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Hill-Rom® Clinical Resource Center

Helping you implement evidence-based programs with connected technologies

Hill-Rom® Clinical Resource Center

Early Mobility

Early Mobility

Getting your critically-ill patients moving early in their recovery can significantly reduce complications and the costs resulting from longer hospital stays.1-3

The Hill-Rom® Progressive Mobility® Program draws on the latest research, deep clinical expertise and strong collaboration with nationally recognized clinical experts. With it, you have the tools on hand to improve clinical outcomes for your critically-ill patients and financial results for your organization.

  • Financial Implications of a Hospital Early Mobility Program
    Bognar K, et al. | ESICM | 2015

    Significant evidence has shown that early mobility programs improve clinical outcomes for patients in critical care conditions. However, the lack of evidence associated with the financial benefit of early mobility programs has served as a barrier to program implementation. This study evaluates the financial benefits associated with the clinical outcomes of early mobility programs in the ICU environment. The study concludes that early mobility programs can generate annual savings up to $1,250,000 for a capitated delivery system, $925,000 for a Hospital, or $325,000 for a private payer.

  • A Survey of International Practices And Infrastructure To Support Early Mobilization
    Bakhru RN, et al. | Intensive Care Medicine | 2014

    This abstract, presented at ESCIM 2014 in Barcelona, Spain, summarizes the findings of an international survey concerning early mobilization practices and infrastructure. The authors found that ICU's infrequently have a written early mobilization protocol (20-30% across four researched countries). The authors also found that common barriers to mobilization include safety concerns, staffing levels, and competing priorities. They conclude that written early mobility protocols are uncommon, infrastructure is limited, and regional differences exist.

  • Impact of Early Mobilization on Mechanical Ventilation and Cost in Neurological ICU
    Klein, K., et al. | 2015

    This secondary analysis determined the impact of an early progressive mobility protocol implemented in a 22-bed neuro ICU on hospital costs and mechanical ventilation. The original prospective pre-post study showed significant clinical outcomes, including a reduction in ICU and hospital LOS but did not evaluate cost impact.  The protocol included 4 mobility milestones, beginning in bed through ambulation. The investigators used Hill-Rom(R) TotalCare® ICU beds.  It showed a 30% reduction in overall hospital costs and a 51% reduction in ventilator days.

  • Clinical and Psychologic Effects of Early Mobilization in Patients Treated in a Neurologic ICU: A Comparative Study
    Klein K, et al. | Critical Care Medicine | 2014

    In this study in Cleveland Clinic's Neuro ICU, an early mobility program was used to mobilize 637 patients during a pre/post study. The authors found that with an early mobility program, patients had shorter ICU and hospital length of stay (LOS), were more likely to be discharged home, and had fewer complications including decreased bloodstream infections, hospital-acquired pressure ulcers, and anxiety.

  • The Effect of Patient Migration in Bed on Torso Elevation
    Wiggermann N, et al. | Nursing Research | 2015

    Head of bed (HOB) elevation has been shown to reduce incidence of ventilator-associated pneumonia (VAP) in mechanically ventilated patients. AACN and ATS recommend HOB elevation of at least 30°. The authors of this study measured the relationship between HOB elevation and actual patient position to determine the impact of patient migration. Using motion capture methods on ten healthy participants in a lab setting, the authors were able to quantitatively determine this relationship with a linear regression. The authors conclude that patient migration results in lower HOB elevations. They further state that clinicians should consider protocols and equipment that minimize patient migration in order to help maintain guidelines recommended HOB  elevations designed to protect patients from VAP.

  • Examing the Positive Effects of Exercise in Intubated Adults in ICU: A Prospective Repeated Measures Clinical Study
    Winkelman C, et al. | Intensive and Critical Care Nursing | 2012

    This prospective study compared clinical outcomes in ICU patients who either received standard care or an intervention comprised of 20 minutes of exercise once daily for 2-7 days. Patients in the intervention group had a significantly decreased length of stay in the ICU.

  • The Effect of Increased Mobility on Morbidity in the Neurointensive Care Unit
    Titsworth WL, et al. | Journal of Neurosurgery | 2012

    This article describes a study investigating the effectiveness of increased mobility among neurointensive care unit patients. In this study, a mobility bundle toolkit was utilized, including the Progressive Upright Mobility Protocol (PUMP) algorithm. The authors purchased additional mobility aides and interdisciplinary education was initiated. This resulted in increased mobility in neurointensive care unit patients by 300%, reduced LOS in the neurointensive care unit by 13%, significantly decreased hospital LOS (12.0 days to 8.6 days), decreased hospital-acquired infections by 60%, and significantly decreased ventilator-associated pneumonia from a rate of 2.14 per 1000 days to 0. Increased mobility did not lead to increases in adverse events.

  • Physiotherapy in Intensive Care: An Updated Systematic Review
    Stiller K | CHEST | 2013

    This systematic review article summarizes all papers published from 1999 through 2013 on the topic of physiotherapy in the ICU. It found 85 new articles on the subject, with 26 specifically on the use of early mobility. The findings are clear that early mobility is safe and feasible, and has human benefits that may reduce ICU and Hospital LOS.

  • Integrating a  Multidisciplinary Mobility Programme into Intensive Care Practice (IMMPTP): A Multicentre Collaborative
    Bassett RD, et al. | Intensive and Critical Care Nursing | 2012

    This article describes an initiative to implement an evidence-based early mobility continuum into current ICU culture in 8 hospitals in the United States. This multicenter initiative included process design, culture change, and education. 130 patients were evaluated and the results showed substantial utilization of physical therapy within 24 hours of admission and a reduction in ventilator days (3.0 days pre vs. 2.1 days post; p=0.06).

  • Using Care Bundles to Improve Health Care Quality
    Resar R, et al. | Institute for Healthcare Improvement | 2012

    This Institute for Healthcare Improvement white paper provides a great overview of what a healthcare bundle is and the historic context for why they were developed. It then discusses why bundles may produce better outcomes for patients.

  • Early Physical and Occupational Therapy in Mechanically Ventilated, Critically Ill Patients: A Randomized Controlled Trial
    Schweickert, et al. | The Lancet | 2009

    This randomized trial evaluated the impact of physical and occupational therapy on functional outcomes in mechanically vented patients in the ICU. Of 104 patients, 59% returned to independent functional status at discharge in the intervention arm, compared with 35% in the control arm. Patients in the intervention arm also had shorter duration of delirium (P=0.02) and more ventilator-free days (P=0.05) compared to the control arm. Discontinuation due to patient instability occurred in 4% of all therapy sessions.

  • Early Intensive Care Unit Mobility Therapy in the Treatment of Acute Respiratory Failure
    Morris PE, et al. | Critical Care Medicine | 2009

    This prospective cohort study evaluated the impact of implementing a mobility protocol on the proportion of ICU patients receiving physical therapy vs. usual care. Eighty percent of protocol patients received at least one physical therapy session compared to usual care (47%). Protocol patients were out of bed 6 days earlier than SICU patients. ICU stay was improved by 1.4 days (P=0.025), and hospital length of stay was improved by 3.3 days (P=0.006) in protocol patients.

  • Improvements in Outcomes through a Progressive Mobility® Program in Cancer Patients
    Wright R, et al. | 2015

    In this retrospective investigation, a stepwise Progressive Mobility® Program was developed and followed in all mechanically ventilated patients admitted to a single subspecialty cancer hospital ICU. Prior studies have demonstrated improvements in LOS and ventilator days when an early mobility program was implemented, however, malignancy and short term life expectancy have been exclusions from the data. This study examines the safety and effectiveness of an early mobility program in the critically ill population of ventilated cancer patients. Patients in the intervention group showed a trend toward decreased ventilator days, as well as decreased hospital and ICU length of stay, with no difference in complications between pre and post groups related to the Progressive Mobility Protocol.

  • Nurses’ Role in Implementing the ABCDEF Bundle
    Patty Henderson, RN, CCRN | Crit Care Nurse | 2018

    I read the articles regarding implementing the ABCDEF bundles in the intensive care unit (ICU) and the positive impact the bundle has on patients’ length of stay, complications, and family involvement (“Implementing the ABCDEF Bundle: Top 8 Questions Asked During the ICU Liberation ABCDEF Bundle Improvement Collaborative” [2019;39(1):36-45] and “Common Challenges to Effective ABCDEF Bundle Implementation: The ICU Liberation Campaign Experience” [2019;39(1):46-60]). I read these articles with interest, but 1 thing that stood out to me was the qualifications of the Collaborative: there was not 1 bedside registered nurse (RN) on the team. Can we acknowledge that the main implementer of this bundle is the RN who is at the bedside for 12 hours? I am not downplaying the importance of physicians, respiratory therapists, physical therapists (PTs), occupational therapists (OTs), pharmacists, spiritual counselors, social workers, etc, in the patient’s journey in the ICU,...


  • Sustainability of a nurse-driven early progressive mobility protocol and patient clinical and psychological health outcomes in a neurological intensive care unit.
    Klein KE, et al. | Intensive Crit Care Nurs | 2018


    OBJECTIVES:To determine sustainable impact of an early progressive mobility protocol on mobility level and clinical outcomes.

  • Preventing Falls - Optimal Bed Height
    Hillrom | 2016

    Falls are a problem
    Falls are the most commonly reported hospital adverse
    event1 in the adult inpatient setting and a single fall with
    serious injury costs the hospital on average $13,000.2
    Evidence-based protocols and equipment that help
    prevent falls improve patient safety and reduce cost.

  • Cancer Center Reduces ICU LOS by 35% and Cost of Care by 17%
    Hillrom | 2015

    A multidisciplinary team of caregivers reviewed and adopted the Hill-Rom® Progressive Mobility® Program protocol to ambulate mechanically ventilated cancer patients. A three month pre / post quality improvement study was conducted. Hill-Rom TotalCare® ICU beds were used. Clinical and financial results were measured using the Impact Tracker™ Quality Improvement Program. ICU length of stay declined 35% and cost of care by approximately 17%.

  • Medical/Surgical ICU Reduces Length of Stay by 16%, Total Ventilator Days by 20%, and Saves an Estimated $508,000
    Hillrom | 2017

    A Clinical Nurse Specialist and a joint nursing and physical therapy team decided to improve patient outcomes by targeting functional decline in the medical/surgical intensive care unit (ICU). They utilized the Progressive Mobility® Program and
    implemented it using existing Hill‑Rom® Progressa® ICU beds. A 3-month pre- and post-quality improvement study was conducted, and the Impact Tracker™ Quality Improvement Program was used to measure clinical outcomes. ICU length of
    stay (LOS) was reduced by 16%, total number of days patients were receiving mechanical ventilation support was reduced by 20%. By comparing projected baseline period with intervention period spending on clinical conditions, the hospital
    saved an estimated $508,000.

  • Mary Lanning Healthcare Reduces Overall Pressure Injury Prevalence by 77%
    Ehly, R et al. | 2017

    In 2015, the management team of Mary Lanning Healthcare, a 161 bed community hospital in Hastings, Nebraska, were faced with an over 18% hospital-acquired pressure injury prevalence combined with house-wide support surfaces that were
    beyond therapeutic lifespan, and a recognized pressure ulcer prevention and treatment staffing knowledge deficit. They needed support to address these issues. They partnered with Hill-Rom’s Clinical Outcomes Manager who provided access to
    needed education and staff training, a support surface evaluation and a tiered 2-year bed replacement plan.

    In 2016, hospital-acquired pressure injury prevalence dropped by 77%, and there were no PI’s identified that were Stage 2 or greater. Staff were able to provide excellent evidence based care, the hospital has recently listed among the top 10% of
    hospitals for patient safety and medical excellence in the state of Nebraska.

  • Safety of Patient Mobilization and Rehabilitation in the Intensive Care Unit. Systematic Review with Meta-Analysis.
    Nydahl P, et al. | Ann Am Thorac Soc. | 2017



    Early mobilization and rehabilitation of patients in intensive care units (ICUs) may improve physical function, and reduce the duration of delirium, mechanical ventilation, and ICU length of stay. However, safety concerns are an important barrier to widespread implementation.

  • Clinical and Psychological Effects of Early Mobilization in Patients Treated in a Neurologic ICU: A Comparative Study*
    Klein, K et al. | Critical Care Medicine | 2015

    Objective: To determine if an early mobilization protocol increased
    mobility and improved clinical and psychological outcomes. Currently,
    there is minimal research on the effects of early mobilization
    in patients with primary neurologic injury.

  • PADIS Guidelines Teaching Slides: Immobility
    Nikooie, R. MD et al. | Society of Critical Care Medicine | 2018

    These teaching slides address implementing the 2018 Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU, known as the PADIS Guidelines. This presentation addresses implementing the portion of the guidelines related to immobility.

  • Safe Patient Handling and Mobility: Interprofessional National Standards
    Matz MW, et al. | American Nurses Association | 2013

    This interprofessional national standard from the American Nurses Association reviews the need for safe patient handling and mobility for healthcare recipients and care providers in terms of safety for all involved. It proposes eight standards that are relevant to those involved regardless of the care setting.

  • Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU
    Devlin, J et al. | Critical Care Medicine | 2015


    To update and expand the 2013 Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the ICU.

    Prospective, two-group pre/post comparative design with data collection 4 months pre- and postintervention with a 4-month run-in period.

    Twenty-two-bed neurologic ICU in a 1,200-bed urban, quaternary-care, academic hospital in Northeast Ohio.

  • SCCM ABCDEF Bundle
    Society of Critical Care Medicine | SCCM

    The ICU Liberation Bundle (A-F) elements individually and collectively can help reduce delirium, improve pain management and reduce long-term consequences for adult intensive care unit (ICU) patients.

  • ICU Early Physical Rehabilitation Programs: Financial Modeling of Cost Savings
    Lord RK, et al. | Critical Care Medicine | 2013

    This articles provides a framework for financial justification of implementing an early mobility protocol in ICU's. It uses previously published cost data with measured reductions in ICU and Hospital Length of Stay to provide the financial justification. John's Hopkins saw a net cost savings of $817,836 from their investment in an early mobility protocol and technology.


    Bedside Mobility Assessment Tool (BMAT)

  • Progressive Mobility® Program POCKET GUIDE

    Initial Patient Assessment
    Assess patient’s mobility levels within 8 hours of admission to the ICU and
    reassess at least every shift.

  • Progressive Mobility® Program POSTER

    Initial Patient Assessment
    Assess patient’s mobility levels within 8 hours of admission to the ICU and
    reassess at least every shift.

  • People With Brain Injuries Heal Faster If They Get Up And Get Moving (Audio)
    Kroen GC | National Public Radio (NPR) | 2015

    In this National Public Radio (NPR) feature story, Kate Klein and Edward Manno, who are part of the Neurointensive Care Unit at Cleveland Clinic, discuss the benefits of early mobilization in patients with neurological injuries. Over the course of a year, Klein tracked 600 patients with brain injury, getting more than half of them up and out of bed as early as the first day they were admitted to the ICU. Patients who progressed in their rehabilitation early spent less time in the ICU and hospital, had decreased rates of pressure ulcers and infections, spent 51% less time on ventilator therapy, and reduced overall hospital costs by 30%.

    Listen to or read about the story here.

    Additional information regarding Kate Klein's study is available here on the Clinical Resource Center.

    This story originally aired July 6, 2015.

  • Early mobilization with safety equipment optimizes recovery, experience and safety for patients (Video)
    Cleveland Clinic | 2016

    Early mobilization with safety equipment optimizes recovery, experience and safety for patients (View Video)

    In this video, the Cleveland Clinic demonstrates their use of the Progressive Mobility protocol in their Neurointensive Care Unit. This story, told by a patient and their family, provides a powerful example of early mobilization practices. 

  • The Cleveland Clinic, mobility and safe patient handling care path.

    Developed by the Cleveland Clinic Neurological Intensive Care Unit. How getting patients up and moving can impact their recovery, reduce complications, decrease time in ICU and save money.

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