Keep Your Move in the Tube: An Evaluation of Longitudinal Patient Outcomes and Readiness for Change Amongst Staff

Background: Traditional sternal precautions following median sternotomy have remained largely unchanged for decades, restricting patients from lifting more than 5–10 pounds for eight weeks and limiting bilateral arm movements, despite limited supporting evidence and growing concerns about delayed functional recovery. The “Keep Your Move in the Tube” (KYMITT™) protocol offers a less restrictive alternative, allowing patients to move their arms within an imaginary tube around their torso while maintaining sternal stability. Methods: This retrospective pre/post cohort comparison evaluated patient outcomes before and after KYMITT implementation at a large tertiary cardiac surgery center in the Rocky Mountain West, comparing adult sternotomy patients in matched summer periods: pre-intervention June–August 2023 (n = 54) under traditional precautions and post-intervention June–August 2024 (n = 65) under KYMITT. Results: Cohorts were comparable in age, sex, and BMI. A concurrent staff readiness assessment used the ORCA and CD-RISC-25. Among CABG survivors, the mean length of stay decreased from 7.6 to 5.9 days (p = 0.042), with variance decreasing 7-fold (F = 7.17, p < 0.001), indicating more predictable recovery trajectories. Valve readmission dropped from 54.5% to 12.5% (p = 0.033), while CABG readmission remained stable at ~15%. Conclusion: In-hospital mortality did not differ significantly. Staff knowledge and practice experience increased significantly, with resilience and organizational readiness maintained throughout implementation. KYMITT was associated with shorter, more predictable CABG recovery and reduced valve readmission, with no increase in sternal complications. Application: These findings support replacing traditional restrictive sternal precautions with evidence-based movement guidelines and underscore the importance of structured change management in facilitating clinical practice change.