Abstract WP33: Impact of Early Mobilization on Length of Stay in Acute Ischemic Stroke

Abstract

Background: IV rt-tPA is standard of care in patients presenting within 4.5 hours of acute ischemic stroke (AIS) symptom onset. Despite its short half-life, concerns regarding the safety of early mobilization remain, which may delay patients’ time to rehabilitation evaluation. We previously demonstrated the safety of early mobilization, using stratification based on stroke severity. This study aims to compare time from mobility order to PT/OT evaluation and total length of stay between patients whose mobility orders were congruent with institutional guidelines to those with incongruent orders. Methods: This is a retrospective case-cohort study of AIS patients who received IV tPA and/or mechanical thrombectomy (MT), admitted to our center April 2018 to December 2019. Prior to this, a 24 hour bedrest protocol post-rtPA was in place. In April of 2018, a new mobility protocol was established stratifying bedrest time following tPA and/or MT to 1, 6, or 8 hours, based on NIHSS and clinical stability. All patients in this cohort (N=524) should have been assigned the new mobility protocol. For patients receiving both tPA and MT, the mobility assignment for thrombectomy was assessed. 37 patients were excluded from analysis due to missing data points. Results: A total of 384 patients received tPA only, with 89% (n=354) receiving congruent orderset. 59 patients received tPA and MT, and 74 received MT only. Mean LOS days for tPA only with congruent orderset was 5.33 + 5.76 (n=350) vs. 6.45 + 6.06 (n=55) with incongruent orders. Mean LOS days for MT only with congruent orders was 10.03 + 6.42 (n=58) vs. 10.28 + 7.64 (n=57) with incongruent orders. Mean time in hours from PT/OT order to evaluation for tPA only with congruent orders was 17.72 + 13.01 (n=341) vs. 32.63 + 29.45 (n=41) with incongruent orders. For MT only patients with a congruent orderset, mean hours from PT/OT order to evaluation was 33.74 + 16.91 (n=54), and 50.7 + 34.12 (n=47) for incongruent orders. Conclusions: There was an increase in both PT/OT order to evaluation time and total LOS for patients with incorrect orders. Following the early mobilization protocol leads to an earlier PT/OT evaluation and disposition.