(P142) IMPLEMENTATION OF AN EARLY MOBILIZATION PROTOCOL TO ACCELERATE RECONDITIONING AFTER TRANSCATHETER AORTIC VALVE IMPLANTATION: IDENTIFICATION OF BARRIERS TO STANDARDIZED NURSING PRACTICE

Background/Purpose: Early mobilization is associated with improved outcomes in older patients. We examined the barriers of early nurse-led mobilization after transcatheter aortic valve implantation (TAVI) to support accelerated reconditioning, return to baseline status, and safe next-day discharge home.

METHODS/RESULTS: We conducted a prospective observational cohort study of patients treated in 2019-2021 using a standardized post-procedure nursing care standard to promote mobilisation in 4 to 6 hours after TAVI. Results are presented as mean (standard deviation) for continuous variables and as number (percentage) for categorical data; student t test was used to compare continuous variables and χ2 and Fisher exact tests were used to compare categorical variables. The cohort included a convenience sample of 139 patients (64 women, 46%) mean age 82.5±6.7 years, NYHA III/IV n=72 (51.8%), prior pacemaker n=18 (13%), and prior n=SAVR 11 (7.9%). Patients were treated under local anaesthesia only (n=29, 20.9%) or conscious sedation (n=106, 76.3%) with a balloon expandable device (n=134, 96.4%) in a cardiac catheterization laboratory (n=111, 79.9% vs. hybrid operating room: n=28, 25.2%), and early recovery in cardiac telemetry (n=101, 72.7% vs. critical care n=38, 27.3%). Early mobilization ( < 6 hours) was achieved in 113 patients (81.3%: 4 hours: n=100, 4-6 hours: n=13); there were no significant (p≤0.05) differences in baseline characteristics between patients with early vs. late mobilization; the primary reasons for delayed mobilization included monitoring or managing cardiac conduction issues (n=6), vascular access hemostasis (n=6) and neurological status (n=4), patient preference or other self-reported issue (n=5) and nursing workload (n=5). In patients who achieved early mobilization, 94% were able to walk to the bathroom and/or outside of room; 81.4% were discharge on post-operative day 1, and 99.1% returned directly home. There was no significant difference in 30-day readmission between the two groups.

CONCLUSION/IMPLICATIONS FOR PRACTICE: Early nurse-led protocol-driven mobilization is safe and effective to facilitate rapid reconditioning and safe transition home after uncomplicated TAVI. Research is needed to better understand patient and systems-level enablers to improve standardization of practice.