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Implementation of an Early Mobility Pathway in Neurointensive Care Unit Patients With External Ventricular Devices
Megan Moyer1, Bethany Young, Eileen Maloney Wilensky
1Questions or comments about this article may be directed to Megan Moyer, MSN ACNP-BC CNRN, at megan.moyer@uphs.upenn.edu. She is an Inpatient Nurse Practitioner, Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA. Bethany Young, MSN RN AGCNS-BC, is Clinical Nurse Specialist, Neurointensive Care Unit, Hospital of the University of Pennsylvania, Philadelphia, PA. Eileen Maloney Wilensky, MSN ACNP-BC, is Director of Clinical Research Division and Co-Director of Quality & Safety Program, Hospital of the University of Pennsylvania, Philadelphia, PA. Joseph Borst, PT DPT, is Physical Therapist, Hospital of the University of Pennsylvania, Philadelphia, PA. William Pino, PT DPT, is Physical Therapist, Hospital of the University of Pennsylvania, Philadelphia, PA. Marisa Hart, MS OTR/L, is Occupational Therapist, Hospital of the University of Pennsylvania, Philadelphia, PA. Jesse LoBreglio, MOT OTR/L, is Occupational Therapist, Hospital of the University of Pennsylvania, Philadelphia, PA. Derek Zaleski, PT DPT, is Physical Therapist, Hospital of the University of Pennsylvania, Philadelphia, PA. Isaira Leonor, BSN RN, is Registered Nurse, Neurointensive Care Unit, Hospital of the University of Pennsylvania, Philadelphia, PA. David Kung, MD, Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA. Michelle Smith, MD, Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA. Eric Zager, MD, Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA. M. Sean Grady, MD, Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA. Monisha Kumar, MD, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Implementing a new protocol for mobilizing patients with external ventricular drains (EVDs) safely enables earlier patient movement. This approach is linked to shorter intensive care unit stays and improved discharge outcomes for subarachnoid hemorrhage patients.
Area of Science:
- Neurosurgery
- Critical Care Medicine
- Patient Mobility Protocols
Background:
- Patients with external ventricular drains (EVDs) often face delayed mobilization due to concerns about catheter dislodgement and cerebrospinal fluid drainage.
- Delayed mobilization can lead to prolonged hospital stays and increased risks of immobility-related complications.
Purpose of the Study:
- To evaluate the safety and feasibility of a standardized external ventricular drain mobilization protocol.
- To assess the impact of this protocol on patient outcomes, including intensive care unit length of stay and discharge disposition.
Main Methods:
- A multidisciplinary team developed a formal algorithm for mobilizing subarachnoid hemorrhage (SAH) patients with EVDs.
- A prospective cohort was compared with a historical control group, analyzing outcomes such as ICU length of stay and time to first mobilization.
Main Results:
- Early mobilization was significantly earlier in the post-intervention group (6.5 days vs. 18.7 days, P < .0001).
- No instances of catheter dislodgement occurred. The percentage of patients discharged to home or acute rehabilitation was higher in the post-intervention group (88.5% vs. 63.2%).
Conclusions:
- Mobilizing patients with EVDs using a structured protocol is safe and feasible.
- This protocol may lead to earlier mobilization, reduced ICU length of stay, and improved discharge destinations without major complications.
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