Date of Graduation

Fall 12-17-2021

Document Type


Degree Name

Doctor of Nursing Practice (DNP)


School of Nursing and Health Professions




Executive Leader DNP

First Advisor

Dr. Juli Maxworthy

Second Advisor

Dr. Elena Capella


Patient Placement Matters: The Impact of Unnecessary Lateral Movement on Patients


Background: National trends to decrease the number of licensed beds have created inpatient capacity constraints which have resulted in increased unnecessary lateral patient movement events, which contribute to decreased patient safety and quality of care. The incidence of adverse events increases significantly when multiple unnecessary lateral relocations result from secondary efforts to relieve hospital capacity constraints and improve efficiency.

Problem: At a 352 acute care hospital, 12,906 patient movement events were evaluated over a baseline period of three months resulting in an average of 1.48 unnecessary lateral patient movement events per patient stay. The calculation of hospital-acquired adverse harm events, expressed in odds ratio, measured at 0.90 during the baseline period.

Methods: The Doctor of Nursing (DNP) Project is focused on implementing an improvement model that empowers frontline staff, through senior leadership support, to reduce the overall volume of unnecessary lateral patient movement through the application of the Assess – Innovate – Develop – Engage – Devolve Model (AIDED). This model provided a framework for organizational improvement in culture, recognition of system-designed latent conditions and cultivated innovation within an Innovator Team focusing on strategies to decrease unnecessary lateral movement of patients. The project also aimed at evaluating the effects of senior leadership support of improvement efforts and the impact on both innovation and performance improvement.

Interventions: The focus of this project included the successful implementation of interventions through the application of the AIDED model to reduce unnecessary lateral movement while building culture within an innovator team consisting of frontline staff. The model supports and guides the innovator team in developing and implementing operational changes to reduce latent system conditions that result in unnecessary lateral patient movement, which subsequently places patients at a potentially significantly higher rate of harm.

Results: A Doctoral Nursing Practice (DNP) Project was initiated assessing 5,176 patient transfer events with an intervention applied, resulting in decreased unnecessary lateral patient movement events by 0.17 (p

Conclusions: The operational workflows designed to increase throughput, address capacity constraints, and improve efficiency has a negative effect on the outcomes of patients within the acute care setting. Statistical significance was reached demonstrating reductions in unnecessary lateral patient movement with noted decreases in patient harm events. Improvements in the culture of the Innovator Team do indicate a need for a lengthier longitudinal study to fully evaluate the effects of the intervention over a timeframe exceeding three months duration.

Key words: patient placement, lateral movement, harm events, quality, capacity