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PICU Up!: Impact of a Quality Improvement Intervention to Promote Early Mobilization in Critically Ill Children
Beth Wieczorek1, Judith Ascenzi, Yun Kim
11Department of Anesthesiology and Critical Care Medicine, Charlotte R. Bloomberg Children's Center, Johns Hopkins University School of Medicine, Baltimore, MD.2Department of Pediatric Nursing, Charlotte R. Bloomberg Children's Center, Johns Hopkins Hospital, Baltimore, MD.3Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD.4Department of Child Life, Charlotte R. Bloomberg Children's Center, Johns Hopkins Hospital, Baltimore, MD.5University of Maryland School of Nursing, Baltimore, MD.6Pediatrix Medical Group, Herman-Walter Samuelson Children's Hospital at Sinai, Baltimore, MD.7Department of Pediatrics, Charlotte R. Bloomberg Children's Center, Johns Hopkins Hospital, Baltimore, MD.8Interactive Learning, Johns Hopkins Medicine, Baltimore, MD.
Insights
Early mobilization in the pediatric intensive care unit (PICU) is safe and feasible. The PICU Up! program increased therapy involvement and mobilization activities for critically ill children without adverse events.
Area of Science:
- Pediatric critical care medicine
- Quality improvement in healthcare
- Rehabilitation therapies
Background:
- Critically ill children in the pediatric intensive care unit (PICU) often experience prolonged immobility.
- Early mobilization aims to mitigate adverse effects of immobility and improve patient outcomes.
- Implementing structured early mobilization programs requires careful planning and interdisciplinary collaboration.
Purpose of the Study:
- To assess the safety and feasibility of an early mobilization program in a pediatric intensive care unit (PICU).
- To evaluate the impact of a multicomponent intervention on mobilization activities and therapy involvement.
- To identify barriers and facilitators to early mobilization in critically ill pediatric patients.
Main Methods:
- Observational, pre-post study design involving a quality improvement initiative.
- Implementation of the "PICU Up!" program, a tiered, interdisciplinary plan for early mobilization.
- Data collection on therapy consultations and mobilization activities before and after intervention in 200 pediatric patients.
Main Results:
- The "PICU Up!" program increased occupational therapy (44% vs 59%) and physical therapy (54% vs 66%) consultations by PICU day 3.
- Median patient mobilizations increased from 3 to 6 by PICU day 3 (p < 0.001).
- Increased engagement in active bed positioning (p < 0.001) and ambulation (p = 0.04) was observed, with no adverse events.
Conclusions:
- Early mobilization programs in the PICU are feasible and safe, as demonstrated by the "PICU Up!" initiative.
- The intervention successfully enhanced physical and occupational therapy involvement and increased early mobilization activities.
- Structured early mobilization may contribute to improved short- and long-term outcomes for critically ill children.
Objective:
To determine the safety and feasibility of an early mobilization program in a PICU.
Design:
Observational, pre-post design.
Setting:
PICU in a tertiary academic hospital in the United States.
Patients:
Critically ill pediatric patients admitted to the PICU.
Intervention:
This quality improvement project involved a usual-care baseline phase, followed by a quality improvement phase that implemented a multicomponent, interdisciplinary, and tiered activity plan to promote early mobilization of critically ill children.
Measurements And Main Results:
Data were collected and analyzed from July to August 2014 (preimplementation phase) and July to August 2015 (postimplementation). The study sample included 200 children 1 day through 17 years old who were admitted to the PICU and had a length of stay of at least 3 days. PICU Up! implementation led to an increase in occupational therapy consultations (44% vs 59%; p = 0.034) and physical therapy consultations (54% vs 66%; p = 0.08) by PICU day 3. The median number of mobilizations per patient by PICU day 3 increased from 3 to 6 (p < 0.001). More children engaged in mobilization activities after the PICU Up! intervention by PICU day 3, including active bed positioning (p < 0.001), and ambulation (p = 0.04). No adverse events occurred as a result of early mobilization activities. The most commonly reported barriers to early mobilization after PICU Up! implementation was availability of appropriate equipment. The program was positively received by PICU staff.
Conclusions:
Implementation of a structured and stratified early mobilization program in the PICU was feasible and resulted in no adverse events. PICU Up! increased physical therapy and occupational therapy involvement in the children's care and increased early mobilization activities, including ambulation. A bundled intervention to create a healing environment in the PICU with structured activity may have benefits for short- and long-term outcomes of critically ill children.
