Date of Completion
Fall 2026
Document Type
DNP Scholarly Project
Academic Department
School of Nursing
Degree Type
Doctoral
Degree Name
Doctor of Nursing Practice
First Advisor
Dr. Kristie Lowry
Second Advisor
Dr. Melanie Brewer
Abstract
Problem: Prolonged length of stay (LOS) reflected through throughput inefficiency at a Level II trauma center in western United States. Average hospital LOS was 5.3 days, exceeding the organizational benchmark and national average of 4.9 days. Gap analysis identified lack of standardized early mobilization (EM) and inconsistent case management (CM) participation in rounds, contributing to delayed progression, reactive discharge planning, higher costs, reduced bed capacity, and complication risk.
Aim: To reduce hospital LOS by targeting adult trauma patients as a pilot population, aiming to decrease average LOS from 5.3 to 4.9 days over 12 weeks through an early mobility bundle (EMB) and proactive CM integration into daily rounds.
Review of the Evidence: Synthesis of eight studies (2021-2026), including meta-analyses, systematic reviews, and RCTs, supported EM and interprofessional coordination. Evidence showed EM reduced intensive care LOS by approximately 1.8 days and hospital LOS by approximately 2.6 days. Prolonged immobility was associated with mortality, delirium, and deconditioning.
Project Design: The quality improvement project used iterative Plan-Do-Study-Act cycles and the OhioHealth Change Management Model – Planning, Connecting, and Adopting – to guide engagement, education, adoption, and sustainability.
Intervention: The 12 – week intervention included: (1) nurse-driven EMB requiring mobilization within 24 hours of admission and out-of-bed by 2 p.m. daily, supported by standardized RN documentation, visual cues, education, coaching, and audits; and (2) a weekday 2 p.m. Teams huddle between trauma nurse practitioners and CMs to identify discharge barriers and coordinate planning.
Significant Findings / Outcomes: Average hospital LOS decreased from 5.3 to 5.1 days (0.2-day reduction), demonstrating improvement toward the 4.9-day goal. Trauma-specific LOS improved from 6.3 to 5.6 days (0.7-day reduction). Mobilization by 2 p.m. improved from 23% to 85%; mobilization within 24 hours rose from 83% to 91%. Huddle participation averaged 88%. Documentation improved 33% to 57% on day shift and 23% to 62% on night shift. Falls were 0%, and 30-day readmissions 0.34%, indicating no safety compromise.
Implications for Nursing: Findings support nurse-led mobility and proactive interdisciplinary collaboration. Sustainment includes embedding mobility into handoff and huddles, “Up with Meals” expectations, continued audits, unit recognition, and expansion to other services to support efficient value-based care.
Recommended Citation
Mir, Sadaf, "Improving Hospital Throughput Through Early Mobilization and Proactive Case Management" (2026). All Doctor of Nursing Practice (DNP) Scholarly Projects. 93.
https://fuse.franklin.edu/dnp-project/93
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