LAUSR

Purpose: To assess patient safety and discharge outcomes of initiating early mobility after 12 hours of receiving thrombolytic therapy (tPA) for stroke at a Primary Stroke Center. Background: Patients receiving tPA are traditionally maintained on bedrest for 24 hours due to an alleged risk of increased complications or falls, however this standard is not supported by data. Prior data among patients receiving tPA supports the concept of providing early mobility before 24 hours without an increased risk of falls or other adverse response. There is also evidence that early mobility in other critical care populations has positive impact on discharge disposition and decreasing the length of stay (LOS). Methods: A validated Early Mobility Protocol was implemented within 24 hours for all patients receiving tPA for stroke with a focus to progress each patient through the stages of the mobility protocol based on clinical presentation. Data from pre-implementation (January – May 2018) and post implementation (June 2018-December 2018) were compared for outcomes, including discharge disposition, adverse responses and LOS. T-test and Chi-square were used to determine significant difference in outcomes between groups. Results: Between January to December 2018 44 patients received tPA (18 pre-implementation and 26 post implementation). For the post implementation group 18/26 early mobility was initiated with 24 hours, 4/26 were placed on comfort care and 4/26 were transferred to a comprehensive stroke center. Among the early mobility group, there were no falls or adverse physiological events. Patients that participated with early mobility were more likely to discharge home, 46.15% vs 33.33%, less likely to require post-acute services, 15.38% vs 27.78%, and less likely to require transfer to a higher level of care, 15.38% vs 33.78%. There was not a significant difference in LOS. Conclusion: Providing early mobility to patients post thrombolytic therapy between 12-24 hours does not cause an increase in adverse physiological events. Additionally, providing early mobility has a positive impact on patient discharges to home. Further study may include initiating mobility at an early timeframe to examine the correlation to LOS and discharge outcomes.