• Saki Miwa, Paul Visintainer, Richard Engelman, Amanda Miller, Tara Lagu, Erin Woodbury, Peter K Lindenauer, and Quinn R Pack.
• Department of Internal Medicine, Baystate Medical Center, Springfield, Mass; Department of Cardiology, State University of New York Downstate Medical Center, Brooklyn.
• Am. J. Med. 2017 Nov 1; 130 (11): 1306-1312.

BackgroundDespite 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.MethodsWe 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.ResultsWe 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.ConclusionThe 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.Copyright © 2017 Elsevier Inc. All rights reserved.

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