Cultivating quality: early postoperative ambulation: back to basics.

A quality improvement project increases postoperative ambulation and decreases patient complications. T he ambulation of patients soon after surgery, now a fundamental part of nursing care, wasn't common practice until the middle of the past century. In an article published in 1949, D. J. Leithauser, a Detroit surgeon, stated, " Ten years ago early ambulation was considered a 'crack-pot' idea. Today, it is recognized and is rapidly approaching a 'must' procedure following a surgical operation. " 1 Indeed, the practice of having patients walk as soon as possible after surgery constituted a major change in patient care, based on then new evidence of the benefits of exercise and its positive impact on patient recovery. Since then, facilitating ambulation has been considered an important part of excellent nursing care, particularly in postopera-tive patients. Despite the widespread belief that early ambula-tion promotes surgical recovery, when we attempted to research the subject we found little evidence to support this nursing practice. To our surprise, we found only one published study on the effect of ambulation alone on postoperative ileus, and the findings did not support the use of early ambulation as a means of increasing gut motility. 2 Early ambulation after surgery has been included as part of multimodal, fast-track, or enhanced recovery after surgery (ERAS) periop-erative programs. Although many small studies have reported reduced complication rates or lengths of stay with fast-track programs, 3-5 a recent Cochrane review found that the evidence was not of sufficiently high quality to justify implementing a fast-track or ERAS program as standard care. 6 (It should be noted that there seems to be no consensus among published studies on the exact definition of early ambulation; in our institution, the term refers to patients getting out of bed and walking on the day of surgery, and patients are told before surgery to expect this.) As health care has evolved, technology has come to play an ever-greater role in nursing care; as a result , computers are now prominent at the bedside. The current focus on improving outcomes requires not only that nursing care be provided in a timely manner, but also that it be documented in the medical record as quickly and accurately as possible. However , with decreasing lengths of stay and increasing requirements placed on nurses, time to perform basic nursing care is limited. As Storfjell and colleagues demonstrated, many nurses spend more than half …