whereby researchers and research users (clinicians) work together to design the implementation process. And the implementation is modified according to the context in which it is being used so its not just a simple plug and play. We want to make sure the intervention is appropriate for the setting and circumstances.
Through this project, we will collectively implement an inter-professional approach that focuses on early and consistent mobilization of older patients throughout the hospital stay. This strategy shifts mobilization from being a designated task assigned to a single professional group to a shared team responsibility, with each team member having complementary roles.
Our key messages for the sessions will focus on actionable recommendations: at least three times a day, progressive, scaled mobilization; and mobility assessment and care pathway to be implemented within 24 hours of the decision to admit.
Ideally wed like to make sure that all patients are mobilized when in hospital to preserve their function but for this project were targeting older adults in particular.
Can you share with us a preview of some of the early learnings from the CAHO MOVE ON ARTIC project?
Data from observations on inpatient units conducted in 2010-2011 in academic hospitals in Toronto found that less than 30% of older patients were mobilized regularly in hospital this is a substantive issue!
Our work to date has also highlighted how important it is to ensure that the implementation intervention is contextualized to the institution to ensure that it is appropriate for that environment.
Another key learning is how important it is to have a collaborative, multidisciplinary team to work on projects like these. We have a wonderful team working on this project and I am fortunate to work with the fantastic Dr. Barbara Liu who is based at Sunnybrook Hospital.
Can you describe to our readers research you and your team are working on in addition to the MOVE ON application at St. Michaels?
We are working on a number of projects focused on advancing the practice and science of knowledge translation. These initiatives target patients, managers and health care providers. Some examples include implementation and evaluation of a delirium prevention strategy in acute care, and implementation and evaluation of self management tools for patients with chronic diseases (such as urinary incontinence and osteoporosis). We are working with a number of groups on implementing and evaluating clinical practice guidelines including the WHO, which is trying to implement guidelines to optimize maternal and infant health in low and middle income countries and the Canadian Task Force on Preventive Health Care.
When you are not working at St. Michaels, what do you like to do in your spare time?
I love to read and spend time with my family and friends.