Keep Moving: Sustainability of an Early Mobility Protocol in an Academic Pediatric ICU
Jenna E Domann1, Lindsay E Davies1, Elizabeth E Zivick2
1From the Department of Physical & Occupational TherapyMUSC Children's Health, Charleston, S.C.
Insights
Implementing early mobility protocols in pediatric intensive care units (ICUs) significantly reduces therapy consultation times and increases patient mobilization. Addressing barriers to timely consults is key for sustained success.
Area of Science:
- Pediatric Critical Care Medicine
- Rehabilitation Therapy
- Intensive Care Unit Management
Background:
- Early mobilization protocols are recognized as safe and feasible for critically ill pediatric patients in the intensive care unit (ICU).
- Sustaining these protocols long-term presents challenges, necessitating focused strategies for consistent implementation.
- This study addresses the need for a sustainable early mobility protocol within a pediatric ICU setting.
Purpose of the Study:
- To describe a focused early mobility protocol implemented and sustained over five years in a single pediatric intensive care unit.
- To analyze the impact of the protocol on therapy consultation timeliness and patient mobilization rates.
- To identify barriers to early physical and occupational therapy consultation.
Main Methods:
- A formal ICU mobility protocol was integrated into a unit-wide ICU liberation bundle.
- Annual data from 2017 to 2023 (3-month periods) were analyzed for physical and occupational therapy (PT/OT) consults, mobilization rates, and time to consult.
- Barriers to early PT/OT consultation were assessed in 2023.
Main Results:
- A sustained decrease in the average time to therapy consultation was observed, from 3.8 days (PT) and 7 days (OT) in 2017 to 1.9 days (PT) and 1.6 days (OT) in 2023.
- The patient mobilization rate significantly increased from 20.3 sessions per 100 patient days in 2017 to 48.2 in 2023.
- No adverse events were reported, though a trend towards delayed consults during high ICU census periods was noted.
Conclusions:
- An established ICU early mobility protocol effectively reduces therapy consultation times and enhances patient mobilization rates.
- Sustained implementation requires ongoing assessment and intervention to overcome barriers, particularly during periods of high patient volume.
- Future efforts should prioritize mitigating these barriers to ensure consistent and timely therapy access for critically ill pediatric patients.
Introduction:
Mobilization protocols are safe and feasible for critically ill pediatric patients in the intensive care unit (ICU), but barriers exist to sustainability. This study described a focused early mobility protocol, sustained over 5 years, which is on time for therapy consults and patient mobilization at a single institution.
Methods:
A formal ICU mobility protocol was implemented as part of a unit-wide ICU liberation bundle. As part of the ongoing program assessment, over a specific 3-month timeframe annually from 2017 to 2023, the number of physical and occupational therapy (PT/OT) consults, mobilization rate, and time to PT/OT consult were analyzed. In addition, in 2023, we assessed specific barriers to early PT/OT consultation.
Results:
Annually, for each study timeframe, there was a sustained decrease in time to therapy consult from a mean of 3.8 days for PT and 7 days for OT in 2017 to 1.9 and 1.6 days, respectively, in 2023. Similarly, the mobilization rate increased from 20.3 sessions per 100 patient days in 2017 to 48.2 in 2023. There was a trend toward missed or delayed therapy consults at times of higher ICU census. No adverse events were associated with mobilization.
Conclusions:
An ICU early mobility protocol leads to a sustained decrease in the time to therapy consultation, an increase in the number of therapy consults, and an increase in the mobilization rate. Future interventions should focus on mitigating barriers to timely consultation, specifically at times of higher ICU census.
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