"Keep Your Move in the Tube" safely increases discharge home following cardiac surgery.

INTRODUCTION Restrictive sternal precautions intended to prevent cardiac surgery patients from damaging healing sternotomies lack supporting evidence and may decrease independence and increase post-acute care utilization. Data regarding the impact of alternative approaches on safety and outcomes are needed to guide evidence-based best practices. OBJECTIVE To examine whether an approach allowing greater freedom during activities of daily living than permitted under commonly-used restrictive sternal precautions can safely decrease post-acute care utilization. DESIGN Before-and-after study, using propensity score adjustment to account for differences in patient clinical and demographic characteristics, surgery type, and surgeon. SETTING 600-bed acute care hospital. INTERVENTION Beginning March 2016, our institution replaced traditional weight- and time-based precautions given to patients who underwent median sternotomy with the "Keep Your Move in the Tube" (KMIT) approach for mindfully performing movements involved in the activities of daily living, guided by pain. MAIN OUTCOME MEASURES We compared sternal wound complications, discharge disposition, 30-day readmission, and functional status between consecutive cardiac surgery patients with "independent" or "modified independent" preoperative functional status who underwent median sternotomy in the 1.5 years before (n = 627, standard precautions group) and after (n = 477, KMIT group) KMIT implementation. RESULTS The odds of discharge to home, vs to inpatient rehabilitation or skilled nursing facility, was ~3 times higher for KMIT than standard precautions patients (risk-adjusted odds ratio [rOR], 95% confidence interval [CI] = 2.90, 1.95-4.32, and 3.03, 1.57-5.86, respectively). KMIT patients also had significantly higher odds of demonstrating "independent" or "modified independent" functional status on final inpatient physical therapy treatment for bed mobility (rOR, 95%CI = 7.51, 5.48-10.30) and transfers (rOR, 95%CI = 3.40, 2.62-4.42). No significant difference was observed in sternal wound complications (in-hospital or causing readmission) (rOR, 95%CI = 1.27, 0.52-3.09) or all-cause 30-day readmissions (rOR, 95%CI = 0.55, 0.23-1.33). CONCLUSIONS KMIT increases discharge-to-home for cardiac surgery patients without increasing risk for adverse events and reducing utilization of expensive institutional post-acute care. This article is protected by copyright. All rights reserved.