Effects of an Ambulation Orderly Program Among Cardiac Surgery Patients

Am J Med. 2017 Nov;130(11):1306-1312. doi: 10.1016/j.amjmed.2017.04.044. Epub 2017 May 25.


Background: Despite the known benefits of ambulation, most hospitalized patients remain physically inactive. One possible approach to this problem is to employ "ambulation orderlies" (AOs) - employees whose main responsibility is to ambulate patients throughout the day. For this study, we examined an AO program implemented among postcardiac surgery patients and its effect on patient outcomes.

Methods: We evaluated postoperative length of stay, hospital complications, discharge disposition, and 30-day readmission for all patients who underwent coronary artery bypass or cardiac valve surgery in the 9 months prior to and after the introduction of the AO program. In addition to pre-post comparisons, we performed an interrupted time series analysis to adjust for temporal trends and differences in baseline characteristics.

Results: We included 447 and 478 patients in the pre- and post-AO intervention groups, respectively. Postoperative length of stay was lower in the post-AO group, with median (interquartile range) of 10 (7, 14) days vs 9 (7, 13) days (P <.001), and also had significantly less variability in mean monthly length of stay (Levene's test P = .03). Using adjusted interrupted time series analysis, the program was associated with a decreased mean monthly postoperative length of stay (-1.57 days, P = .04), as well as a significant decrease in the trend of mean monthly postoperative length of stay (P = .01). Other outcomes were unaffected.

Conclusion: The implementation of an AO program was associated with a significant reduction in postoperative length and variability of hospital stay. These results suggest that an AO program is a reasonable and practical approach towards improving hospital outcomes.

Keywords: Ambulation; Cardiac surgery; Hospital outcomes; Mobility.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Cardiac Rehabilitation* / methods
  • Cardiac Rehabilitation* / statistics & numerical data
  • Coronary Artery Bypass / rehabilitation*
  • Female
  • Heart Valve Prosthesis Implantation / rehabilitation*
  • Humans
  • Length of Stay / statistics & numerical data
  • Male
  • Middle Aged
  • Patient Readmission / statistics & numerical data
  • Postoperative Complications* / etiology
  • Postoperative Complications* / prevention & control
  • Program Evaluation
  • United States
  • Walking / statistics & numerical data*