A Closed-Loop Audit of Early Mobilization of Thoracic Surgery Patients on Postoperative Day 0

Introduction Early mobilization in the postoperative period, particularly on the day of surgery, is crucial for reducing morbidity and mortality in thoracic surgery patients. Starting physical activity as soon as clinically feasible enhances recovery and is a key component of enhanced recovery pathways. Effective implementation of early mobilization protocols requires collaboration among multidisciplinary teams (MDT), emphasizing its importance in postoperative care. This audit evaluates adherence to early mobility protocols for thoracic surgery patients at Queen Elizabeth Hospital, Birmingham (QEHB), focusing on mobilization rates on postoperative day 0 (POD-0) in line with the Enhanced Recovery After Surgery (ERAS) guidelines. It also aims to identify barriers to optimal practice and improve current practice through targeted interventions, including MDT training and posters to enhance healthcare professionals' adherence. Methods This closed-loop audit at QEHB targeted thoracic surgery patients from November 2023 to June 2024. Data collection occurred in three cycles: the first from November to December 2023 (60 patients), the second from February to March 2024 (59 patients), and the third from May to June 2024 (39 patients). Retrospective data were collected using an electronic documentation system, capturing demographic and clinical variables, including age, sex, preoperative mobility, comorbidities, and surgical details. The primary outcomes assessed were POD-0 mobilization rates and mobility levels achieved. Interventions included MDT training on ERAS guidelines and reminder posters for doctors. Data were analyzed by using descriptive statistics for demographic and clinical variables. Additionally, regression analysis was performed to assess the impact of interventions on mobilization rates on POD-0. Results Pre-intervention data showed that only 30% (n=18) of patients mobilized on POD-0. Ward patients had a 44% (n=15) mobilization rate, while rates were lower in the high dependency unit (HDU) and enhanced post-operative care (EPOC) at 16.7% (n=3) and 0% (n=0), respectively. After two interventions (MDT training and posters), mobilization on POD-0 increased to 45.8% (n=27) and 67.6% (n=25) in subsequent cycles. Among ward patients mobilization on POD-0 increased to 94.1% (n=16), while HDU patients improved to 55.5% (n=5). Additionally, it varied by surgical approach, with robotic-assisted thoracoscopic surgery (RATS) patients rising from 30% (n=6) to 45.5% (n=15) and video-assisted thoracoscopic surgery (VATS) patients increasing from 23.8% (n=5) to 81.8% (n=9) at the end of the third cycle. Patients mobilizing on POD-0 had a shorter median length of stay (two days; interquartile range (IQR)=3) compared to those who did not (five days; IQR=5). Confounding factors were not considered, so no causal conclusions should be drawn. Conclusion This audit demonstrates the successful implementation of early mobilization protocols for thoracic surgery patients at QEHB, highlighting the positive impact of targeted interventions on adherence to ERAS guidelines. Initially, only 30% of patients mobilized on POD-0, but this improved to 67.6% after interventions. This notable increase highlights the importance of coordinated efforts among healthcare professionals in promoting early mobilization to enhance patient outcomes post-surgery.