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Mobilization Therapy in the Pediatric Intensive Care Unit: A Multidisciplinary Quality Improvement Initiative
Blair R L Colwell1, Cydni N Williams2, Serena P Kelly2
1Blair R. L. Colwell is a pediatric critical care physician at University of California Davis, Sacramento, California. Cydni N. Williams is an assistant professor of pediatrics at Oregon Health and Science University, Portland, Oregon. Serena P. Kelly is an assistant professor of pediatrics at Oregon Health and Science University. Laura M. Ibsen is a professor of pediatrics and anesthesiology at Oregon Health and Science University. brcolwell@ucdavis.edu.
Insights
Implementing a goal-directed mobilization protocol in a pediatric intensive care unit (PICU) safely improved patient mobilization in over 50% of cases. This strategy is effective for critically ill children, though barriers to mobilization persist.
Area of Science:
- Pediatric critical care medicine
- Quality improvement initiatives
- Rehabilitation therapy
Background:
- Mobilization in critically ill adults is safe and improves outcomes.
- Limited data exists on the mobilization of critically ill children.
- Standardized protocols are needed to guide pediatric intensive care unit (PICU) mobilization.
Purpose of the Study:
- To implement a standardized, goal-directed mobilization therapy protocol in a PICU.
- To enhance patient mobilization within the PICU setting.
Main Methods:
- A quality improvement project was conducted in a 20-bed cardiac and medical-surgical PICU.
- A goal-directed mobilization protocol was instituted, with goals based on patient age and illness severity.
- Data collected included illness severity, activity limitations, functioning, mobilization level, complications, and barriers.
Main Results:
- Over 9 months, 567 patient encounters were analyzed, with 52% achieving goal mobilization.
- Patients achieving goals were younger and more severely ill, with fewer identified barriers.
- The complication rate was 2.5%, with no serious adverse events.
Conclusions:
- A multidisciplinary, goal-directed mobilization protocol successfully achieved mobilization goals in over half of PICU patients.
- Older, less ill patients and those with mobilization barriers were less likely to meet goals.
- The protocol is safe and effective for improving mobilization in critically ill children.
Background:
Mobilization is safe and associated with improved outcomes in critically ill adults, but little is known about mobilization of critically ill children.
Objective:
To implement a standardized mobilization therapy protocol in a pediatric intensive care unit and improve mobilization of patients.
Methods:
A goal-directed mobilization protocol was instituted as a quality improvement project in a 20-bed cardiac and medical-surgical pediatric intensive care unit within an academic tertiary care center. The mobilization goal was based on age and severity of illness. Data on severity of illness, ordered activity limitations, baseline functioning, mobilization level, complications of mobilization, and mobilization barriers were collected. Goal mobilization was defined as a ratio of mobilization level to severity of illness of 1 or greater.
Results:
In 9 months, 567 patient encounters were analyzed, 294 (52%) of which achieved goal mobilization. The mean ratio of mobilization level to severity of illness improved slightly but nonsignificantly. Encounters that met mobilization goals were in younger (P = .04) and more ill (P < .001) patients and were less likely to have barriers (P < .001) than encounters not meeting the goals. Complication rate was 2.5%, with no difference between groups (P = .18). No serious adverse events occurred.
Conclusions:
A multidisciplinary, multiprofessional, goal-directed mobilization protocol achieved goal mobilization in more than 50% of patients in this pediatric intensive care unit. Undermobilized patients were older, less ill, and more likely to have mobilization barriers at the patient and provider level.
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