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Development and Implementation of Pediatric ICU-based Mobility Guidelines: A Quality Improvement Initiative

Stefanie G Ames1, Lauren J Alessi2, Maddie Chrisman3

  • 1Critical Care Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah.

Pediatric Quality & Safety
|May 28, 2021
PubMed

Insights

Implementing early mobility guidelines in pediatric intensive care units (ICUs) significantly increased physical (PT) and occupational therapy (OT) consultations. However, frequent deferrals limited the number of actual therapy sessions, highlighting the need to address barriers for critically ill children.

Area of Science:

  • Pediatric critical care medicine
  • Rehabilitation therapy
  • Healthcare guideline implementation

Background:

  • Critical illness in children often leads to physical impairments.
  • Early mobility interventions in the intensive care unit (ICU) show promise in mitigating these impairments.

Purpose of the Study:

  • To develop and implement ICU-based mobility guidelines for critically ill children.
  • To evaluate the success of guideline implementation by assessing therapy utilization and functional status changes.

Main Methods:

  • A multidisciplinary team developed and implemented ICU mobility guidelines.
  • Compared preimplementation and postimplementation cohorts for physical therapy (PT) and occupational therapy (OT) consultation rates and functional status.
  • Assessed barriers to treatment and adverse events.

Main Results:

  • Postimplementation, PT/OT consultation by 72 hours increased significantly (81.5% vs. 17%).
  • No increase in total ICU therapy sessions or shorter time to active therapies was observed.
  • High deferral rates for PT/OT sessions persisted (around 40%), with sedation and illness severity as key barriers.
  • No difference in new morbidity between cohorts.

Conclusions:

  • ICU mobility guideline implementation led to a four-fold increase in PT/OT consultations.
  • Frequent deferrals due to patient-specific barriers prevented an increase in therapy sessions.
  • Future guidelines must address identified barriers to optimize treatment for critically ill pediatric patients.

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