Swing Bed Improvement in Risk-Adjusted Mobility  


Kearney County Health System (KCHS), a Critical Access Hospital (CAH) in southcentral Nebraska, participated in a yearlong Swing Bed Quality Improvement project sponsored by the Nebraska State Office of Rural Health and the Flex Program. KCHS staff needed to improve their Risk-Adjusted Mobility Performance scores for their swing bed patients, and KCHS’s rehabilitation staff and nursing staff needed to work as a team in motivating their swing bed patients to achieve their mobility goals, heal, and return home.


Kearney County Health System joined Stroudwater’s Swing Bed Quality Improvement Project, which Stroudwater facilitates across 11 states. The Swing Bed Quality Improvement Project focused on the five metrics listed below. KCHS developed an action plan for Measure 3: Risk-adjusted Performance Improvement in Mobility.

  1. Return to Acute (unplanned)
  2. Return to Acute Post 30-Day Discharge
  3. Risk-adjusted Performance Improvement in Mobility
  4. Risk-adjusted Performance Improvement in Self-Care
  5. Discharge to Community

KCHS’s action plan included getting patients in a chair for all meals unless medically contraindicated and setting a targeted number of times for patients to ambulate each day. The staff was provided with monthly education on the importance of keeping patients moving multiple times a day as recommended by therapy. Along with staff education, patients’ mobility goals were written on the whiteboard in the patient’s room so that the staff, patient, and patient’s family were aware of the goal. As the project progressed, rehabilitation staff added orders around mobility so nursing staff would be able to chart against the patient’s activity throughout the day. KCHS now has electronic care boards where they post daily goals as well as reminders for patients and their families to continue to work on mobility.


The collaboration between Kearney County Health System and Stroudwater led to significant improvement in communication, care coordination, and clinical outcomes for KCHS’s swing bed patients.

Qualitative Results

  • Increased communication between rehabilitation staff, nursing, and the patient
  • Education for nursing staff, patients, and patient’s families on the importance of staying mobile and increasing daily activities to heal
  • Utilization of a whiteboard to put daily goals in front of staff, patient, and patient’s family
  • Discussions between staff, patient, and family (if present) of patients’ daily goals, ensuring that patients understand their accountability in being active

Quantitative Results

  • Risk-adjusted Performance Improvement in Mobility: Risk adjusting the mobility assessment produces an expected improvement score for mobility. Stroudwater compared the actual improvement score to the expected improvement score and returned the percentage of discharges that met or exceeded the expected improvement score.
    • Baseline value: Q3 2021 – 15.4%
    • Improvement was shown in Q1 2022 at 31.7% and again for Q2 2022 at 64%


The more discussion there is about mobility, the more motivated patients become. Working with Stroudwater, KCHS staff made changes that put mobility front and center for staff, patients, and families during the healing process. Having mobility goals on the care boards in the patient rooms, for example, helps families to become part of the discussion and motivation, even if they are not able to be at the bedside for rounds. The best practices that KCHS staff employed to emphasize mobility to patients and increase collaboration among rehab and nursing staff helped them achieve their goals and improve outcomes for swing bed patients.