Early Mobilization in the Pediatric Intensive Care Unit: A Quality Improvement Initiative
Jodi M Herbsman1, Michael D'Agati1, Daniella Klein1
1Rusk Rehabilitation, NYU Langone Health, New York, N.Y.
Insights
Early mobilization in the pediatric intensive care unit (PICU) significantly improved patient outcomes. This quality improvement project increased early mobilization rates and reduced hospital length of stay (LOS).
Area of Science:
- Pediatric Intensive Care
- Quality Improvement Science
- Patient Mobility
Background:
- Early patient mobilization in intensive care units (ICUs) is linked to better clinical and functional results.
- The existing early mobilization rate in the pediatric intensive care unit (PICU) was 62%.
Purpose of the Study:
- To enhance the percentage of PICU patients mobilized early from 62% to a target of 80%.
- To assess the impact of early mobilization on patient outcomes and resource utilization.
Main Methods:
- A quality improvement project was conducted from September 2015 to December 2016.
- Interventions included an algorithm for patient identification, barrier management, and staff education.
- Data collected compared pre- and post-intervention groups on mobilization rates, therapy orders, and length of stay (LOS).
Main Results:
- The percentage of patients mobilized early increased by 25% post-intervention.
- Significant improvements were observed in activity orders (+50%), physical therapy (+14%), occupational therapy (+11%), and speech-language pathology orders (+7%).
- Hospital LOS decreased by 35%, and PICU LOS decreased by 34%.
Conclusions:
- The early mobilization program led to statistically significant improvements in mobilization rates and therapy orders.
- The initiative was associated with reduced hospital and PICU length of stay.
- Early mobilization is an effective strategy for improving outcomes in the PICU.
Abstract:
Mobilizing patients during an intensive care unit admission results in improved clinical and functional outcomes. The goal of this quality improvement project was to increase the percentage of patients in the pediatric intensive care unit (PICU) mobilized early from 62% to 80%. Early mobilization was within 18 hours of admission for nonmechanically ventilated (non-MV) patients and 48 hours for mechanically ventilated (MV) patients.
Methods:
We collected data from September 15, 2015, to December 15, 2016, identified key drivers and barriers, and developed interventions. Interventions included the development of an algorithm to identify patients appropriate for mobilization, management of barriers to mobilization, and education on the benefits of early mobilization. The percentage of PICU patients mobilized early; the percentage of patients with physical therapy, occupational therapy (OT), speech-language pathology (SLP), and activity orders; identified barriers; PICU and hospital length of stay (LOS) and discharge disposition, were compared between the pre- and postintervention groups and the non-MV and MV subgroups. The MV subgroup was too small for statistical testing.
Results:
All measures in the combined postintervention group improved and reached significance (<0.05), except for the percentage of SLP orders and discharged home. Percentage mobilized early increased 25%, activity orders 50%, physical therapist orders 14%, OT orders 11%, SLP orders 7%, and discharged home 6%. Hospital LOS decreased by 35%, and PICU LOS decreased by 34%. All measures in the postintervention, non-MV subgroup improved and reached significance (<0.05).
Conclusions:
This early mobilization program was associated with statistically significant improvements in the rate of early mobilization, activity and therapy orders, and hospital and PICU LOS.
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