Purpose: Multiple hospitals in Alberta implemented the End PJ Paralysis - a multicomponent inpatient ambulation initiative aimed at preventing the adverse physical and psychological effects patients experience due to low mobility during admission. To inform a scale-up strategy, this study assessed the impact of the initiative based on select process and outcome measures.
Materials and methods: Clinical and administrative data were obtained from the hospital Discharge Abstract Database, Research Electronic Data Capture (Redcaps), and Reporting and Learning System for Patient Safety. The variables explored were length of stay, inpatient falls, discharge disposition, pressure injury, patient ambulation, and patient dressed rates. We then used the Interrupted Time Series design for impact analysis.
Results: The analysis included discharge abstracts for 32,884 patients and the results showed significant improvements in outcomes at the participating units. The length of stay and inpatient falls were reduced immediately by 1.8 days (B2=-1.80, p = 0.044, 95% CI [-3.54, -0.05]), and 2.2 events (B2=-2.22, p = 005, 95% CI [-3.75, -0.69]). The percentage of patients discharged home increased overtime (B2=.39, p=.006, 95% CI [.11, .66]). Mobilization and dressed rates also improved.
Conclusions: The findings imply the interventions safely mitigated the risk of immobility-induced complications, including deconditioning and hospital-acquired disability.
Keywords: Hospital-acquired disability; PJ Paralysis; functional capacity; mobilization; pajamas (pyjamas) paralysis; patient ambulation; physiological deconditioning.
Immobility during hospitalization is endemic in hospitals and, without intervention, presents a significant risk of physiological deconditioning and subsequent adverse health outcomes, such as functional decline and hospital-acquired disability.This study elevates the importance of preserving functional capacity and dignity of hospitalized patients by encouraging them to get up, dress in personal clothes, and move as much possible.Function-focused initiatives, that include intentional patient ambulation, have the potential to mitigate the risk of immobility-induced deconditioning and other adverse outcomes, such as falls and pressure injury, in older adults.In this study, we have demonstrated the End PJ Paralysis had a positive impact on patient ambulation, length of stay, inpatient falls, and discharge disposition.The study also informed a proposed transformational roadmap to strengthen rehabilitation in the provincial health system and spread the initiative to all the major hospitals to potentially benefit more patients.