Implementing Early Mobility Practices in a Respiratory Care Unit: A Quality Improvement Project

Area of Science:

• Critical care medicine
• Quality improvement science
• Rehabilitation therapy

Background:

• Early mobility (EM) is crucial for critically ill patients but underutilized in intermediate care.
• Respiratory care units (RCUs) face challenges like clinical severity and limited staff confidence hindering EM adoption.
• Low EM rates (<10%) were observed in the RCU, compounded by poor collaboration with physical therapy.

Purpose of the Study:

• To assess the impact of a nurse-driven EM program on mobility outcomes in an RCU.
• To evaluate the effectiveness of staff education and protocol implementation in overcoming EM barriers.
• To determine changes in physical therapy consultations and discharge mobility post-intervention.

Main Methods:

• A pre-post implementation quality improvement study design was employed.
• A 10-bed RCU implemented a nurse-driven EM program with a multidisciplinary team.
• Staff education, an evidence-based protocol, and barrier mitigation strategies were utilized.

Main Results:

• Physical therapy consultations significantly increased from 36% to 73% (P=.01).
• Higher discharge mobility was achieved by 69% of patients post-implementation, compared to 59% pre-implementation.
• No significant changes were observed in length of stay or patient mortality.

Conclusions:

• Nurse-driven early mobility programs effectively enhance patient mobility in intermediate care settings.
• Multidisciplinary education and collaboration are key to successful EM implementation.
• EM interventions can improve functional outcomes without negatively impacting critical care metrics.