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Beginning Restorative Activities Very Early: Implementation of an Early Mobility Initiative in a Pediatric
Saad Ghafoor1, Kimberly Fan2, Sarah Williams1
1Division of Critical Care Medicine, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States.
Insights
Implementing early mobility in pediatric oncology intensive care units is safe and feasible. This initiative improved rehabilitation consults and patient mobilization, showing promise for reducing pediatric post-intensive care syndrome (PICS-p) in vulnerable children.
Area of Science:
- Pediatric Critical Care Medicine
- Pediatric Oncology
- Rehabilitation Medicine
Background:
- Children with cancer or hematologic diseases in intensive care face unique risks for functional impairments due to pediatric post-intensive care syndrome (PICS-p).
- Early mobilization and rehabilitation are potential strategies to mitigate PICS-p, but their application in pediatric oncology critical care remains understudied.
Purpose of the Study:
- To describe the development and assess the feasibility of an early mobility quality improvement initiative.
- To evaluate the impact of this initiative on rehabilitation consults, patient mobilization, and delirium screening in a pediatric onco-critical care unit.
Main Methods:
- A quality improvement initiative focused on early mobility was implemented in a dedicated pediatric onco-critical care unit.
- Key outcomes measured included: rehabilitation consults within 72 hours, patient mobilization within 72 hours, and positive delirium screens after 48 hours.
Main Results:
- Rehabilitation consults within 72 hours significantly increased from 25% to 56% (p<0.001).
- Patient mobilization within 72 hours increased from 21% to 30% (p=0.02).
- The initiative was safe, showing no increase in adverse events like unplanned extubations or catheter removals.
Conclusions:
- Early mobility initiatives are safe and feasible in pediatric onco-critical care settings.
- Further research is necessary to confirm the impact of early mobilization on long-term patient outcomes.
Introduction:
Children with underlying oncologic and hematologic diseases who require critical care services have unique risk factors for developing functional impairments from pediatric post-intensive care syndrome (PICS-p). Early mobilization and rehabilitation programs offer a promising approach for mitigating the effects of PICS-p in oncology patients but have not yet been studied in this high-risk population.
Methods:
We describe the development and feasibility of implementing an early mobility quality improvement initiative in a dedicated pediatric onco-critical care unit. Our primary outcomes include the percentage of patients with consults for rehabilitation services within 72 h of admission, the percentage of patients who are mobilized within 72 h of admission, and the percentage of patients with a positive delirium screen after 48 h of admission.
Results:
Between January 2019 and June 2020, we significantly increased the proportion of patients with consults ordered for rehabilitation services within 72 h of admission from 25 to 56% (p<0.001), increased the percentage of patients who were mobilized within 72 h of admission to the intensive care unit from 21 to 30% (p=0.02), and observed a decrease in patients with positive delirium screens from 43 to 37% (p=0.46). The early mobility initiative was not associated with an increase in unplanned extubations, unintentional removal of central venous catheters, or injury to patient or staff.
Conclusions:
Our experience supports the safety and feasibility of early mobility initiatives in pediatric onco-critical care. Additional evaluation is needed to determine the effects of early mobilization on patient outcomes.
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