Abstract
Background
Early mobilization after total joint arthroplasty decreases postoperative complications and optimizes future functional outcomes. The purpose of this study was to evaluate the effectiveness of a supervised patient ambulation program following total joint arthroplasty.
Methods
In 2014, our institution initiated a mandatory supervised patient ambulation program termed “No One Walks Alone” (NOWA). The program requires that all patients who mobilize are accompanied by a nurse or physical therapist. Gait belts are worn whenever a patient ambulates. Bed and chair alarms are utilized to alert if a patient tries to ambulate alone. If a patient experiences a fall, he or she is immediately evaluated by the nursing staff, and details regarding the fall and any injury sustained are documented.
A retrospective review of patients undergoing total knee or hip arthroplasty between 2011–2017 was conducted. Patients who had surgery between 2011–2013, before the program, were included in the pre-implementation group (N= 3,069) and those having surgery between 2016–2017, after the program started, were included in the post-implementation group (N=3,947). The incidence of patient falls, fall-related complications were compared between groups.
Results
The number of patient falls was 23 in the pre-implementation group (0.7%) and 9 in the post-implementation group (0.2%). Fall-related complications occurred in 14 of 23 falls in the pre-implementation group (0.5% overall) and 2 of 9 falls in the post-implementation group (0.05% overall) (p<0.001).
Patients who experienced a fall were more likely to have undergone total knee arthroplasty (81.3%) compared to those who did not fall (58%) (p=0.008).
Conclusion
A supervised patient ambulation program can be successful at reducing the incidence of patient falls and complications related to falls in the immediate postoperative setting.
