Patient-Specific Mobilization: A Structured, Systemwide Model of Mobility Care.

Abstract

Hospital-associated functional decline resulting from immobility and prolonged bed rest is a widespread yet underrecognized complication in acute care. Despite strong evidence linking immobility directly to severe in-hospital complications and significant postdischarge impairments - including reduced independence, diminished quality of life, and impaired ability to perform activities of daily living (ADLs) - many U.S. hospitals lack standardized mobility care programs. Mobility practices vary widely and are typically driven by individual clinician knowledge, institutional culture, and informal bedside decision-making rather than evidence-based protocols. To address these systemic shortcomings, in December 2023, Kaiser Permanente Northern California (KP NCAL) implemented Patient-Specific Mobilization (PSM), a structured, systemwide model of mobility care. The PSM model assigns individualized daily mobility goals based on standardized bedside functional assessments integrated directly into existing electronic health records (EHRs) and nursing workflows. This enables clearly defined and actionable mobility objectives, making patient movement a transparent and shared priority for the entire care team. Since implementing PSM, KP NCAL's 21 hospitals have achieved sustained improvements, including an 8-percentage-point increase in mobility assessments (to 95% from 87%) and a 12-percentage-point increase in appropriate patient mobilization (to 72% from 60%). The initiative was developed and implemented through a multidisciplinary regional structure that included input from clinical, operational, and quality stakeholders. This included a region-wide forum in which hospital quality leaders from all 21 medical centers could review, provide feedback on, and vote on proposed initiatives and measures. Consistent mobilization to patient-specific goals was associated with lower odds of intensive care unit transfer, of functional decline, and of discharge to a skilled nursing facility. These results demonstrate that structured mobilization can be delivered at scale, offering a replicable model for embedding function-preserving care into hospital systems nationwide.